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Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 6

Rheumatic fever prophylaxis: Down the memory lane

Department of Cardiology, AIIMS, New Delhi, India

Date of Web Publication22-May-2015

Correspondence Address:
Prof. Anita Saxena
Department of Cardiology, AIIMS, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-5414.157552

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How to cite this article:
Saxena A. Rheumatic fever prophylaxis: Down the memory lane. J Pract Cardiovasc Sci 2015;1:6

How to cite this URL:
Saxena A. Rheumatic fever prophylaxis: Down the memory lane. J Pract Cardiovasc Sci [serial online] 2015 [cited 2023 Mar 21];1:6. Available from: https://www.j-pcs.org/text.asp?2015/1/1/6/157552

The article by Wyber, et al., [1] takes us down the memory lane through the journey of development of secondary prophylaxis against rheumatic fever. There is enough scientific evidence to confirm the role of penicillin in reducing the recurrence of rheumatic fever and progression of the disease in rheumatic heart disease (RHD). It is also well-known that the injectable benzathine penicillin G (BPG) is superior to oral penicillin and sulfonamides; authors have cited references for this fact. They address a very important question about the efficacy and safety of various BPG preparations available in the market. The powdered form of BPG, which is available in India, Africa and many other low-resource countries has never been compared with the liquid preparations available in Australia, New Zealand and many other high-income countries. The powdered form is cheaper and is not cold chain-based like the liquid formulation. However, it has to be dissolved in distilled water. The suspension is thick and may lead to needle blockage. These injections are also more painful to the patients. There is no established data to suggest that an allergic reaction to powdered penicillin is higher, but often minor allergic reactions have been blamed to impurities in the suspension. A multicentric study is necessary to define the actual incidence of an allergic reaction to penicillin, especially the serious ones as many patients are asked to discontinue secondary prophylaxis even after a minor allergic reaction. The question of doing a skin testing before each dose of BPG also remains unanswered, and practice varies from region to region. Fortunately, the allergic reactions to BPG are very rare in children but it is well-known that reaction may occur in a given case even after several previous uneventful injections. Availability of BPG or oral penicillin is another big concern in India, which needs to be addressed urgently. The rates of secondary prophylaxis remain abysmally low for various reasons including nonavailability of BPG, reluctance of health facilities to administer injections and the fear of pain. Should we consider the possibility of secondary prophylaxis with oral penicillin in patients with past history of rheumatic fever with little or no cardiac involvement?

Secondary prophylaxis is the backbone of any successful control program for RHD and hence penicillin must be available freely in the market and in health centers, especially in high prevalence zones of India. Facilities for its administration must also be freely available, and such centers should have adequate measures to deal with any reaction that may arise in a rare case.

  References Top

Rosemary Wyber, Jonathan Carapetis . Evolution, Evidence and Effect of Secondary Prophylaxis Against Rheumatic Fever. Journal of the Practice of Cardiovascular Sciences. 2015;1:9-14.  Back to cited text no. 1


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