Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital : cardiovascular topics

Introduction of secondary prophylaxis for patients with rheumatic fever is felt to be a major reason for improved prognosis of rheumatic heart disease.1,2(p163) The article by Ginsburg et al,3 raising questions concerning the efficacy of this practice, has prompted me to report our experience in the Rainbow Rheumatic Fever Clinic, Rainbow Babies and Childrens Hospital, where more than 80% of the patients receive 1,200,000 units of benzathine penicillin intramuscularly every 28 days. Seventy percent of the patients with rheumatic mitral regurgitation have lost their murmur, and no patient receiving regular intramuscular prophylaxis has developed stenosis.4

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Safety and concerns of secondary prophylaxis for rheumatic heart disease with benzathine penicillin: A tertiary care cardiac centre experience

Journal of Clinical and Preventive Cardiology ◽

10.4103/jcpc.jcpc_23_21 ◽

2021 ◽

Vol 10 (4) ◽

pp. 129

Author(s):

ArunB Shivashankarappa ◽

Prabhavathi Bhat ◽

RadhaB Krishnappa ◽

ManjunathC Nanjappa

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Tertiary Care ◽

Secondary Prophylaxis ◽

Benzathine Penicillin ◽

Cardiac Centre ◽

Rheumatic Heart

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Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital

Patient Preference and Adherence ◽

10.2147/ppa.s238423 ◽

2020 ◽

Vol Volume 14 ◽

pp. 343-352

Author(s):

Kajela Kibirat Mekonen ◽

Malede Berihun Yismaw ◽

Alfoalem Araba Abiye ◽

Tamrat Assefa Tadesse

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Teaching Hospital ◽

Tertiary Care ◽

Secondary Prophylaxis ◽

Penicillin G ◽

Benzathine Penicillin ◽

Benzathine Penicillin G ◽

Cardiac Center ◽

Rheumatic Heart

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High risk of early sub-therapeutic penicillin concentrations after intramuscular benzathine penicillin G injections in Ethiopian children and adults with rheumatic heart disease

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009399 ◽

2021 ◽

Vol 15 (6) ◽

pp. e0009399

Author(s):

Ezra B. Ketema ◽

Nigus Z. Gishen ◽

Abraha Hailu ◽

Abadi Leul ◽

Abera Hadgu ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Day Treatment ◽

Secondary Prophylaxis ◽

Population Variation ◽

Penicillin G ◽

Benzathine Penicillin ◽

Indigenous Australian ◽

Benzathine Penicillin G ◽

Rheumatic Heart

Introduction Intramuscular benzathine penicillin G (BPG) injections are a cornerstone of secondary prophylaxis to prevent acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Uncertainties regarding inter-ethnic and preparation variability, and target exposure profiles of BPG injection are key knowledge gaps for RHD control. Methods To evaluate BPG pharmacokinetics (PK) in patients receiving 4-weekly doses in Ethiopia, we conducted a prospective cohort study of ARF/RHD patients attending cardiology outpatient clinics. Serum samples were collected weekly for one month after injection and assayed with a liquid chromatography-mass spectroscopy assay. Concentration-time datasets for BPG were analyzed by nonlinear mixed effects modelling using NONMEM. Results A total of 190 penicillin concentration samples from 74 patients were included in the final PK model. The median age, weight, BMI was 21 years, 47 kg and 18 kg/m2, respectively. When compared with estimates derived from Indigenous Australian patients, the estimate for median (95% confidence interval) volume of distribution (V/F) was lower (54.8 [43.9–66.3] l.70kg-1) whilst the absorption half-life (t1/2-abs2) was longer (12.0 [8.75–17.7] days). The median (IQR) percentage of time where the concentrations remained above 20 ng/mL and 10 ng/mL within the 28-day treatment cycle was 42.5% (27.5–60) and 73% (58.5–99), respectively. Conclusions The majority of Ethiopian patients receiving BPG as secondary prophylaxis to prevent RHD do not attain target concentrations for more than two weeks during each 4-weekly injection cycle, highlighting the limitations of current BPG strategies. Between-population variation, together with PK differences between different preparations may be important considerations for ARF/RHD control programs.

