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Antibodies to penicillin in children receiving long-term secondary prophylaxis for rheumatic fever
I L Strannegård1, H A Majeed, S Ahlstedt
1Dept. of Paediatrics, University of Kuwait.
Insights
Long-term penicillin prophylaxis for rheumatic fever in children rarely causes adverse reactions. Most children develop IgG antibodies, with few showing IgE antibodies, indicating safe treatment.
Area of Science:
- Immunology
- Pediatrics
- Rheumatic Diseases
Background:
- Rheumatic fever prophylaxis is crucial for preventing cardiac damage.
- Penicillin is the standard treatment for rheumatic fever prophylaxis.
- Long-term penicillin use may elicit immune responses.
Purpose of the Study:
- To investigate the occurrence of IgE and IgG antibodies to penicillin in children receiving long-term penicillin prophylaxis for rheumatic fever.
- To assess the safety of long-term penicillin treatment in this pediatric population.
Main Methods:
- Utilized Phadebas RAST and ELISA to detect IgE and IgG antibodies to penicillin G and V.
- Studied 18 children on long-term penicillin prophylaxis (1.5 months to 5 years).
- Compared antibody levels with 12 patients with acute rheumatic fever not yet on long-term treatment.
Main Results:
- 12 out of 18 children (67%) on long-term penicillin developed IgG antibodies.
- 2 out of 18 children (11%) developed IgE antibodies.
- 2 out of 12 children (17%) not on long-term treatment had IgG antibodies.
- No adverse reactions or signs of immune complex-mediated disease were reported.
Conclusions:
- Long-term intramuscular depot-penicillin appears safe for rheumatic fever prophylaxis in children.
- Development of IgG antibodies is common, while IgE antibodies are rare.
- Penicillin remains the drug of choice for preventing rheumatic fever recurrences and associated cardiac damage.
Abstract:
The occurrence of IgE and IgG antibodies to penicillin G and V in children on long-term treatment with penicillin as secondary prophylaxis for rheumatic fever was studied using Phadebas RAST (Pharmacia Diagnostics, Uppsala, Sweden) and ELISA respectively. The duration of the prophylaxis ranged between 1.5 months and 5 years (mean 1.8 years). Of 18 patients who had been given penicillin for more than 1.5 months, two had IgE antibodies and 12 had IgG antibodies to penicillin. Patients with acute rheumatic fever who had not yet received long-term treatment with penicillin had antibodies of the IgG class in two out of 12 cases. The patients gave no history of adverse reactions to the penicillin injections and there were no signs of immune complex-mediated disease. The two children who had IgE antibodies were switched to oral erythromycin instead of the penicillin injections. Penicillin is the drug of choice in the prophylaxis of rheumatic fever and can apparently be safely given as intramuscular injections of depot-penicillin to prevent recurrences of the disease and ensuing cardiac damage.