Once weekly azithromycin in secondary prevention of rheumatic fever

Abstract

A B S T R A C TRheumatic fever and rheumatic heart disease (RHD) are still important problems in developing countries. Secondary prophylaxis which is the most cost-effective method in preventing recurrences of rheumatic fever is fraught with problems of drug compliance. The utility of 500 mg once weekly azithromycin (AZT), an orally effective long-acting antibiotic was evaluated against oral penicillin (phenoxy methyl penicillin 250 mg twice daily) in this study. Forty-eight consecutive patients (44% males, mean age 29.4 years) with established RHD were randomised into two groups-26 patients received AZT and 22 received oral penicillin. Patients were evaluated at randomisation, at 1 month, 3 months, and 6 months, clinically, serologically and by throat swab culture. End points were absence of streptococcal colonisation, infection or fever at the end of 6 months. During the study, 4 patients (15.4%) in the AZT group developed sore throat and fever, had positive throat culture and positive serology indicating streptococcal infection. None satisfied the criteria for rheumatic fever reactivation. None in the oral penicillin group developed streptococcal infection. In conclusion, weekly 500 mg of AZT is not effective in the prevention of streptococcal throat infection compared to oral penicillin therapy in adult patients with established RHD.

Throat culture positivity rate and antibiotic susceptibility pattern of beta-hemolytic streptococci in children on secondary prophylaxis for rheumatic heart disease

“…It seems that Group F and G BHS were prominent in the present study, a finding which is comparable with other studies conducted elsewhere, such as in Mumbai where Group C and G streptococcal disease burden was higher than GAS among schoolchildren [ 2 , 32 ]. Even though the type of prophylaxis and the methodology is different, the present finding showed a lower culture positivity rate as compared with a carrier rate of 15.4 % GAS among 26 patients on once-weekly azithromycin (AZT), but higher than 22 patients taking oral penicillin (0 %) [ 33 ].…”

Echinacea can help with Azithromycin in prevention of recurrent tonsillitis in children

“…Snider et al 25 13 reported that 15.4% of their patients with established rheumatic heart disease had recurrent tonsillitis with once weekly AZT dose. In our study; patients still had tonsillitis attacks with AZT use.…”

“…Other possibilities of AZT failure may be due to: poor patient compliance, failure of the drug to reach adequate concentration in the mucosa, microbial tolerance to AZT, recurrent exposure of patients to virulent strains of GABHS, suppression of natural immunity and disturbance of normal flora of throat. 13 AZT inhibits growth of alpha streptococci that are normal defenders of pharyngeal mucosa against pathogens at lower MIC. 27 Intracellular accumulation of macrolides have been shown in leucocytes but not in epithelial cells, which are probably the principal cells targeted by GABHS.…”

“…Sirimanna et al 10 reported the usefulness of long-acting penicillin in recurrent tonsillitis prevention. However; long-term use of penicillin may result in hypersensitivity reactions, J o u r n a l P r e -p r o o f 4 Gopal et al 13 reported that use of 500 mg once weekly oral AZT was effective in prevention of streptococcal throat infection compared to oral penicillin therapy.…”

Quality of life after tonsillectomy versus azithromycin

“…Gopal et al. [ 14 ] mentioned the use of 500 mg once weekly oral azithromycin was effective in the prevention of streptococcal throat infection compared with oral penicillin therapy.…”