Confirmed penicillin allergy among patients receiving benzathine penicillin prophylaxis for acute rheumatic fever

Kaya, Ayşenur; Erkoçoğlu, Mustafa; Senkon, Oben Gözde; Ekici, Filiz; Toyran, Müge; Çetin, İ̇brahim İ̇lker; Kocabaş, Can Naci

doi:10.1016/j.aller.2012.12.007

Cited by 12 publications

(6 citation statements)

References 19 publications

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“…Secondary prophylaxis for rheumatic fever can be safely administered in schools and settings other than hospital and health centers with few incidents of lifethreatening allergic reactions reported. [26][27][28][29] Of 17 641 penicillin injections administered among 535 children diagnosed with rheumatic fever in Turkey, there were only 11 reported allergies of which one was confirmed as a penicillin allergy. According to Grayson et al, in the New Zealand health system, the delivery of rheumatic fever prophylaxis at the community level (school, work, home, and clinic) resulted in high rates of adherence.…”

Section: Thompson Et Al Low Adherence To Secondary Prophylaxis Amongmentioning

confidence: 99%

Low adherence to secondary prophylaxis among clients diagnosed with rheumatic fever, Jamaica

Thompson

Brown

Edwards

et al. 2014

Pathogens and Global Health

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Objectives:To determine the level of adherence and possible barriers to secondary prophylaxis among clients with rheumatic fever in Kingston, Jamaica. Methods: Cross-sectional survey of 39 clients diagnosed with rheumatic fever, receiving penicillin prophylaxis for more than a year using a 22-item self-administered questionnaire on adherence to secondary prophylaxis and knowledge of rheumatic fever. The patients' records were reviewed to determine the number of prophylaxis injections the patients received for the year 2010. Results: The majority of participants (74%) were females and 51% were adults. Only 48.7% had a high level of adherence. The majority (72%) had low knowledge levels regarding their illness, while only 5% had a high knowledge level score. Most clients (70%) strongly agreed that nurses and doctors encouraged them to take their prophylaxis. However, over 60% reported that they travelled long distances and or waited long periods to get their injections. One-third reported that they missed appointments because of fear of injections and having to take time off from work or school. Discussion: Clients attending the health centers studied had limited knowledge about rheumatic fever. Barriers to adherence included fear of the injections, long commutes, and long waiting periods at the facilities studied.

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Section: Thompson Et Al Low Adherence To Secondary Prophylaxis Amongmentioning

confidence: 99%

Low adherence to secondary prophylaxis among clients diagnosed with rheumatic fever, Jamaica

Thompson

Brown

Edwards

et al. 2014

Pathogens and Global Health

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“…Our early data also suggest that there is no need to perform routine penicillin-allergy testing prior to BPG administration in patients without a prior history of adverse reactions to penicillin.This position is supported by several large published studies that evaluated interventions with BPG in RHD patients, wherelarge numbers of BPG injections were administered withoutprior penicillin-allergy testing, 33 , 34 and reported the incidence of adverse reactions, including anaphylaxis, was exceedingly low. 36…”

Section: Discussionmentioning

confidence: 86%

“…A multinational study in 1991 that included 32 430 BPG injections in 1 790 patients estimated the risk of anaphylaxis to be exceedingly low, at approximately one in 10 000 injections, 33 and a 2014 retrospective study of BPG treatment in RF in Turkey found confirmed allergy in one of 535 patients (0.18% of 17 641 injections) but documented no anaphylactic reactions. 34 Three fatalities that were temporally related to BPG injection were reported from Zimbabwe more than 15 years ago, although clinical details were not well described and so it is not clear that drug allergy played a role. 35…”

Section: Discussionmentioning

confidence: 99%

A programme to increase appropriate usage of benzathine penicillin for management of streptococcal pharyngitis and rheumatic heart disease in Zambia

Long

Lungu

Machila

et al. 2017

CVJA

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SummaryRheumatic heart disease is highly prevalent and associated with substantial morbidity and mortality in many resourcepoor areas of the world, including sub-Saharan Africa.Primary and secondary prophylaxis with penicillin has beenshown to significantly improve outcomes and is recognisedto be the standard of care, with intra-muscular benzathine penicillin G recommended as the preferred agent by many technical experts. However, ensuring compliance with therapyhas proven to be challenging. As part of a public–privatepartnership initiative in Zambia, we conducted an educationaland access-to-medicine programme aimed at increasing appropriate use of benzathine penicillin for the preventionand management of rheumatic heart disease, according tonational guidelines. The programme was informed early onby identification of potential barriers to the administration ofinjectable penicillin, which included concern by health workers about allergic events. We describe this programme andreport initial signs of success, as indicated by increased useof benzathine penicillin. We propose that a similar approach may have benefits in rheumatic heart disease programmes in other endemic regions.

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“…There were no reported fatalities in this study. In 2014, a Turkish group reported suspected allergic reaction in 11 of 535 children, although following further testing all skin prick tests were negative and only one provocation test was positive 22. In Nigeria, an 11-year-old girl was successfully resuscitated following reported anaphylaxis after BPG for RHD; while in India a 40-year-old woman died 23 24.…”

Section: Resultsmentioning

confidence: 99%

Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis: cardiac compromise more likely than anaphylaxis

et al. 2019

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ObjectiveSecondary prophylaxis through long-term antibiotic administration is essential to prevent the progression of acute rheumatic fever to rheumatic heart disease (RHD). Benzathine penicillin G (BPG) has been shown to be the most efficacious antibiotic for this purpose; however, adverse events associated with BPG administration have been anecdotally reported. This study therefore aimed to collate case reports of adverse events associated with BPG administration for RHD prophylaxis.Study designA literature review was used to explore reported adverse reactions to BPG and inform development of a case report questionnaire. This questionnaire was circulated through professional networks to solicit retrospective reports of adverse events from treating physicians. Returned surveys were tabulated and thematically analysed. Reactions were assessed using the Brighton Collaboration case definition to identity potential anaphylaxis.ResultsWe obtained 10 case reports from various locations, with patients ranging in age from early-teens to adults. All patients had clinical or echocardiogram-obtained evidence of valvular disease. The majority of patients (80%) had received BPG prior to the event with no previous adverse reaction. In eight cases, the reaction was fatal; in one case resuscitation was successful and in one case treatment was not required. Only three cases met Level 1 Brighton criteria consistent with anaphylaxis.ConclusionThese results indicate that anaphylaxis is not a major cause of adverse reactions to BPG. An alternative mechanism for sudden death following BPG administration in people with severe RHD is proposed.

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Confirmed penicillin allergy among patients receiving benzathine penicillin prophylaxis for acute rheumatic fever

Abstract: Our data suggest that the frequency of penicillin allergy is much lower than suspected among children on penicillin prophylaxis for ARF. Consequently, penicillin prophylaxis should not be given up without proper evaluation of drug allergy.

Cited by 12 publications

References 19 publications

Low adherence to secondary prophylaxis among clients diagnosed with rheumatic fever, Jamaica

Low adherence to secondary prophylaxis among clients diagnosed with rheumatic fever, Jamaica

A programme to increase appropriate usage of benzathine penicillin for management of streptococcal pharyngitis and rheumatic heart disease in Zambia

Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis: cardiac compromise more likely than anaphylaxis

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