Penicillin for secondary prevention of rheumatic fever

Abstract

BackgroundPeople with a history of rheumatic fever are at high risk of recurrent attacks of rheumatic fever and developing rheumatic heart disease following a streptococcal throat infection. Giving penicillin to these people can prevent recurrent attacks of rheumatic fever and subsequent rheumatic heart disease. However, there is no agreement on the most e ective method of giving penicillin. ObjectivesTo assess the e ects of penicillin compared to placebo and the e ects of di erent penicillin regimens and formulations for preventing streptococcal infection and rheumatic fever recurrence. Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) in

Prescribing for people with acute rheumatic fever

“…1,[14][15][16] Acute rheumatic fever is well documented to occur following group A streptococcal pharyngitis (throat infection). 17 In Australian indigenous communities, there is much circumstantial evidence that high rates of acute rheumatic fever can also occur after skin infection with group A streptococci.…”

“…Prevention of subsequent streptococcal infections 16 1. Benzathine penicillin G 900 mg (child <20 kg: 450 mg)* intramuscularly as a single dose once every 21 or 28 days…”

“…Oral penicillin is strongly discouraged and is known to be associated with higher rates of acute rheumatic fever recurrence. 16 This should be accompanied by advice to families about the need for prompt treatment when a suspected group A streptococcal infection occurs. They should also be advised of ways to reduce exposure at home, for example by avoiding sharing of beds when possible and culturally appropriate.…”

Rheumatic fever: New ideas in diagnosis and management

“…(19) The standard for prophylaxis is an intramuscular penicillin injection rather than oral prophylaxis. (20) could probably be ascribed to an improvement in the average living conditions and a decline in the virulence of the causative organisms.…”

Diretrizes

“…(I-A) Sua eficácia para prevenir a doença está bem estabelecida 2,75,[81][82][83] . Outras vantagens do uso da penicilina são o baixo custo, a pouca incidência de efeitos colaterais, o baixo espectro antimicrobiano e inexistência de cepas do EBGA resistentes à penicilina 76 .…”