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Prophylactic efficiency of 3-weekly benzathine penicillin G in rheumatic fever
B Oran1, A Tastekin, S Karaaslan
1Department of Pediatrics, Selçuk University, Tip Fakültesi Cocuk Klinigi, Konya, Turkey.
Abstract:
Benzathine penicillin G (BPG) is effective for secondary prophylaxis of rheumatic fever (RF). However, interval between injections a remains a controversial matter. In a study population of 74 patients, following the initial diagnosis of RF, 3-weekly BPG (1.2 million units) regimen was started. During the first three-week period, serum penicillin concentrations were examined on the 7th, 14th and 21st days and throat culture done for group-A b hemolytic streptococcal (GABHS) infection. Ten patients (13.5%) at 21st day of injection had low serum penicillin concentration after the first BPG. GABHS was isolated in 5 patients during this period. Although two of these 5 patients had symptoms of respiratory tract infection, according to laboratory data, the other three were accepted as carriers. All 74 patients were then followed-up for rheumatic recurrence (RR) during long-term period (6 to 60 months, mean 25 +/- 5 months). There was no RR among regular (missing no more than one injection a year) group. We concluded that 3-weekly BPG regimen was satisfactory for secondary prophylaxis in RF, even though serum penicillin level was inadequate during the third week in some of the patients.
Insights
Benzathine penicillin G (BPG) given every three weeks is effective for preventing rheumatic fever recurrence. While some patients had low penicillin levels by day 21, no recurrences were observed in those adhering to the schedule.
Area of Science:
- Cardiology
- Infectious Diseases
- Rheumatology
Background:
- Rheumatic fever (RF) is a serious complication of group A beta-hemolytic streptococcal (GABHS) infections.
- Secondary prophylaxis is crucial to prevent rheumatic recurrence (RR).
- Benzathine penicillin G (BPG) is a primary agent for RF prophylaxis, but optimal dosing intervals are debated.
Purpose of the Study:
- To evaluate the efficacy of a 3-weekly Benzathine penicillin G (BPG) regimen for secondary prophylaxis of rheumatic fever (RF).
- To assess serum penicillin concentrations and GABHS carriage during the 3-weekly BPG regimen.
- To determine the rate of rheumatic recurrence (RR) in patients receiving 3-weekly BPG.
Main Methods:
- A cohort of 74 patients diagnosed with RF received 3-weekly BPG (1.2 million units) for secondary prophylaxis.
- Serum penicillin levels were measured on days 7, 14, and 21 post-injection during the initial 3-week period.
- Throat cultures for GABHS were performed, and patients were followed long-term (6-60 months) for rheumatic recurrence.
Main Results:
- Ten patients (13.5%) exhibited low serum penicillin concentrations by day 21 after the first BPG injection.
- GABHS was isolated from 5 patients during the 3-week period, with 3 identified as carriers.
- No rheumatic recurrences (RR) were observed in the group of 74 patients who adhered to the 3-weekly BPG regimen (missing no more than one injection annually).
Conclusions:
- A 3-weekly Benzathine penicillin G regimen is a satisfactory and effective strategy for the secondary prophylaxis of rheumatic fever.
- Despite potential sub-therapeutic penicillin levels in some individuals by the third week, the 3-weekly BPG schedule effectively prevents rheumatic recurrence when administered regularly.
- Regular adherence to the 3-weekly BPG prophylaxis is critical for preventing rheumatic fever recurrence.