Intramuscular Injection Of Benzathine Penicillin Research Articles

Insights into ocular syphilis in Nepal.

This study aims to elucidate the demographic characteristics, clinical features, diagnostic approaches, and medical management of patients with ocular syphilis, known as 'the great masquerader,' at a tertiary eye care center in Nepal. We conducted a retrospective review involving 15 eyes from ten patients with ocular syphilis treated at a uveitis referral center between 2020 and 2022. Lumbar puncture was performed if neurosyphilis was suspected. Treatment success was defined as the absence of ocular inflammation in both eyes and a decrease in Veneral disease research laboratory (VDRL) titres after completing therapy. A total of 15 eyes of 10 patients were diagnosed with syphilitic uveitis based on positive treponemal and non-treponemal serological tests. The mean age of the patient was 39.9years (range 22-54years) with an equal distribution between males and females. HIV coinfection was not found in any of the patients. Syphilitic uveitis was the primary presentation in nine patients (90%), while one patient presented with recurrent nodular scleritis. Ocular involvement was bilateral in 50% (5 patients). The mean duration between the initial symptom and the first presentation was 8.7weeks (range: 4days to 24weeks). The most common ocular findings was panuveitis (6 eyes). Eight patients with early syphilis received weekly intramuscular injections of benzathine penicillin G for 3 weeks whereas 2 patients with neurosyphilis were treated with intravenous ceftriaxone 1 gm twice a day for 14 days. Signs and symptoms of majority of patients improved with systemic therapy for syphilis. Syphilitic uveitis should be included in the differential diagnosis of any form of ocular inflammation.

Nursing Effects of Modified Intramuscular Injection Technique in Syphilis Treatment with Benzathine Penicillin

Nursing Effects of Modified Intramuscular Injection Technique in Syphilis Treatment with Benzathine Penicillin

Case Report: Secondary Syphilis And Human Immunodeficiency Virus Coinfection

Introduction: Syphilis is a sexually transmitted infection that is chronically progressive, with a broad spectrum of active clinical and asymptomatic periods. A total of 80.6% of men with syphilis were Men Who Sex with Men (MSM), 47% of the population was coinfected with Human Immunodeficiency Virus (HIV). Case Presentation: Male, 23-yo, MSM, unmarried, HIV, complaining of red bumps and spots on the palms, soles, and upper arms since 4 days ago. One week earlier, he complained of sores in the genitals, which recurred 1 year ago and healed on their own. Dermatological examination revealed multiple erythematous patches and papules. The corpus penis, glans penis, and scrotum showed erosions and multiple ulcers with an erythematous-based, covered with yellowish crusts. VDRL and TPHA were reactive. The patient was diagnosed with secondary syphilis and treated with an intramuscular injection of benzathine penicillin 2.4 million IU once. A 1-month evaluation showed significant lesion improvement, VDRL titer 1:64. Evaluation of the 3rd and 6th months revealed a VDRL titer of 1:4. Conclusion: The clinical manifestations of syphilis patients with HIV coinfection are generally more atypical, aggressive, and overlap caused by changes in the immune system in HIV infection. Unsafe sexual behavior in MSM increases the transmission of syphilis infection. Diagnosis and therapy are generally the same. Men Who Sex with Men is a factor that allows the transmission of syphilis in HIV patients. Administration of benzathine penicillin injection once gave lesion improvement and significantly reduced VDRL.

Secondary Syphilis During Pregnancy: The Importance of Screening and Clinical Management

