Oral antibiotic prophylaxis and empiric emergency antibiotics in asplenic and hyposplenic adults

Strategy	Preferred options	Alternative options
Daily prophylaxis^*	Penicillin V 250 mg twice daily or Amoxicillin 500 mg twice daily	Cephalexin^¶ 250 mg twice daily or Azithromycin 250 mg daily
Emergency antibiotics (for fever or suspected infection)^Δ	Amoxicillin-clavulanate 875 mg/125 mg twice daily	Cefdinir^¶ 300 mg twice daily or Levofloxacin 750 mg daily or Moxifloxacin 400 mg daily

This table should be used in conjunction with the UpToDate topic on prevention of infection in patients with impaired splenic function. The doses in this table are intended for adults with normal renal function. The doses of many of these agents must be adjusted in the setting of renal insufficiency; refer to the drug-specific monographs included within UpToDate for renal dose adjustments.

* The need for daily antibiotic prophylaxis and its duration is typically determined individually based on patient age, immune status, history of infection, potential for adverse drug reactions, and other factors. Refer to the UpToDate topic on preventing infection in patients with impaired splenic function for further discussion.

¶ For patients with mild non-immunoglobulin (Ig)E-mediated reactions to penicillins or for patients with IgE-mediated reactions to penicillins in whom cephalosporins are deemed to be safe based on allergy consultation.

Δ All asplenic or hyposplenic patients should be given an emergency supply of antibiotics to take for the development of fever or other concern for systemic infection, along with instruction to present to the nearest medical facility immediately. Refer to the UpToDate topic on infections in patients with impaired splenic function for additional detail.

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Oral antibiotic prophylaxis and empiric emergency antibiotics in asplenic and hyposplenic adults