Oral penicillin suggested for patients with rheumatic heart disease

More than 39 million people worldwide have rheumatic fever (RHD), a condition in which the heart valves are permanently damaged by rheumatic fever, which can occur if a strep infection or scarlet fever is not treated. treatment or inadequate treatment.

The recommended treatment for RHD is benzathine penicillin G (BPG) intramuscular injection every three to four weeks for an extended period of time.

BPG treatment for RHD has been limited in part because of patient and clinician concern about a serious allergic reaction known as anaphylaxis, despite the risk of anaphylaxis following BPG injection is low.

“Until recently, deaths within minutes and hours of BPG injection were attributed to anaphylaxis,” said team chairperson and presidential adviser Amy E. Sanyahumbi, MD, pediatric cardiologist at Texas Children’s Hospital and Assistant Professor of Pediatrics at Baylor College of Medicine.

“However, an increasing number of reports of BPG-related deaths do not have the features of classical anaphylaxis but instead indicate cardiovascular reactions. This distinction is important, as it demonstrates the need for different strategies to prevent or stop these responses to BPG.”

Signs of a cardiovascular reaction usually occur soon after BPG administration, sometimes even with injection. These include low blood pressure, which can be corrected by changing posture, slow heart rate, and fainting, all of which can lead to low blood flow to the heart, irregular heartbeat, and sudden cardiac death.

Signs of anaphylaxis after BPG injection are often delayed, even up to an hour later, and include cough, respiratory distress, tachycardia, and low blood pressure unresponsive to change. site, fainting, itching and redness at the injection site.

The risk of a cardiovascular reaction to BPG is highest in people with severe mitral stenosis, coarctation of the aorta, aortic insufficiency or reduced left ventricular systolic function, and those with RHD symptoms.

It is advised that people with a low risk of cardiovascular reactions and no history of penicillin allergy or anaphylaxis should be prescribed BPG for the treatment and prevention of RHD.

BPG has been shown to be the best treatment for preventing recurrent rheumatic fever.

For all patients being treated for BPG, the following standard approaches are recommended:

  • Reduce injection pain and patient anxiety, both of which are risk factors for injection syncope. Methods to relieve pain include pressing firmly on the area for 10 seconds, applying ice, or using pain relievers (such as acetaminophen, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs)).
  • The patient should be well hydrated before the injection. Drink at least 500 ml of water before the injection to prevent reflex fainting.
  • Eat a small amount of solid food within an hour before the injection.
  • Injections while lying down can reduce the risk of hematoma in the extremities.
  • Providers administering BPG should be taught how to recognize and quickly treat symptoms such as low blood pressure, low heart rate, or fainting.
  • “This counseling is urgently needed to raise awareness, provide risk stratification, and educate healthcare professionals on easy-to-follow procedures to reduce risk and overcome reluctance.” in the management and reception of BPG for rheumatic heart disease”, Andrea Z. Beaton, MD, associate. Lead the advisory group.

    Source: Medindia

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