Synopsis
Prevent overwhelming infection after absent or impaired splenic function through coordinated vaccination, antibiotic prophylaxis, emergency self-management, travel advice and durable documentation.
- Loss of splenic function creates lifelong vulnerability to rapidly progressive infection, especially from encapsulated bacteria including pneumococcus, meningococcus and Haemophilus influenzae type b.
- Plan indicated vaccines at least 2 weeks before elective splenectomy when possible; if they were not given before emergency surgery, start them at least 2 weeks afterwards using the current Green Book product and interval schedule.
- Annual influenza vaccination reduces influenza and secondary bacterial risk; pneumococcal, meningococcal and Hib protection requires age, prior-dose and risk-based scheduling.
- Offer daily antibiotic prophylaxis for at least 2 years after splenectomy and continue lifelong in higher-risk groups after individual review; adherence, allergy, prior invasive infection and immune status need active reassessment.
- Provide an emergency oral antibiotic supply with written instructions, but make clear that taking it does not replace urgent medical assessment.
- Give a splenectomy card or medical alert, inform primary care and dental teams, and address travel malaria, animal bites and access to care abroad.
Key red flags
Abrupt fever, rigors, vomiting, myalgia, confusion, mottling or shock may progress within hours even when no focal source is initially apparent.
Dog and other mammalian bites can transmit Capnocytophaga and polymicrobial infection; early wound care and antibiotic assessment are especially important after splenectomy.
Investigation priorities
Determine which risk-based vaccines and boosters have been received and when.
Management branches
Splenectomy is planned and there is time to review vaccination and education beforehand.
- Reconcile vaccines and immune treatment, administer indicated products at least 2 weeks before surgery when feasible using the current Green Book schedule, and document products and doses precisely.
- Prescribe daily prophylaxis and an emergency supply with allergy, renal and interaction review; teach the difference between prevention, rescue dose and hospital treatment.
- Issue alert information, notify primary care, create recall dates and provide fever, bite and travel action plans before the operation.
Key medicines
Phenoxymethylpenicillin prophylaxisA common adult prophylactic regimen is 250 mg orally twice daily, continued for the risk-based duration in local policy.Confirm adherence, renal considerations and allergy phenotype; breakthrough infection remains possible and fever still requires immediate rescue treatment and hospital assessment.
Erythromycin prophylaxis alternativeA common adult alternative is 500 mg orally twice daily when true immediate penicillin allergy prevents phenoxymethylpenicillin use.Check QT prolongation, electrolytes, liver disease and gastrointestinal tolerance. Erythromycin is a strong CYP3A4 inhibitor with important statin, antiarrhythmic and anticoagulant interactions; verify the allergy phenotype and local resistance before substitution.