• antibiotics
• immunisation
• systemic lupus erythematosus

We read with great interest the leader by Gilliland and Tsokos on the prophylactic use of antibiotics and immunisation in systemic lupus erythematosus (SLE).¹ We strongly agree that prophylactic treatment against tuberculosis should be considered in certain groups of patients with SLE, and in particular that co-trimoxazole prophylaxis should be used in patients receiving potent cytotoxic treatment such as cyclophosphamide.

However, the important relationship between hypocomplementaemia, splenic dysfunction, and infection in SLE should also be emphasised. In Western countries, pyogenic infection in SLE is a major cause of morbidity and mortality.² Infection with Streptococcus pneumoniae and Neisseria meningitidis appears to be particularly important.^3–5 We have recently seen in our unit six patients with SLE who died in the past five years. Of these, five had overwhelming infection with S pneumoniae.

Defective clearance of bacteria by the spleen as a result of functional hyposplenism is likely to be the cause of the increased risk of infection with S pneumoniae and N meningitidis in SLE. Corticosteroids and other …