A Cochrane review included 3 studies with a total of 880 children. All trials showed a reduced incidence of infection in children with sickle cell disease (SS or Sβ0Thal) receiving penicillin preventatively. Initiation of penicillin reduced the incidence of pneumococcal infection compared to placebo or no treatment (OR 0.37, 95% CI 0.16 to 0.86; 2 studies) in children aged 3 to 36 months at recruitment. One study evaluated the consequences of discontinuing penicillin prophylaxis in children with sickle cell disease at the age of five years (OR for continuing penicillin vs. placebo 0.49, 95% CI 0.09 to 2.71). In this study, the children had been taking penicillin prophylactically for at least two years and all children had received pneumococcal vaccination within the 12 months preceding the start of the trial.
Adverse drug effects were rare and minor. Rates of pneumococcal infection were found to be relatively low in children over the age of five.