Background: Syphilis is one of the most serious sexually transmitted diseases worldwide, and has tremendous consequences for the mother and her developing fetus if left untreated. The burden of morbidity and mortality due to congenital syphilis is high. Purpose: Screening and prompt to know the importance of treatment of syphilis during pregnancy. Case: A 32-year-old multigravida in 5 months of pregnancy presented with multiple raised lesions over her labia. It was accompanied by fluor and smelly fishy odor. There was no history of genital ulcers in either spouse and no history of sexual promiscuity. History of antenatal care in public health showed non-reactive status of HIV, syphilis and hepatitis B. Clinical examination revealed multiple flat, moist warts over her labia mayora and minora, and multiple roseola syphilitica on the plantar pedis sinistra. Darkfield microscopic examination presence spirochete, venereal disease research laboratory (VDRL) titer was 1:16 and T. pallidum particle agglutination assay (TPHA) titer was 1:2560. Obstetric ultrasonography examination was suggestive no mayor congenital abnormalities. Both of serology VDRL and TPHA were non-reactive in her husband. Significant of lesion improvement and decrease a fourfold titer serologic in VDRL (1:4) and TPHA (1:320) as follow-up 3 months after being treated with single intra-muscular injections of benzathine penicillin 2.4 million units. Discussion: Coordinated prenatal care and treatment are vital. It’s implemented before the fourth month of pregnancy to reduce vertical transmission and all associated side effects of congenital syphilis. Penicillin is highly efficacious in maternal syphilis and prevention of congenital syphilis. Conclusion: Universal screening and adequate pregnancy care must be a priority.

Using an Indigenous framework to contextualise Immunology education within the Health Sciences setting

Abstract Indigenous Māori and Pacific children and young people remain disproportionately affected by Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD), with rates in Aotearoa/New Zealand and the Pacific Region of significant concern. ARF is the body’s autoimmune response to an untreated Group A Streptococcal (GAS) throat or skin infection. If multiple or severe episodes of ARF occur and are left untreated, this can lead to permanent cardiac damage known as RHD. RHD remains a major cause of morbidity and mortality globally. In the absence of a GAS vaccine, the best recommended treatment and management approach consists of painful monthly intramuscular injections of Benzathine Penicillin G (BPG) administered to the upper thigh area, and given for at least 10 years or more. A new Penicillin for ARF/RHD prevention is urgently needed. The purpose of this work was to employ the use of an Indigenous Pacific framework within the undergraduate Health Sciences education setting to support learning and teaching efforts appropriate to vulnerable communities affected by ARF and RHD. The Talanoa approach was utilised within the classroom setting to support discussions relating to ARF and RHD and vulnerable communities that was appropriate and respectful to the Indigenous cultural setting. Well-received by students, this approach was not only applicable to the cultural setting for those communities affected by ARF/RHD in Aotearoa/New Zealand, but also helped with contextualisation, supporting courteous class discussions with relevant in-class learning opportunities and experiences. This work highlighted the importance of Indigenous frameworks for supporting Immunology education within the Health Sciences education setting.

Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children

Acute rheumatic fever (ARF) is a sequela of streptococcal infection—typically following 2 to 3 weeks after group A streptococcal pharyngitis—that occurs most commonly in children and has rheumatologic, cardiac, and neurologic manifestations. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. Secondary prophylaxis with regular intramuscular injections of benzathine penicillin G (BPG) is a key component to prevent ARF and RHD recurrent. This study aimed to evaluate the secondary prophylaxis effectiveness based on the profile of clinical manifestations and blood laboratory findings. The data were collected by interviews, complete blood counts, the anti-streptolysin titer O (ASTO) analysis, the C-reactive protein Assay, electrocardiography, and echocardiography. Data were analyzed using SPSS 18, and the results were presented as the percentage frequency. The samples were 63 patients with ARF and RHD who get secondary prophylaxis, consisting of 32 males (50.8%) and 31 females (49.9%). The echocardiography examination showed that valve regurgitation was more common than valve stenosis, indicating longer P-R interval in 49 subjects (77.7%). Sixty subjects (92.2%) received secondary prophylaxis with BPG injection, and three subjects (4.8%) got Erythromycin oral. The main factor of secondary prophylaxis adherence is pain and injection disliking. How to Cite this Article Pubmed Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Web Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. http://www.sysrevpharm.org/?mno=11016 [Access: March 29, 2021]. doi:10.31838/srp.2020.9.63 AMA (American Medical Association) Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Vancouver/ICMJE Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. (2020), [cited March 29, 2021]; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Harvard Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Turabian Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. 2020. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Chicago Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11 (2020), 452-457. doi:10.31838/srp.2020.9.63 MLA (The Modern Language Association) Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11.9 (2020), 452-457. Print. doi:10.31838/srp.2020.9.63 APA (American Psychological Association) Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63

Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial.

