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Intramuscular penicillin prophylaxis and valve progression in adults with mild rheumatic heart disease: a propensity

Ayse Huseyinoglu Aydin1, Fatih Aydın1

  • 1Cardiology Department, Eskisehir City Hospital, Eskisehir, Turkey.

Acta Cardiologica
|August 1, 2026
PubMed

Insights

Intramuscular penicillin prophylaxis did not significantly reduce valve progression or new valve disease in adults with mild rheumatic heart disease (RHD). Careful monitoring is recommended for selected patients.

Area of Science:

  • Cardiology
  • Rheumatology
  • Public Health

Background:

  • Evidence for intramuscular penicillin prophylaxis in rheumatic heart disease (RHD) primarily comes from pediatric studies.
  • The efficacy of penicillin prophylaxis in adults with mild RHD remains uncertain, particularly regarding its impact on valve progression.

Purpose of the Study:

  • To evaluate the effect of intramuscular penicillin prophylaxis on valve progression and new valve disease in adults with early-stage RHD.
  • To determine if penicillin prophylaxis alters the long-term cardiac outcomes in this patient population.

Main Methods:

  • Retrospective cohort study of 312 adults with World Heart Federation Stage A or B RHD.
  • Patients were stratified based on receipt of intramuscular penicillin prophylaxis.
  • Propensity score matching (1:1) was used to control for baseline differences; outcomes were compared using relative risks and time-to-event analysis.

Main Results:

  • Over a median follow-up of 10.1 years, event rates were low in both prophylaxis and no-prophylaxis groups.
  • No significant difference was observed in valve progression (2.0% vs 1.7%) or new valve disease (2.0% vs 2.6%) between groups.
  • After propensity score matching, penicillin prophylaxis was not associated with the composite outcome of valve progression or new valve disease (OR 0.70; 95% CI 0.22-2.28).

Conclusions:

  • Intramuscular penicillin prophylaxis does not appear to reduce valve progression or new valve disease in adults with mild RHD.
  • Clinical and echocardiographic monitoring may be a suitable management strategy for carefully selected patients with early-stage RHD.
Abstract

Keywords:
Propensity score matchingRheumatic heart diseasesecondary prophylaxisvalve progression

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