[Secondary prophylaxis in rheumatic fever. Oral antibiotic therapy versus benzathine penicillin]

Abstract

Purpose: To detect problems related to secondary prophylaxis of rheumatic fever in the setting out patient follow-up.

Methods: Among 113 pediatric patients admitted with diagnosis of this disease, in a period of five years, we selected 80 records. They were divided in group 1 (60 cases), that only received prescription of benzathine penicillin for prophylaxis and group 2 (20 patients) to whom it was changed from parenteral to oral antibiotics after the detection problems using the first scheme.

Results: In group 1, among 53 who had carditis, 27 (45%) had severe disease; 22 cases (37%) were re-admitted with relapsed carditis following the refusal to use benzathine penicillin. Also, we observed that after discharged 32 (55%) did not return to the out-patient clinic in HUAP. In group 2, from 16 who had carditis, 10 (50%) had severe disease. Only two (10%) did not return to ambulatory control and there was no case of readmission. The difference between the groups was statistically significant. (p < 0.01).

Conclusion: It was very high the percentage of cases that missed the control visits and abandoned the prophylaxis when it was insisted on parenteral penicillin. We should evaluate every case and remember that oral antibiotics might avoid a major problem.