The aim of this study was to determine the effect of using three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures on patients' pain and satisfaction levels during intramuscular benzathine penicillin injection. A randomized controlled trial. The study population consisted of 91 patients who were prescribed intramuscular benzathine penicillin medication. The participants were stratified by gender and assigned to three groups (control, virtual reality and distraction cards groups). The visual analogue scale was used to assess pain and patient satisfaction. A one-way analysis of variance and Dunnett's post hoc tests were used to compare the pain and satisfaction levels by group. The mean pain was 6.67 (2.17) in the control group, 4.4 (2.71) in the distraction cards group and 4.93 (3.07) in the virtual reality group and the difference was statistically significant (F=5.84, p˂.01). The average of the satisfaction levels in the groups was 3.57 (2.23) in the control group, 7.13 (2.86) in the distraction cards group and 8.07 (2.55) in the virtual reality group. The difference between the satisfaction levels was statistically significant (F=25.77, p˂.01). The three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures were effective in reducing pain associated with intramuscular benzathine penicillin injection and increasing patient satisfaction. The results of this study will contribute to evidence-based nursing practices for the pain associated with intramuscular benzathine penicillin injection. NCT04420559.

Essential syphilitic alopecia: Non-scarring alopecia in 21-year-old man

ABSTRACT Alopecia syphilitica is a less common clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of. The main difference between alopecia areata and Alopecia syphilitica is the detection of Treponema pallidum in syphilis. We present the case of a 21- year-old belgium man with different patches of non-cicatricial alopecia of his scalp. The patient denied previous history of genital or other skin lesions. Laboratory evaluation was positive for syphilis. The diagnosis of alopecia syphilitica was made and he was treated with single intramuscular injections of benzathine penicillin. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

15119 Reducing the pain of intramuscular benzathine penicillin injection in syphilis by using 1% lidocaine as a diluent: A prospective, randomized, double-blinded trial study

Background: According to the Centers for Disease Control and Prevention 2015 sexual transmitted disease treatment guidelines, Benzathine penicillin G (BPG) is the recommended first-line treatment for the treatment of syphilis. In our general practice, using lidocaine as the diluent of BPG causes pain at the injection sites. This study aimed to compare the effect of BPG diluted in 1% lidocaine versus that diluted in sterile water on injection sites.

Nicolau syndrome after intramuscular benzathine penicillin injection

Abstract Background Nicolau syndrome is a rare, potentially severe complication that may occur after any drug injection, particularly after intramuscular, subcutaneous or intraarticular injection. The pathogenesis of the necrosis is not completely known, it's presumed that ischemic necrosis is induced by direct vascular injury, perivascular inflammation, and vascular constriction. Few case was reported since the first description by Freudenthal in 1924 and Nicolau in 1925. Case report we report two cases of Nicolau syndrome in the child after benzathine penicillin intramuscular injection in the thigh. The cases were complicated by a necrosis of the extremities and a Volkmann syndrome. Conclusion Nicolau syndrome is an uncommon iatrogenic ischemic necrosis of the skin and deeper tissue. It is reported to occur after intramuscular injection for certain drugs such as benzathine penicillin. The pathogenesis is unknown but embolic occlusion, inflammatory and physical obstruction of blood vessels have been suggested in our cases. There is no standard guideline for its management.

Extensive Deep Tissue Involvement in Nicolau Syndrome and Below-Knee Amputation: A Case Report and Literature Review.

