Asplenic patients should get antibiotics for any episode of fever
Asplenic patients who develop a fever should be given parenteral antibiotics immediately. Due to the increased risk of pneumococcal sepsis in asplenic patients, vaccinations against these particular bacteria are specifically recommended.
Since pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) can interact with each other they should be given at least 8 weeks apart.
Prophylactic penicillin given orally twice a day is particularly important in children under 5 years of age who are asplenic, and may be considered for 1–2 years post-splenectomy in older patients. Lifelong daily antibiotics may be considered following post-splenectomy sepsis. The risk for Haemophilus influenza type b infection is not increased in asplenic patients, so additional vaccine is not needed for those who have already been vaccinated.
Live attenuated influenza vaccine may be used in asplenic patients, unless they have sickle cell disease.
“In an asplenic patient, fever might be an initial manifestation of a catastrophic infection and must be treated immediately with a parenteral antibiotic agent. Quick administration of antibiotics might prevent sepsis. Mortality can be as high as 50% among patients with post-splenectomy sepsis. Intravenous or intramuscular ceftriaxone is recommended for patients who have normal laboratory test results and who do not appear ill. If the patient lives more than 2 hours from a medical facility that can administer parenteral antibiotic therapy, oral antibiotics should be given.” ABFM Critique
“Amoxicillin, levofloxacin, and moxifloxacin should be taken by asplenic patients with a new onset of fever if they cannot get to a medical facility within 2 hours for evaluation. Fever should be reported immediately due to the lifelong significant risk of sepsis. Unless otherwise contraindicated, asplenic patients should receive annual influenza immunization. Pneumococcal polysaccharide vaccine (PPSV23) should be given twice, with the second dose given 5 years after the first.” ABFM critique
Give your asplenic patients a prescription for oral amoxicillin or levofloxacin (Levaquin) for initial empiric treatment of a fever if he is unable to obtain medical care within a few hours.
Reference
Rubin LG, Schaffner W: Care of the asplenic patient. N Engl J Med 2014;371(4):349-356.