+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Long-term outcome of patients with rheumatic fever receiving benzathine penicillin G prophylaxis every three weeks versus every four weeks



Long-term outcome of patients with rheumatic fever receiving benzathine penicillin G prophylaxis every three weeks versus every four weeks



Journal of Pediatrics 125(5 Part 1): 812-816



Objective: To compare the efficacy of injections of 1.2 million units of benzathine penicillin G given every 3 weeks versus every 4 weeks for secondary prevention of rheumatic fever, based on the long-term outcome of patients receiving such prophylaxis. Methods: A total of 249 consecutive patients with rheumatic fever, randomly assigned to either a 3-week or a 4-week regimen, were examined every 3 to 6 months, and followed for 794 and 775 patient-years, respectively. Results: Compliance with each regimen was comparable 83 (66.9%) of 124 patients in the 3-week group versus 92 (73.6%) of 125 patients in the 4-week group stayed in the program (p gt 0.05). Streptococcal infections occurred less frequently in those receiving the 3-week regimen: 7.5 versus 12.6 per 100 patient years (p lt 0.01). Prophylaxis failed in 2 patients receiving the 3-week regimen and in 10 receiving the 4-week regimen (0.25 and 1.29 per 100 patient-years respectively; p = 0.015). Serum penicillin levels were adequate ( gtoreq 0.02 mu-g/ml) in 100 (56%) of 179 samples obtained 21 days after penicillin injection in the 3-week regimen, and in 51 (33%) of 155 samples obtained 28 days after injection in the 4-week regimen (p lt 0.01). Of 71 patients with mitral regurgitation in the 3-week regimen, 47 (66%) no longer had the murmur; of 87 patients in the 4-week regimen, 40 (46%) no longer had the murmur (p lt 0.05). Conclusions: This 12-year controlled study indicates that the outcome of patients with rheumatic fever is better with a 3-week than with a 4-week penicillin prophylaxis regimen. Greater emphasis and more widespread use of the 3-week regimen should be recommended.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 008971521

Download citation: RISBibTeXText

PMID: 7965439

DOI: 10.1016/s0022-3476(06)80188-5


Related references

Long-term prognosis of rheumatic fever patients receiving regular intramuscular benzathine penicillin. Circulation 45(3): 543-551, 1972

Incidence of anaphylactic reactions to benzathine penicillin g in rheumatic fever patients on long term prophylaxis. Orefici, G (Ed ) Zentralblatt Fuer Bakteriologie Suppl., 22 New Perspectives on Streptococci And Streptococcal Infections; (International Journal Of Medical Microbiology, 22 New Perspectives on Streptococci And Streptococcal Infections); Xi Lancefield International Symposium on Streptococci And Streptococcal Diseases, Siena, Italy, September 10-14, 1990 Xix+569p Gustav Fischer Verlag: Stuttgart, Germany; New York, New York, Usa Illus 401-403, 1992

Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. International Rheumatic Fever Study Group. Lancet 337(8753): 1308-1310, 1991

Confirmed penicillin allergy among patients receiving benzathine penicillin prophylaxis for acute rheumatic fever. Allergologia et Immunopathologia 42(4): 289-292, 2014

Sister-chromatid exchange analysis on long-term benzathine penicillin for secondary prophylaxis of rheumatic fever. Indian Journal of Pediatrics 68(2): 121-122, 2001

Evaluation of DNA damage using the comet assay in children on long-term benzathine penicillin for secondary prophylaxis of rheumatic fever. Pediatrics International 43(3): 276-280, 2001

Effect of benzathine penicillin treatment on antibiotic susceptibility of viridans streptococci in oral flora of patients receiving secondary prophylaxis after rheumatic fever. Journal of Infection 56(4): 244-248, 2008

Allergic reactions in rheumatic fever patients on long-term benzathine penicillin G: the role of skin testing for penicillin allergy. Pediatrics 97(6 Pt 2): 981-983, 1996

Penicillin Dried Blood Spot Assay for Use in Patients Receiving Intramuscular Benzathine Penicillin G and Other Penicillin Preparations To Prevent Rheumatic Fever. Antimicrobial Agents and ChemoTherapy 61(8):, 2017

Antibodies to penicillin in children receiving long-term secondary prophylaxis for rheumatic fever. Allergy 42(7): 502-506, 1987

Secondary prophylaxis in rheumatic fever. Oral antibiotic therapy versus benzathine penicillin. Arquivos Brasileiros de Cardiologia 67(5): 331-333, 1996

Benzathine penicillin G for rheumatic fever prophylaxis: 2-weekly versus 4-weekly regiments. Indian Journal of Pediatrics 59(6): 741-748, 1992

Rheumatic fever prophylaxis using benzathine penicillin G (BPG): two- week versus four-week regimens: comparison of two brands of BPG. Pediatrics 97(6 Pt 2): 992-995, 1996

Prophylaxis in patients with rheumatic fever: every three or every four weeks?. Journal of Pediatrics 115(1): 89-91, 1989

Benzathine penicillin for rheumatic fever prophylaxis. Ceylon Medical Journal 39(1): 58-60, 1994