Nicolau syndrome (NS) is a rare cutaneous drug reaction in response to injections administered via any route. Based on the available studies in the medical literature, NS presents as skin and subcutaneous fat necrosis, and typically, it does not cause severe complications such as acute limb ischemia or death. In this study, we report the case of a 6-year-old boy who received an intramuscular injection of benzathine penicillin G for the treatment of bacterial pharyngitis, and subsequently developed a severe case of NS, which eventually led to below-knee amputation of the right lower limb. Although a few approaches have been suggested for the management of NS, they might not be effective under certain circumstances. Early detection, close monitoring, and consistent interventions, such as surgical fasciotomy and debridement procedures, might be necessary in severe cases of NS.

Coincidence of Nicolau Syndrome and Rhabdomyolysis after Intramuscular Benzathine Penicillin Injection: A Case Report

Nicolau syndrome (NS) is a rare but well-known complication of intramuscular Benzathine Penicillin (BP) injection, manifesting by symptoms of livedoid discoloration of the skin, edema, as well as classical clinical features of myalgia, muscle weakness and pigmenturia immediately after intramuscular. NS or embolia cutis medicamentosa was first described in 1925 by Nicolau and Freudenthal following intramuscular injection of bismuth salt for the treatment of syphilis. Since then, a few cases have been reported both in adult and children.

Compartment syndrome and acute lower limb ischemia with paralysis complicating intramuscular benzathine penicillin injection

Nicolau dermatitis (ND) is a well-known but rare adverse drug reaction involving the skin and the subcutaneous and even muscle tissues at the site of intramuscular injection (IMI). Benzathine penicillin (BP) is the most frequent medication causing serious and acute complications such as limb ischemia, compartment syndrome (CS), and nerve paralysis. The subsequent damage to the lower limb (LL) might be due to microemboli, leading to progressive deterioration of the downstream tissue bed. We describe a 7-year-old boy with a diagnosis of ND after IMI of BP and diclofenac sodium to the medial mid-right thigh. Two days earlier, the patient seemed to experience an acute suppurative complication of circumcision and underwent the aforementioned treatment (September 15, 2018). The circumcision and injection of drugs were illicitly carried out by a nonmedical practitioner. The child complained of severe pain and disability of his right LL. On admission (September 16, 2018), he was found to have acute LL ischemia and CS with cyanosis, hypoesthesia and paresis. Fasciotomy was achieved and medical therapy with heparin, corticoid, and an antibiotic was made for 7 days. Postoperative periods were uneventful. Livedoid violaceous patch and erythematous plaque and ecchymosis have evolved progressively during 10th day, with formation of a diffuse necrotic spot before healing up within 2 months. The length of hospital stay was 10 days. The rehabilitation for walking was started 2 weeks after the operation. Between 6 and 12 months of follow-up, the motor deficit involved the entire LL and persisted despite the tremendous achievement of regular neuromuscular physiotherapy. The paralysis was considered permanent.

Ischémie aiguë de membre sévère sanctionnée par désarticulation de sauvetage dans un contexte de syndrome de Nicolau suite à une injection intramusculaire de pénicilline

Nous décrivons le cas d'un enfant de 9 ans qui a présenté une ischémie aiguë sévère de membre dans un contexte de syndrome de Nicolau du membre pelvien gauche faisant suite à une injection intramusculaire glutéale de benzathine-pénicilline. Outre la rareté de l'ischémie aiguë de membre chez l'enfant, la particularité de ce syndrome de Nicolau compliqué associant une thrombose artérielle aiguë et d'une rhabdomyolyse sévère ayant conduit à une désarticulation de sauvetage de la hanche font l'intérêt de ce cas.

