Allergic Reactions in Rheumatic Fever Patients on Long-term Benzathine Penicillin G: The Role of Skin Testing for Penicillin Allergy

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 981-983
Author(s):  
Milton Markowitz ◽  
Hung-Chi Lue
Keyword(s):  
Developing Countries ◽  
Rheumatic Fever ◽  
The United States ◽  
World Health ◽  
Penicillin G ◽  
Allergic Reactions ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G ◽  
The Impact

An injection of 1.2 million U benzathine penicillin G (BPG) every 3 or 4 weeks has proven by far to be the most effective method to prevent recurrences of acute rheumatic fever.1-3 The efficacy of this method of prophylaxis was first demonstrated more than 40 years ago, and since its introduction, it has played a major role in reducing the morbidity and mortality from rheumatic fever.4 Rheumatic fever causes 25% to 40% of all cardiovascular diseases in developing countries.5 Because of the impact of this disease on public health, the World Health Organization (WHO) has helped establish programs for prevention of recurrent attacks of rheumatic fever in many developing countries.6 WHO recommends BPG as the prophylactic drug of choice. One of the problems encountered has been the high drop-out rates among patients enrolled in these programs. Among the reasons for discontinuing prophylaxis is the fear of an allergic reaction.7 The initial study using BPG for the prevention of recurrences of rheumatic fever in children and adolescents reported only 5 (1.2%) mild allergic reactions among 410 patients receiving monthly injections.1 Since then, although rheumatic fever prevention in the United States (U.S.) has consisted almost exclusively of using BPG, there been very few documented reports of serious allergic reactions in rheumatic fever patients on long-term prophylaxis. The only fatalities reported in the American literature occurred in four adults with advanced rheumatic heart disease.8,9 The salutary experience with BPG in the U.S. contrasts sharply with the numerous anecdotal reports of fatal allergic reactions to BPG in many developing countries.

Three-Versus Four-week Administration of Benzathine Penicillin G: Effects on Incidence of Streptococcal Infections and Recurrences of Rheumatic Fever

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 984-988
Author(s):  
Hung-Chi Lue ◽  
Mei-Hwan Wu ◽  
Jou-Kou Wang ◽  
Fen-Fen Wu ◽  
Yu-Nian Wu
Keyword(s):  
Rheumatic Fever ◽  
Color Doppler ◽  
Clinic Visit ◽  
Penicillin G ◽  
Controlled Study ◽  
Streptococcal Infections ◽  
Benzathine Penicillin ◽  
Acute Phase Reactants ◽  
Weight Percentage ◽  
Benzathine Penicillin G

Objective. To investigate the effects of 3-week versus 4-week administration of benzathine penicillin G (BPG) on the incidence of Group A streptococcal infections and the recurrences of rheumatic fever (RF). Study Design. We started, in 1979, randomly allocating all patients with RF to a 3-week or 4-week BPG prophylaxis program. They were examined at the RF clinic, every 3 to 6 months, and at any time they did not feel well. During 1979 to 1989, throat cultures and sera for antistreptolysin O and streptozyme titers were obtained at each clinic visit. Chest radiographs, electrocardiogram, color Doppler echocardiograms, and acute phase reactants were obtained. Subjects. Two hundred forty-nine patients fulfilled the revised Jones criteria and were followed until December 1991: 124 in the 3-week and 125 in the 4-week program. Their age, sex, weight, percentage with history of RF, severity of cardiac involvement, follow-up duration, and compliance to program were comparable. Eight hundred eighty throat cultures were collected in the 3-week program and 770 were collected in the 4-week program. Six hundred sixteen and 627 sera were determined in each program for antistreptolysin O, and 582 and 592 sera for streptozyme titers. Results. True streptococcal infections occurred in both programs: 39 infections in the 3-week program, and 59 infections in the 4-week program (7.5 vs 12.7 per 100 patient-years). Four infections with no antibody response occurred in the 3-week program, and three such infections in the 4-week program. Nine RF recurrences occurred in 8 patients in the 3-week program, and 16 recurrences in 16 patients in the 4-week program. Prophylaxis failure occurred in 2 of 124 patients in the 3-week program, and in 10 of 125 patients in the 4-week program (0.25 vs 1.29 per 100 patient-years). The overall recurrences/infections rate in each program was comparable, 13.6% vs 15.5%, but the recurrences/infections rate due to prophylaxis failure was higher in the 4-week program than in the 3-week program, 3.0% versus 9.7%. Conclusions. This 12-year prospective and controlled study documented that streptococcal infections and RF recurrences occurred more often in the 4-week program than in the 3-week program. The risk of prophylaxis failure was fivefold greater in the 4-week program than in the 3-week program.

