Kassem A S, Madkour A A, Massoud B Z, Zaher S R
Department of Pediatrics, University of Alexandria, Egypt.
Indian J Pediatr. 1992 Nov-Dec;59(6):741-8. doi: 10.1007/BF02859412.
Rheumatic fever is still one of the major public health problems in Egypt and the developing countries. It is characterized by a high tendency to recur following streptococcal infections. The use of long acting penicillin for prophylaxis against strep infections was a good achievement in this field, yet, recurrences have been reported in patients following monthly prophylactic programs. Clinical experience in Alexandria have shown for a long time that giving penicillin every 2 weeks is followed by less recurrences of rheumatic fever. Recently, reports came showing that effective penicillin levels are not maintained except for 2 to 3 weeks after the injection. In the present study, we compared two regimens of prophylaxis with 190 patients in the 2-weekly regimen, and 170 patients in the 4-weekly regimen being followed up for 2 consecutive years. Two hundred and sixty nine streptococcal infections occurred during this period. Although the streptococcal infection rate was equal in both groups, the rheumatic fever recurrence rate and the RF attack rate were significantly higher in the group of patients on the 4-weekly schedule. The results of this study have shown the superiority of the 2-weekly schedule in the adequate control of RF recurrences. We suggest that this schedule should be implemented for secondary prophylaxis of rheumatic fever in Egypt and other areas with severe RF.
风湿热仍是埃及和发展中国家主要的公共卫生问题之一。其特点是链球菌感染后复发倾向较高。使用长效青霉素预防链球菌感染在该领域是一项不错的成果，然而，在采用每月预防方案的患者中仍有复发报告。亚历山大的临床经验长期表明，每2周注射一次青霉素后风湿热复发较少。最近有报告显示，注射后除2至3周外，无法维持有效的青霉素水平。在本研究中，我们比较了两种预防方案，2周方案组有190例患者，4周方案组有170例患者，连续随访2年。在此期间共发生269例链球菌感染。虽然两组的链球菌感染率相同，但4周方案组患者的风湿热复发率和风湿热发作率显著更高。本研究结果表明，2周方案在充分控制风湿热复发方面具有优越性。我们建议，在埃及和其他风湿热严重的地区，应采用该方案进行风湿热的二级预防。
