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Penicillin and the marked decrease in morbidity and mortality from rheumatic fever in the United States
B F Massell1, C G Chute, A M Walker
1Division of Medicine, Children's Hospital, Boston, Mass.
The New England Journal of Medicine
|February 4, 1988
Summary
Penicillin significantly reduced rheumatic carditis severity and mortality starting in 1946. Continued diagnosis and treatment of streptococcal pharyngitis remain crucial for preventing rheumatic fever.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Rheumatic fever historically caused significant mortality.
- Rheumatic carditis, a complication, led to severe heart damage.
- The advent of antibiotics marked a potential turning point.
Purpose of the Study:
- To evaluate the impact of penicillin on rheumatic carditis.
- To analyze trends in rheumatic carditis mortality and murmur resolution.
- To underscore the importance of treating streptococcal pharyngitis.
Main Methods:
- Retrospective analysis of patient data from House of the Good Samaritan, Boston.
- Examination of mortality rates for rheumatic carditis.
- Assessment of murmur resolution rates in patients.
Main Results:
- Penicillin use, beginning around 1946, correlated with a decline in rheumatic carditis severity.
- Mortality due to rheumatic carditis decreased to zero at the studied hospital.
- Murmur resolution rates accelerated post-1946, exceeding 40% by 1970.
- National mortality rates for rheumatic carditis showed a fourfold acceleration in decline with antibiotic use.
Conclusions:
- Penicillin played a critical role in reducing rheumatic carditis.
- Antibiotics have dramatically decreased rheumatic fever's impact.
- Prompt diagnosis and treatment of Group A streptococcal pharyngitis are essential for prevention.
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