Preliminary consultation on preferred product characteristics of benzathine penicillin G for secondary prophylaxis of rheumatic fever

Wyber, Rosemary; Boyd, Ben J.; Colquhoun, Samantha; Currie, Bart J.; Engel, Mark E; Kado, Joseph; Karthikeyan, Ganesan; Sullivan, Mark; Saxena, Anitá; Sheel, Meru; Steer, Andrew C.; Mucumbitsi, Joseph; Zühlke, Liesl; Carapetis, Jonathan R.

doi:10.1007/s13346-016-0313-z

Cited by 27 publications

(23 citation statements)

References 26 publications

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“…In addition to a project in New Zealand that trialed the use of lignocaine injection and a small vibrating bee-shaped device with ice-pack wings placed specifically in relation to the injection site and nerve fibers (22), an Australian pediatric service based in Townsville serving remote communities through outpatient visits has been trialing a child friendly method, with anecdotally reported success 6 . Others concur with the need for more patient-centered approaches to penicillin use (23). Specifically, 10 clinical experts in RHD identified characteristics of benzathine penicillin G formulations which could be changed to improve adherence with secondary prophylaxis.…”

Section: Strengthening Ams In Remote Settingsmentioning

confidence: 99%

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

Oliver

Cush

Ward

2017

Front. Public Health

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BackgroundTo support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing.What we didFinding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee.What we learnedPrescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee.Strengthening AMS in remote settingsAs AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.

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Section: Strengthening Ams In Remote Settingsmentioning

confidence: 99%

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

Oliver

Cush

Ward

2017

Front. Public Health

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“…[6465] Modifying this trend is a difficult task despite significant research and investment, with efforts thus far only really improving patients from poor to moderate adherence. [66]…”

Section: Problems With Echocardiographic Screening For Rheumatic Hearmentioning

confidence: 99%

“…[67] An important barrier to adherence also relates to BPG itself, i.e., painful injections and frequent administration (prompting some authors to call for a reformulated BPG with an ideal dosing interval of 3–6 months). [66]…”

Section: Problems With Echocardiographic Screening For Rheumatic Hearmentioning

confidence: 99%

Rheumatic heart disease screening

Dougherty

Khorsandi

Herbst

2017

Annals of Pediatric Cardiology

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Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.

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“…Anecdotal reports of adverse reactions to BPG have been commonly heard at cardiology conferences for several years, highlighting clinician concern over perceived quality issues 8. In 2013, the World Heart Federation surveyed 39 clinicians prescribing BPG: 20% reported having a patient die from anaphylaxis and 26% knew of a case of anaphylaxis to BPG causing death 9…”

Section: Introductionmentioning

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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Preliminary consultation on preferred product characteristics of benzathine penicillin G for secondary prophylaxis of rheumatic fever

Cited by 27 publications

References 26 publications

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

Rheumatic heart disease screening

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

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