In a new study, penicillin significantly reduces the risk of underlying rheumatic heart disease progression in children and adolescents.
The research also showed that early screening was critical for preventing serious rheumatic heart disease progression and death in young children. Rheumatic heart disease affects 40.5 million people globally, causing 306 000 or more deaths every year. The chronic disease results from damage to the valves of the heart after a case of Strep throat. It’s considered a disease of poverty and disadvantage.
Associate Professor Andrea Beaton of Cincinnati Children’s Hospital Medical Center said that prior to this study, it was unknown if antibiotics were effective at preventing the progression of latent rheumatic heart disease.
“The trial is the first contemporary randomised controlled trial in rheumatic heart disease. The results are incredibly important on their own, but also demonstrate that high-quality clinical trials are feasible to address this neglected cardiovascular disease,” she said.
The trial involved 818 Ugandan children aged 5 to 17 years with latent rheumatic heart disease, who received either four-weekly injections of penicillin for two years or no treatment. All underwent echocardiography screening at the beginning and end of the trial.
The findings from the screenings, published in the New England Journal of Medicine, reported just three (0.8%) participants who received penicillin experienced latent rheumatic heart disease progression, compared to 33 (8.3%) who didn’t receive the treatment.
Dr Daniel Engelman of Murdoch Children’s Research Institute (MCRI) said the results showed a significant and greater than expected reduction in disease development.
MCRI Professor Andrew Steer said screening for latent rheumatic heart disease was critical to stop progression because heart valve damage was largely untreatable.
“Children with latent rheumatic heart disease have no symptoms and we cannot detect the mild heart valve changes clinically,” he said.
“Currently, most patients are diagnosed when the disease is advanced, and complications have already developed. This late diagnosis is associated with a high death rate at a young age, in part due to the missed opportunity to benefit from preventative antibiotic treatment. If patients can be identified early, there is an opportunity for intervention and improved health outcomes.”
Uganda Heart Institute Dr Emmy Okello said the Ugandan government should strengthen programs that promote screening of rheumatic heart disease and the availability of penicillin.
“Our study found a cheap and easily available penicillin can prevent progression of latent rheumatic heart disease into more severe, irreversible valve damage that is commonly seen in our hospitals with little or no access to valve surgery,” Dr Okello said.
