We are starting to enroll patients with hyper-reactive malarial splenomegaly (also known as tropical splenomegaly) in our NCD clinic in Liberia. The evidence is fairly clear in terms of the role of malaria prophylaxis in this population but I have found much less about whether they should be placed on penicillin prophylaxis (either Pen VK or monthly benzathine PCN) for functional asplenia like we do for patients with sickle cell disease.
I'd be eager to here other's practice and experience. Do you routinely provide penicillin prophylaxis in this population? If so for how long? What are your criteria for initiating and something prophylaxis?