A RETROSPECTIVE ANALYSIS OF 12 CASES OF ORAL SYPHILIS RECENTLY DIAGNOSED AT A SOLE INSITITUTION

Syphilis is an infectious disease caused by the bacterium Treponema pallidum and has 3 classically clinical stages. This disease may mimic several other more common oral mucosa lesions. This study aimed to describe the different oral manifestations of 12 patients diagnosed as having syphilis in the last few years at our institution. Eleven of the 12 syphilis cases presented lesions of secondary syphilis and 1 of primary syphilis. The diagnosis was made through biopsies or/and laboratory tests, and the treatment was conducted by intramuscular injections of benzathine penicillin G with good results. The patients' group examination confirmed the theory that syphilis may resemble several other diseases. Dental surgeons should be aware of the manifestations of oral syphilis, which might be very different from the classical description of mucous patches, to play a desirable key role on the diagnosis and control of this disease. Syphilis is an infectious disease caused by the bacterium Treponema pallidum and has 3 classically clinical stages. This disease may mimic several other more common oral mucosa lesions. This study aimed to describe the different oral manifestations of 12 patients diagnosed as having syphilis in the last few years at our institution. Eleven of the 12 syphilis cases presented lesions of secondary syphilis and 1 of primary syphilis. The diagnosis was made through biopsies or/and laboratory tests, and the treatment was conducted by intramuscular injections of benzathine penicillin G with good results. The patients' group examination confirmed the theory that syphilis may resemble several other diseases. Dental surgeons should be aware of the manifestations of oral syphilis, which might be very different from the classical description of mucous patches, to play a desirable key role on the diagnosis and control of this disease.

Group A Streptococcal Infection, Acute Rheumatic Fever and Rheumatic Heart Disease in the Solomon Islands

Abstract Group A Streptococcal (GAS) infection of the upper respiratory tract (and possibly skin) can trigger Acute Rheumatic Fever (ARF), an autoimmune condition if left untreated. Severe or recurrent attacks of ARF that also remain untreated, can lead to a type of permanent cardiac damage known as Rheumatic Heart Disease (RHD). RHD remains a significant cause of morbidity and mortality globally and is rare in developed countries. In Australia, New Zealand (NZ) and the Pacific Region, the disease burden of ARF and RHD amongst Indigenous and Pacific communities remain one of the highest in the world, usually affecting children and young adults. Since a GAS vaccine remains unavailable, the most effective recommended treatment and management strategy to prevent further GAS infections that can lead to ARF and RHD constitute of painful monthly intramuscular injections of Benzathine Penicillin G (BPG). These BPG injections are administered for at least 10 years or more and are referred to as secondary prophylaxis (SP). Due to the pain, formulation and other issues associated with regular BPG injections, adherence to SP remains problematic globally. A new Penicillin that supports better adherence to SP is urgently needed. This work sought to further understand the local context in the Solomon Islands concerning GAS, ARF and RHD. Preliminary findings indicate very high ARF and RHD rates present in the local setting, in addition to issues with access to ARF/RHD prevention measures with BPG. An electronic database to monitor ARF and RHD as a national disease register will be of clinical relevance to the local setting in the Solomon Islands. Research efforts in the Pacific Region contributing towards the generation of a new Penicillin for BPG SP will be of benefit.

Needle temperature and pain perception in the treatment of rheumatic heart disease

Aim: Patients with rheumatic heart disease (RHD) are committed to lifelong secondary prophylaxis with antibiotics. The study was conducted to evaluate the effect of cold needle to decrease the pain associated with this injection. Material and methods: A randomised crossover single-blinded study was conducted among 100 patients receiving penicillin with room-temperature needle and cold needle (0–2oC) in random order. Pain was evaluated using numerical pain rating scale and bio-physiological measures. Results: There was a significant decrease in subjective pain score when cold needle was used as compared to room-temperature needle (3.37 ±1.75 vs 5.58 ±1.68, P≤0.0001). Conclusion: Cold needle decreased pain perception of patients receiving intramuscular injection of benzathine penicillin. Pain-reducing technique may be useful in improving compliance of patients receiving benzathine penicillin.

