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Evidence summaries

Penicillin for Secondary Prevention of Rheumatic Fever

Intramuscular penicillin may have limited effect in preventing rheumatic fever recurrence and streptococcal throat infections. Level of evidence: "C"

A Cochrane review [Abstract] 1 assessed the effects of penicillin compared to placebo and the effects of different penicillin regimens and formulations for preventing streptococcal infection and rheumatic fever recurrence. Nine studies were included (n=3 008). Three trials (n=1 301) compared penicillin with control. Only one of three studies showed that penicillin reduced rheumatic fever recurrence (RR 0.45, 95% CI 0.22 to 0.92) and streptococcal throat infection (RR 0.84, 95% CI 0.72 to 0.97). Four trials (n=1 098) compared intramuscular with oral penicillin and all showed that intramuscular penicillin reduced rheumatic fever recurrence and streptococcal throat infections compared to oral penicillin. One trial (n=360) compared 2-weekly with 4-weekly intramuscular penicillin. Penicillin given every two weeks was better at reducing rheumatic fever recurrence (RR 0.52, 95% CI 0.33 to 0.83) and streptococcal throat infections (RR 0.60, 95% CI 0.42 to 0.85). One trial (n=249) showed that 3-weekly intramuscular penicillin injections reduced streptococcal throat infections (RR 0.67, 95% CI 0.48 to 0.92) compared to 4-weekly intramuscular penicillin.

Comment: The quality of evidence is downgraded by poor study quality and by inconsistency (variability in results across studies).

    References

    • Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever. Cochrane Database Syst Rev 2002;(3):CD002227 [Last assessed as up-to-date: 28 June 2009]. [PubMed]

Primary/Secondary Keywords