Post-Splenectomy Management in Infectious Mononucleosis

Infection Prophylaxis

• The World Health Organization recommends vaccinating against encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae type b, Neisseria meningitidis) at least 14 days post-operatively in patients who have undergone splenectomy due to splenic rupture 1
• The Centers for Disease Control and Prevention suggest initiating lifelong antibiotic prophylaxis with phenoxymethylpenicillin (penicillin VK) 250-500 mg twice daily, or erythromycin for penicillin-allergic patients, to prevent overwhelming post-splenectomy infection (OPSI) 2
• The American College of Emergency Physicians advises providing emergency standby antibiotics (amoxicillin 3g starting dose, then 1g every 8 hours) for home use at first sign of fever in post-splenectomy patients 1
• The World Health Organization recommends annual influenza vaccination for all post-splenectomy patients over 6 months of age to reduce the risk of OPSI 1
• The Infectious Diseases Society of America suggests issuing Medic-Alert identification and educating patients about the lifelong risk of OPSI, which carries 30-70% mortality 2