Abstract
Background Rheumatic Fever (RF) causes 25-40% of all cardio vascular disease in developing countries. Long term benzathine penicillin injection is being used for secondary prophylaxis of RF / RHD. Although allergic reaction to penicillin is rare skin testing is performed routinely before each and every penicillin injection delivery in most of the hospitals in Nepal. Objectives Objectives of this study was to evaluate safety of long term benzathine penicillin injection and establish recommendations for penicillin skin testing. Methods Data from the registers of National RF/RHD prevention and control programme from 32 hospitals of Nepal were collected and analyzed in a retrospective study. Results 65 patients (1.4%) among 77300 injections of benzathine penicillin given to 4712 patients, had allergic reactions. 5 had anaphylaxis, an incidence of 0.1% (0.7/10000 injections), 60 had minor allergy, an incidence of 1.3%. Conclusions Life-threatening allergic reactions are very rare in patients on long-term intramuscular benzathine penicillin for secondary prevention of RF. With these rare complications, regular skin test before each and every benzathine penicillin injection delivery has no significant role. Nevertheless Skin testing is recommended before 1st injection and patients having different batch number and or brand name. DOI: http://dx.doi.org/10.3126/njh.v8i1.8331 Nepalese Heart Journal Vol.8(1) 2011 pp.16-18
Highlights
Rheumatic Fever (RF) causes 25-40% of all cardio vascular disease in developing countries[1]
The 1.4 % incidence of allergic reaction observed among patients with RF/Rheumatic Heart Disease (RHD) in our study differs from 3.2% incidence reported by International Rheumatic Fever Study Group[7,8] and incidence of 2.24% reported in patients who received short term treatment with benzathine penicillin for sexually transmitted disease 9
Skin tests for penicillin allergy are not recommended for patients without a history of such allergic reactions, it is possible that selective skin test with penicillin might further reduce the already low risk of a fatal reaction in patients with severe RHD
Summary
Rheumatic Fever (RF) causes 25-40% of all cardio vascular disease in developing countries[1]. Disability and death from Rheumatic Heart Disease (RHD) are mainly caused by recurrent attacks of RF2. The efficacy of antibiotic prophylaxis to prevent recurrences of RF has been known for over 70 years 3,4. Because of the impact of this disease on public health, and the proven efficacy of antibiotic prophylaxis, the World Health Organization has helped to establish programmes for prevention of RF in developing countries[5]. RF and RHD are common cardiac problem in Nepal with prevalence rate of 1.2/1000 children aged 5 – 16 years[6]. Fever (RF) causes 25-40% of all cardio vascular disease in developing countries. Long term benzathine penicillin injection is being used for secondary prophylaxis of RF / RHD.
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