Penicillin can prevent latent rheumatic heart disease from progressing in children: Study

Further research needed to assess real-world implementation, population-based screening and initiation of prophylaxis

By Madhumita Paul
Published: Tuesday 16 November 2021

A regular, affordable penicillin treatment can prevent the risk of underlying rheumatic heart disease (RHD) progression in children and adolescents, according to a new study

RHD is serious heart damage caused by rheumatic fever — a condition arising from poorly treated, repeat infections of streptococcus bacteria. Worldwide, around 40.5 million people, mostly people under the age of 25, suffer from the disease and 306,000 people die of it every year, according to recent estimates. 

RHD remains a public health concern in low-resource countries like Uganda, where it is the most common cause of heart disease in young adults. Ugandan patients, moreover, present late in the disease course and almost half present with a complication

In this study, the researchers conducted a randomised controlled trial of secondary antibiotic prophylaxis in Ugandan children and adolescents aged 5-17 years in primary and secondary schools in Gulu, Uganda from July 2018 through October 2020. 

Among 102,200 children and adolescents, 926 received a definitive diagnosis of latent rheumatic heart disease on the basis of confirmatory echocardiography. They  were randomly assigned to receive either injections of penicillin G benzathine every four weeks for two years or no treatment. 

The study result showed secondary antibiotic prophylaxis reduced the risk of disease progression at two years. The findings were published in the New England Journal of Medicine November 13, 2021.

The study concluded that further research is needed to assess real-world implementation, population-based screening and initiation of prophylaxis. The research may be integral components of the National Rheumatic Heart Disease action plans envisioned by the World Health Assembly in 2017 to stop rheumatic heart disease.

This study is the first large-scale clinical trial to understand the scope of penicillin usage in RHD treatment. It was led by an international panel of pediatric cardiac experts from Children’s National, Cincinnati Children’s Medical Center, the Uganda Heart Institute and Murdoch Children’s Research Institute in Melbourne, Australia.

On May 25, 2018, member states of the World Health Organization (WHO) unanimously adopted a Global Resolution on Rheumatic Fever and Rheumatic Heart Disease at the World Health Assembly in Geneva, Switzerland. 

This historic decision marks the first time that Rheumatic Fever and RHD have been recognised as global health priorities on the world stage. 

The Uganda Heart Institute, a semi-autonomous, publicly-funded clinical and research facility in Kampala, has engaged with the Uganda Ministry of Health to develop a national RHD strategy in response to the World Health Assembly (WHA) Resoultion. 

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