Secondary antibiotic prophylaxis for latent rheumatic heart disease

Abstract Background Prevention of rheumatic heart disease (RHD) remains challenging in high-burden settings globally. After acute rheumatic fever (ARF), secondary antibiotic prophylaxis is required to prevent RHD. International guidelines on recommended durations of secondary prophylaxis differ, with scope for clinician discretion. Because ARF risk decreases with age, ongoing prophylaxis is generally considered unnecessary beyond approximately the third decade. Concordance with guidelines on timely cessation of prophylaxis is unknown. Methods We undertook a register-based audit to determine the appropriateness of antibiotic prophylaxis among clients aged ≥35 years in Australia’s Northern Territory. Data on demographics, ARF episode(s), RHD severity, prophylaxis type, and relevant clinical notes were extracted. The determination of guideline concordance was based on whether (1) national guidelines were followed; (2) a reason for departure from guidelines was documented; (3) lifelong continuation was considered appropriate in all cases of severe RHD. Results We identified 343 clients aged ≥35 years prescribed secondary prophylaxis. Guideline concordance was 39% according to national guidelines, 68% when documented reasons for departures from guidelines were included and 82% if patients with severe RHD were deemed to need lifelong prophylaxis. Shorter times since last echocardiogram or cardiologist review were associated with greater likelihood of guideline concordance (P < .001). The median time since last ARF was 5.9 years in the guideline-concordant group and 24.0 years in the nonconcordant group (P < .001). Thirty-two people had an ARF episode after age 40 years. Conclusions In this setting, appropriate discontinuation of RHD prophylaxis could be improved through timely specialist review to reduce unnecessary burden on clients and health systems.

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Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji

Tropical Medicine & International Health ◽

10.1111/tmi.12796 ◽

2016 ◽

Vol 21 (12) ◽

pp. 1583-1591 ◽

Cited By ~ 10

Author(s):

Daniel Engelman ◽

Reapi L. Mataika ◽

Joseph H. Kado ◽

Maureen Ah Kee ◽

Susan Donath ◽

...

Keyword(s):

Heart Disease ◽

Antibiotic Prophylaxis ◽

Rheumatic Heart Disease ◽

Rheumatic Heart

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Mid-term outcome of children with latent rheumatic heart disease in eastern Nepal

Open Heart ◽

10.1136/openhrt-2021-001605 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001605

Author(s):

Nikesh Raj Shrestha ◽

Dorothea Bruelisauer ◽

Surendra Uranw ◽

Rajan Mahato ◽

Kunjang Sherpa ◽

...

Keyword(s):

Heart Disease ◽

Antibiotic Prophylaxis ◽

Rheumatic Heart Disease ◽

Univariate Analysis ◽

Secondary Prophylaxis ◽

Term Outcome ◽

Registration Number ◽

Lost To Follow Up ◽

Rheumatic Heart

IntroductionSystematic echocardiographic screening of children in regions with an endemic pattern of rheumatic heart disease allows for the early detection of valvular lesions suggestive of subclinical rheumatic heart disease. The natural course of latent rheumatic heart disease is, however, incompletely understood at this time.MethodsWe performed a prospective cohort study of children detected to have echocardiographic evidence of definite or borderline rheumatic heart disease according to the World Heart Federation Criteria.ResultsAmong 53 children found to have definite (36) or borderline (17) rheumatic heart disease, 44 (83%) children underwent follow-up at a median of 1.9 years (IQR 1.1–4.5). The median age of the children was 11 years (IQR 9–14) and 34 (64.2%) were girls. Among children with definite rheumatic heart disease, 21 (58.3%) were adherent to secondary antibiotic prophylaxis, 7 (19.4%) were not, information on adherence was missing in 2 (5.6%) children and 6 (16.7%) were lost to follow-up. Regression of disease was observed in 10 children (27.8%), whereas 20 children (55.6%) had stable disease. Among children adherent to secondary prophylaxis, seven (33.3%) showed regression of disease. Among children with borderline disease, seven (41.2%) showed regression of disease, three (17.6%) progression of disease, four (23.5%) remained stable and three (17.6%) were lost to follow-up. On univariate analysis, we identified no predictors of disease regression, and no predictors for lost to follow-up or non-adherence with secondary antibiotic prophylaxis.ConclusionDefinite rheumatic heart disease showed regression in one in four children. Borderline disease was spontaneously reversible in less than half of the children and progressed to definite rheumatic heart disease in one in five children.Trial registration numberNCT01550068.

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