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[Secondary prophylaxis in rheumatic fever. Oral antibiotic therapy versus benzathine penicillin]
G V Herdy1, D C Souza, P B Barros
1Hospital Universitário Antonio Pedro-UFF, Niterói.
Insights
Many children with rheumatic fever missed follow-up appointments and stopped treatment when prescribed injectable benzathine penicillin. Switching to oral antibiotics improved adherence and prevented relapses, highlighting the need for individualized prophylaxis strategies.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Rheumatic fever prophylaxis is crucial for preventing recurrent episodes and long-term cardiac damage.
- Benzathine penicillin G administered intramuscularly is the standard secondary prophylaxis, but adherence can be challenging.
- Outpatient follow-up is essential for monitoring treatment adherence and clinical outcomes.
Observation:
- A significant percentage of pediatric patients (55%) receiving parenteral benzathine penicillin missed outpatient follow-up appointments.
- A substantial proportion of patients (37%) on parenteral prophylaxis experienced relapsed carditis, often linked to non-adherence.
- Patients switched to oral antibiotics demonstrated significantly better adherence and no readmissions for relapsed carditis.
Findings:
- Adherence to parenteral benzathine penicillin prophylaxis in rheumatic fever patients is suboptimal, leading to high rates of missed appointments.
- Switching from parenteral to oral antibiotics significantly improved patient return to ambulatory control and eliminated readmissions due to relapsed carditis.
- The study found a statistically significant difference (p < 0.01) in outcomes between the two prophylaxis groups.
Implications:
- Rethinking the standard parenteral prophylaxis regimen for rheumatic fever is necessary to improve patient adherence and long-term outcomes.
- Oral antibiotic therapy may offer a more feasible and effective alternative for secondary prophylaxis in select pediatric rheumatic fever patients.
- Individualized assessment of patient circumstances and preferences is vital for optimizing rheumatic fever secondary prophylaxis strategies.
Purpose:
To detect problems related to secondary prophylaxis of rheumatic fever in the setting out patient follow-up.
Methods:
Among 113 pediatric patients admitted with diagnosis of this disease, in a period of five years, we selected 80 records. They were divided in group 1 (60 cases), that only received prescription of benzathine penicillin for prophylaxis and group 2 (20 patients) to whom it was changed from parenteral to oral antibiotics after the detection problems using the first scheme.
Results:
In group 1, among 53 who had carditis, 27 (45%) had severe disease; 22 cases (37%) were re-admitted with relapsed carditis following the refusal to use benzathine penicillin. Also, we observed that after discharged 32 (55%) did not return to the out-patient clinic in HUAP. In group 2, from 16 who had carditis, 10 (50%) had severe disease. Only two (10%) did not return to ambulatory control and there was no case of readmission. The difference between the groups was statistically significant. (p < 0.01).
Conclusion:
It was very high the percentage of cases that missed the control visits and abandoned the prophylaxis when it was insisted on parenteral penicillin. We should evaluate every case and remember that oral antibiotics might avoid a major problem.