Asplenia
Splenectomy is associated with fulminant bacterial infection. The risk is long-term but is highest in the first two years after splenectomy.
This guideline also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction (hyposplenism).
- Vaccination, patient/carer education and antibiotics are indicated.
- Antibiotics must be given promptly if a patient with asplenia or dysfunctional spleen presents with signs or symptoms of infection.
Splenectomy (elective & emergency), Asplenia and Hyposplenia - Adults
| Immunisation schedule on first presentation |
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For elective splenectomy - vaccinate patients at least 2 weeks (ideally 4-6 weeks) before the procedure. For emergency splenectomy - vaccinate patients at least 2 weeks after the procedure (typically given at the GP surgery). Vaccines can be given in hospital if admission lasts longer than two weeks. (please see special groups information below for patients receiving chemotherapy and radiotherapy). All patients with asplenia or hyposplenia, regardless of previous vaccination history, should receive:
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Vaccine terminology:
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Special Groups
Chemotherapy and Radiotherapy (or other immunosuppressive treatment)
- Individuals with profound immunosuppression may not mount a full vaccination immune response.
- Individuals undergoing chemotherapy, radiation or other anti-cancer treatment can be vaccinated in accordance with the standard schedule.
- Where it is not practicable to vaccinate TWO WEEKS prior to splenectomy AND prior to anti-cancer treatment and/or radiotherapy, immunisation can be delayed until at least THREE MONTHS after completion of therapy to maximise vaccine response, whilst ensuring adequate antibiotic cover is prescribed in the interim.
- If non-live vaccines are given during chemotherapy, they should be readministered after recovery of immunocompetence, generally after three months following treatment.
Antibiotic prophylaxis
Life-long antibiotic prophylaxis for all asplenic or hyposplenic patients is no longer recommended. Only patients who are deemed to be at high risk of pneumococcal infection should be prescribed prophylactic antibiotics.
Indefinite antibiotic prophylaxis is indicated for the following patient groups:
- Greater than 50 years of age.
- History of previous invasive pneumococcal disease.
- Splenectomy due to thalassaemia, sickle cell disease or malignancy.
- Indefinitely immunocompromised patients.
Antibiotic prophylaxis for the following patient groups is indicated for as long as the patient is fitting one or more of the following criteria:
- Less than 16 years of age
- Up to three years post splenectomy
- Increased risk of exposure to encapsulated organisms (i.e. due to foreign travel)
- Underlying comorbidities, particularly in the context of immunosuppression
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Antibiotic prophylaxis - Preferred |
phenoxymethyl penicillin (penicillin V) 250mg po BD |
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Antibiotic prophylaxis - Penicillin allergic |
erythromycin 500mg po BD |
Rescue Pack Antibiotics
- To empirically treat for fever or other signs of systemic infection.
- To ensure antibiotic treatment is started promptly.
- Patients should still present at the nearest medical facility as soon as signs/symptoms occur.
- Antibiotic prophylaxis should be withheld while the patient is receiving treatment antibiotics that have pneumococcal cover. Discuss with pharmacy if in doubt.
- For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
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Antibiotic treatment - Preferred |
amoxicillin 500mg po TDS for 3 days |
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Antibiotic treatment - Penicillin allergic |
clarithromycin 500mg po BD for 3 days |
Travelling abroad
- Advise patient to take a rescue pack of antibiotics with them in case of infection and carry a medical alert card or device for the benefit of emergency care providers.
- Advise patient to avoid countries where malaria is present. If this cannot be avoided advise them to speak to their GP or their local pharmacist about antimalarial medicine before travelling.
- Advise patient to avoid areas where babesiosis is endemic. If this cannot be avoided advise them on taking appropriate precautions to avoid tick bites.
Human/Animal bites
- Human Bites: Consider antibiotics if the bite has broken the skin, regardless of whether it has drawn blood.
- Animal Bites: Consider antibiotics if the bite has broken the skin and drawn blood (dog and cat bites are of high risk due to the possibility of transmitting C. canimorsus, which can be fatal).
See Bites, human + animal guidelines for management.
References
- The Green Book. Immunisation of individuals with underlying medical conditions. Chapter 7 of The Green Book. Reviewed 10/01/2020. URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/857279/Greenbook_chapter_7_Immunsing_immunosupressed.pdf Accessed 13/08/2025.
- NICE. Human and animal bites: antimicrobial prescribing. NICE. 2020. URL: https://www.nice.org.uk/guidance/ng184/resources/visual-summary-pdf-8897023117 Accessed 13/08/2025.
- The Green Book. Pneumoccocal. Chapter 25 of the Green Book. The Green book of immunisation: chapter 25 - pneumoccocal (publishing.service.gov.uk) Accessed 13/08/2025.