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Trends in rheumatic fever: clinical aspects and perspectives in prophylactic treatments
Kattya Gyselle De Holanda E Silva1, Gillian Barratt, Anselmo Gomes De Oliveira
1Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Rua Cel. Gustavo Cordeiro de Farias, s/n, Petrópolis, CEP 59010-180, Natal-RN, Brazil.
Insights
Benzathine penicillin G injections for rheumatic fever prophylaxis fail to eradicate bacteria. Nanocarrier systems offer a promising alternative to improve treatment outcomes for this neglected disease.
Area of Science:
- Rheumatic fever research
- Infectious disease prophylaxis
- Nanomedicine applications
Background:
- Rheumatic fever (RF) is a systemic illness following GABHS pharyngitis in children, prevalent in resource-limited settings.
- Benzathine penicillin G (BPG) injections are standard secondary prophylaxis for RF due to low cost and history.
- BPG has demonstrated in vitro efficacy but frequently fails to eradicate GABHS in vivo.
Purpose of the Study:
- Review causes of BPG treatment failure in acute RF.
- Identify limitations of current RF prophylactic treatments.
- Propose novel nanocarrier-based pharmacotherapeutic systems as alternatives.
Main Methods:
- Literature review of RF treatment failures.
- Analysis of BPG's pharmacokinetic and pharmacodynamic limitations.
- Exploration of nanocarrier systems for drug delivery.
Main Results:
- BPG's inability to eradicate GABHS contributes to RF treatment failures.
- Current BPG regimen presents inconveniences and treatment gaps.
- Nanocarrier-based systems show potential to overcome BPG limitations.
Conclusions:
- Rheumatic fever is a neglected disease disproportionately affecting low-resource countries.
- Nanocarrier systems can potentially avoid BPG failures in RF prophylaxis.
- Translating nanocarrier research to industrial and clinical levels is crucial for affordable, available treatments, considering all hazards.
Introduction:
Rheumatic fever (RF), a systemic illness that may occur following Group A beta-hemolytic streptococcal (GABHS) pharyngitis in children, is a major problem in countries with limited resources. Because of its long track record and low cost, an injection of benzathine penicillin G (BPG) suspension every 3 or 4 weeks has been used as secondary prophylaxis. Despite its excellent in vitro efficacy, the inability of BPG to eradicate GABHS has been frequently reported.
Areas Covered:
This work reviews the possible causes of failure, as well as the inconvenience of the current prophylactic treatment of acute RF and suggests a new pharmacotherapeutic system that could replace the current one.
Expert Opinion:
RF is a major problem concerning only countries with limited resources and could be considered as a neglected disease. The dose regimen using BPG suspension results in failures, which could be avoided by the use of nanocarrier-based systems. To meet this ultimate goal, the research should be transposed from the laboratory scale to an industrial and clinical application level. This research should be conducted to produce a pharmaceutical dosage form that will be commercially available, consumed by and affordable for patients. However, health, environmental and socioeconomic hazards should be considered.
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