The Benzathine Penicillin G (BPG) Reformulation Preferences Study - Tonga

Abstract Acute Rheumatic Fever (ARF) is an autoimmune condition caused by untreated Group A Streptococcal (GAS) infection of the upper respiratory tract (and possibly skin). Multiple or severe attacks of ARF can cause cardiac damage, known as Rheumatic Heart Disease (RHD) which remains a significant cause of morbidity and mortality globally and is rare in developed countries. In Australia, New Zealand (NZ) and the Pacific Region, the disease burden of ARF and RHD amongst Indigenous and Pacific communities is one of the highest in the world, usually affecting children and young adults. A GAS vaccine remains years from being available and until then, the most effective recommended preventative measure for ARF requires painful monthly intramuscular injections of Benzathine Penicillin G (BPG) for 10 years or more, known as secondary prophylaxis (SP). Adherence to SP remains a challenge in many settings and improved understanding of barriers and novel approaches to BPG delivery are urgently needed. To create a reformulation of BPG that encourages SP adherence, insight is needed into the reformulation preferences of those with ARF/RHD. This work seeks to explore the experiences and investigate children/teen on SP, family, and healthcare professional and practitioner preferences for potential BPG reformulation characteristics in Tonga. Three software applications will be adapted from pre-developed applications already piloted and pretested, and optimized for use to ensure age, cultural appropriateness and efficient data collection. This is the first time software applications have been successfully developed and utilized to collect qualitative and quantitative data on individual preferences for BPG formulations and dosing regimens in Tonga.

Translating knowledge and raising awareness of Immunology related human disease mechanisms via engagement with the general public and lay audience

Abstract Acute rheumatic fever (ARF) is an autoimmune condition caused by untreated Group A Streptococcal (GAS) infection of the upper respiratory tract (and possibly skin). Multiple or severe attacks of ARF can cause cardiac damage known as rheumatic heart disease (RHD). Effective management for ARF requires painful monthly intramuscular injections of Benzathine Penicillin G (BPG) known as secondary prophylaxis. The goal of secondary prophylaxis is to prevent GAS infections that may lead to the recurrence of ARF. Rates of adherence to secondary prophylaxis are usually low due to the frequency and duration of injection, pain and access to proper and timely healthcare. A less painful and longer acting BPG formulation is urgently needed. Research being undertaken in New Zealand seeks to support global BPG reformulation efforts. The purpose of this work was to support knowledge translation of BPG reformulation research efforts and the associated fundamental Immunology concepts within a public setting. A general public and lay audience outreach event was held through the local university, inviting members of the public to attend. A presentation by a female Pacific Biomedical scientist was offered to support increased knowledge and awareness of emergent rheumatic fever related issues locally and internationally. This event was well attended by the general public. Questions from the audience relating to ARF/RHD dominated, with strong interest expressed in the global efforts to reformulate Penicillin. Additional positive verbal and written feedback was received from those in attendance. This public outreach engagement event supported communication of research findings that was culturally appropriate, clear and meaningful.

The Benzathine Penicillin G (BPG) reformulation preferences study-edging closer towards a new Penicillin for Rheumatic Fever and Rheumatic Heart Disease

Abstract Acute Rheumatic Fever (ARF) is the autoimmune condition triggered by untreated Group A Streptococcal (GAS) infection of the upper respiratory tract (and possibly skin). Severe and recurrent untreated attacks of ARF can cause cardiac damage, known as Rheumatic Heart Disease (RHD). RHD remains a significant cause of morbidity and mortality globally and in Australia, New Zealand (NZ) and the Pacific Region, the disease burden of ARF and RHD amongst Indigenous and Pacific communities is one of the highest in the world, usually affecting children and young adults. The most effective recommended preventative measure for ARF requires painful monthly intramuscular injections of Benzathine Penicillin G (BPG) for 10 years or more. Known as secondary prophylaxis, these injections aim to prevent GAS infections that may lead to recurrence of ARF and either cause or worsen RHD. Adherence to secondary prophylaxis remains a challenge in many settings and improved understanding of barriers and a BPG reformulation that is more appropriate are urgently needed. This work sought to explore the BPG reformulation preferences and perspectives of predominantly Māori and Pacific children/teens in New Zealand currently receiving monthly BPG intramuscular injections, their families and healthcare providers using three software applications developed for this purpose. A total of 82 participants comprised of children/teens, family members and health professionals have thus far participated in this research project. This is the first time software applications have been successfully developed to collect qualitative and quantitative data on individual preferences for BPG formulations and dosing regimens in New Zealand.