Prophylaxis of recurrent rheumatic fever. Therapeutic-continuous oral penicillin vs monthly injections

Abstract

For preventing recurrences of rheumatic fever, a repetitive oral penicillin regimen was planned to mimic the action of monthly injections of long-acting penicillin G benzathine. The oral regimen (TCP) contained a therapeutic high level dose for the first ten days of each month, and a continuous low level dose for the remainder of the month. In 343 young rheumatic patients, observed during four calendar years, the group receiving injections had a streptococcal infection attack rate of 6.6 per 100 pati ent\x=req-\ years, and a rheumatic recurrence rate of 0.6%. For patients receiving TCP, the corresponding rates were 22.7% and 4.8%; these rates were higher than the injection rates even when assessed in a subgroup of patients who maintained TCP with excellent fidelity. The TCP results were not significantly different from those of previously tested oral regimens, in which lower doses of penicillin were used.

Mortality due to acute rheumatic fever and rheumatic heart disease in the Northern Territory: a preventable cause of death in Aboriginal people

“…Denominator data were obtained from Northern Territory Health Services and were based on adjusted population data obtained from the 1986, 1991 and 1996 Australian Census figures. The resulting crude death rates were then divided by 18 to give the average yearly crude death rate. The age-specific rates for each 10-year age group were also calculated.Thc above rates were calculated for all deaths due to acute rhcumatic fcver or rheumatic heart disease, and separately for deaths due to each cause.…”

Did we overcome rheumatic heart disease or is it still a public disease burden?

“…Clinical judgment and treatment of patients with penicillin without throat culture is likely to reduce the frequency of RHD [17]. Secondary prophylaxis with intramuscular benzathine penicillin is a low-cost treatment with proven efficacy in the prevention of recurrent streptococcal throat infections and valvular injury and in the prevention of community health [18,19]. The effect of secondary prophylaxis on heart failure development or mortality is related to the onset of the prophylaxis at an early stage of the disease [20].…”

Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis

“…Simply, these studies varied considerably in penicillin doses, and schedules [44][45][46]. Noteworthy that some of these studies used a different penicillin formulation (potassium penicillin) [44][45][46], whereas the oral penicillin V used today is more consistently absorbed showing higher blood levels, and has been shown to decrease recurrences compared to benzathine penicillin [47].…”