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225 Rheumatic heart disease in Timor Leste school students (RHD-TL) follow-up study: assessment of secondary prophylaxis and outcomes in Timor Leste

European Heart Journal ◽

10.1093/ehjci/ehz872.010 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

A Horton ◽

B Remenyi ◽

K Davis ◽

N Mock ◽

E Paratz ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Secondary Prophylaxis ◽

Penicillin G ◽

School Students ◽

Borderline Cases ◽

Follow Up Study ◽

Timor Leste ◽

Rheumatic Heart

Abstract Background The Rheumatic Heart disease in Timor Leste school students (RHD-TL) study identified Timor Leste as having some of the highest rates of definite rheumatic heart disease (RHD) in the world. The RHD-TL follow-up study aimed to assess the delivery and outcomes of the secondary prophylaxis program in known patients with echocardiographic screen detected definite and borderline RHD. Methods School-students in Timor Leste where reassessed over a 3-year period since the initial study in 2016. Prospective assessments included adherence to secondary prophylaxis, complications of prophylaxis, follow-up clinical assessment and serial echocardiography. Of the 48 patients, 25 Definite and 23 Borderline, 38 (79%) of all patients, and 92% of definite RHD cases have had one or more follow-up assessments including full datasets for adherence, recurrence rates and progression of disease. Follow-up is provided by the volunteer paediatric cardiology team and rheumatic heart disease team of two NGOs in collaboration with local clinics. Results The median duration of follow-up of the 38 patients was of 1.6 years. The median age was 13 years (range 8-22) and 75% were female. Adherence rates in patients with definite RHD was on average greater than 95% during the follow-up period. Of the 23 patients with mild or moderate RHD one case with documented acute rheumatic fever (ARF) recurrence progressed whilst 8 cases improved on benzathine-penicillin G (BPG) therapy. There was no progression of the 6 borderline cases who were not prescribed BPG. Out of the 9 borderline cases in whom BPG was prescribed, one, with 67% adherence, had a documented episode of ARF leading to echocardiographic progression and moderate definite RHD. Conclusion This was the first follow-up study to look at disease natural history, both in treated and untreated groups, in Timor-Leste and brought practical insights into the efficacy of the Timor Leste RHD monitoring and prophylaxis programs. Its ongoing project will enable advocacy and quality assessment for the program as it expands. Abstract 225 Figure 1.

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Underuse of Injectable Penicillin in Secondary Prophylaxis of Rheumatic Heart Disease in Nepal

10.37179/rijccm.000004 ◽

2020 ◽

Vol 01 (01) ◽

pp. 009-012

Author(s):

Laudari S

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Cross Sectional Study ◽

Secondary Prophylaxis ◽

Medical Sciences ◽

Cross Sectional ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Rheumatic Heart

Background and Aims: Secondary prophylaxis has remained the mainstay of rheumatic fever and rheumatic heart disease management. Despite the proven ef􀏐icacy and superiority of injectable penicillin in rheumatic heart disease patients, it has been underused in Nepal. Materials and Methods: This is a hospital based cross-sectional study during June 2014 to October 2018 over a period of 52 months at College of Medical Sciences-Bharatpur including 350 patients with clinical and/or echocardiographic evidence of de􀏐inite rheumatic heart disease. Data was collected from both cardiology outpatients and inpatients (admitted in cardioward/coronary care unit). Relevant data and information were entered into the pre-structured proforma and then analyzed by SPSS-16 software. Results: The age of the patients ranged from 6 to 80 years with mean age 36.76±4.6years with female preponderance (F:M=1.26:1). The predominantly involved isolated valve was mitral in 152 patients (44.43%) followed by aortic valve in 70 patients (20.00%) and rest 90 (25.71%) had dual valvular involvement. The common complications encountered were heart failure in 200(57.14%) and arrhythmias in 155(44.29%) patients. Two hundred ten (60.00%) of the patients received penicillin (oral and injectable) and erythromycin. Majority 180/210=85.71%) were prescribed on oral penicillin whereas only 46/210=21.90% received injectable penicillin; the ratio being 3.35:1. Conclusion: RHD is a leading cause of heart failure and death among young population. There is underuse of penicillin with very minimal focus on use of injectable penicillins currently. Hence, Nepal government and other non-governmental organizations should consider implementation of use of penicillin broadly and moreover focus on use and adherence of injectable penicillin. Keywords: Rheumatic Heart Disease, Penicillin, Underuse, Secondary Prophylaxis.

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Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic

Cardiology in the Young ◽

10.1017/s1047951111000266 ◽

2011 ◽

Vol 21 (4) ◽

pp. 436-443 ◽

Cited By ~ 48

Author(s):

Rachel H. Webb ◽

Nigel J. Wilson ◽

Diana R. Lennon ◽

Elizabeth M. Wilson ◽

Ross W. Nicholson ◽

...

Keyword(s):

Heart Disease ◽

New Zealand ◽

High Risk ◽

Mitral Valve ◽

Rheumatic Heart Disease ◽

Secondary Prophylaxis ◽

Accurate Diagnosis ◽

High Risk Population ◽

Step Model ◽

Rheumatic Heart

AbstractAimsEchocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.Methods and resultsTo optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10–13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified asdefinite, probable, orpossible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence ofdefiniteandprobablerheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.ConclusionsWe found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

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