Rheumatic Fever Article Questioned

PEDIATRICS ◽  
1984 ◽  
Vol 74 (6) ◽  
pp. 1133-1134
Author(s):  
SYLVIA P. GRIFFITHS
Keyword(s):  
Rheumatic Fever ◽  
Intramuscular Injection ◽  
Group A Streptococcus ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G ◽  
Group A

To the Editor.— The suggestion of Nordin1 that there may be a need to re-evaluate the current recommended prophylaxis for children with rheumatic fever is valid, particularly if carefully planned and controlled studies could be carried out. However, the author's contention that "It has been assumed that the levels of penicillin [following monthly intramuscular injection of 1.2 million units of benzathine penicillin G] are adequate to prevent reinfection with group A streptococcus, and hence to prevent recurrences of rheumatic fever" has always been qualified by others.

Recurrence of Rheumatic Fever During Prophylaxis with Monthly Benzathine Penicillin G

PEDIATRICS ◽  
1984 ◽  
Vol 73 (4) ◽  
pp. 530-531
Author(s):  
James D. Nordin
Keyword(s):  
Rheumatic Fever ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Real Risk ◽  
Benzathine Penicillin G ◽  
The Subject

A 9-year-old girl had apparent recurrence of rheumatic fever while receiving monthly benzathine penicillin injections. A review of pharmacokinetc studies on the subject suggests that this is a real risk. A need for review of the current recommendations for rheumatic fever prophylaxis is suggested.

Rheumatic Fever Prophylaxis Using Benzathine Penicillin G (BPG): Two-week Versus Four-week Regimens: Comparison of Two Brands of BPG

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 992-995
Author(s):  
Ahmed Samir Kassem ◽  
Salah R. Zaher ◽  
Hamida Abou Shleib ◽  
Abdel Ghany El-Kholy ◽  
Ahmed A. Madkour ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Recurrence Rate ◽  
Penicillin G ◽  
Diffusion Method ◽  
High Recurrence Rate ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G ◽  
Group A ◽  
Upper Respiratory ◽  
The Difference

Objective. This prospective study was aimed at answering two important questions: 1) Is a biweekly schedule of 1.2 million U intramuscular benzathine penicillin G (BPG) superior to a 4-week one in the prevention of upper respiratory Group A beta-hemolytic streptococcal (GABHS) infections and rheumatic fever (RF) recurrences? 2) Is there a difference in the bioavailability of BPG obtained from different manufacturers? Methodology. Three hundred sixty rheumatic patients aged 4 to 20 years were randomly assigned to either a biweekly (190 patients) or 4-week (160 patients) BPG prophylactic schedule and were followed-up monthly for 2 years by clinical examination, throat swab culture for GABHS and measurement of antistreptolysin O titer to detect GABHS infection and/or recurrences of RF (according to revised Jones' Criteria). Thereafter, 34 rheumatic subjects, aged 8 to 16 years were randomly assigned to receive a 4-week injection of 1.2 million U of either a locally manufactured BPG brand (22 patients) or an imported one (12 patients). Sera of all patients were tested for penicillin level by plate diffusion method on days 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28 after the intramuscular injection of BPG. Results. The GABHS infection rate was found to be 0.2% and 0.3% for patients on the biweekly and 4-week BPG schedules, respectively, with no significant differences between them. However, the RF recurrence rate/patient/year for the 4-week schedule patients (0.12) was double that for the biweekly schedule ones (0.06). Estimation of the bioavailability of the two different brands of BPG demonstrated a difference in their pharmacokinetics and a decrease in the serum penicillin concentration below the minimum inhibitory concentration 3 weeks after the injection of either brand. Conclusion. Although a biweekly schedule may not be superior in preventing upper respiratory GABHS infection, it may play a role in preventing the sequelae of such infections. The short duration of penicillinemia explains the superiority of the 2-week schedule in RF prophylais. The difference in the pharmacokinetics of penicillin brands might contribute to the high recurrence rate of RF reported in Egypt.

Benzathine penicillin G for rheumatic fever prophylaxis: 2-Weekly versus 4-weekly regimens

1992 ◽  
Vol 59 (6) ◽  
pp. 741-748 ◽  
Author(s):  
A. S. Kassem ◽  
A. A. Madkour ◽  
B. Z. Massoud ◽  
S. R. Zaher
Keyword(s):  
Rheumatic Fever ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G

scholarly journals Four-Weekly Benzathine Penicillin G Provides Inadequate Protection against Acute Rheumatic Fever in Some Children

2019 ◽  
Vol 100 (5) ◽  
pp. 1118-1120 ◽  
Author(s):  
Jessica L. de Dassel ◽  
Halla Malik ◽  
Anna P. Ralph ◽  
Kate Hardie ◽  
Boglarka Remenyi ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G
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