Table 2.

Treatment Options for Complications from Acute Sickle Cell Disease

Complication		Therapy
Pain	Mild to moderate	Codeine with acetaminophen or aspirin orally every three to four hours Hydrocodone with acetaminophen orally every three to four hours
	Moderate to severe	Morphine sulfate immediate-release (MSIR) IV every two to four hours orally every three to four hours Hydromorphone IV or orally every three to four hours
Infection	Fever without a source (rule out sepsis)	Empirical therapy coverage for: Streptococcus pneumoniae, Salmonella, Haemophilus influenzae, gram-negative enterics
	Meningitis	Streptococcus pneumoniae, Neisseria meningitides, H. influenzae
	Chest syndrome	S. pneumoniae, Legionella, Mycoplasma pneumoniae, respiratory syncytial virus, Chlamydia pneumoniae
	Osteomyelitis/septic arthritis	Salmonella, Staphylococcus aureus, S. pneumoniae
	Urinary tract infection	Escherichia coli, other gram-negative enterics

IV = intravenously.

From National Institutes of Health. The Management of Sickle Cell Disease, 4th ed. revised, June 2002.²²