Lue H C, Wu M H, Wang J K, Wu F F, Wu Y N
Department of Pediatrics, National Taiwan University Hospital, Taipei.
J Pediatr. 1994 Nov;125(5 Pt 1):812-6. doi: 10.1016/s0022-3476(94)70082-6.
To compare the efficacy of injections of 1.2 million units of benzathine penicillin G given every 3 weeks versus every 4 weeks for secondary prevention of rheumatic fever, based on the long-term outcome of patients receiving such prophylaxis.
A total of 249 consecutive patients with rheumatic fever, randomly assigned to either a 3-week or a 4-week regimen, were examined every 3 to 6 months, and followed for 794 and 775 patient-years, respectively.
Compliance with each regimen was comparable: 83 (66.9%) of 124 patients in the 3-week group versus 92 (73.6%) of 125 patients in the 4-week group stayed in the program (p > 0.05). Streptococcal infections occurred less frequently in those receiving the 3-week regimen: 7.5 versus 12.6 per 100 patient-years (p < 0.01). Prophylaxis failed in 2 patients receiving the 3-week regimen and in 10 receiving the 4-week regimen (0.25 and 1.29 per 100 patient-years respectively; p = 0.015). Serum penicillin levels were adequate (> or = 0.02 micrograms/ml) in 100 (56%) of 179 samples obtained 21 days after penicillin injection in the 3-week regimen, and in 51 (33%) of 155 samples obtained 28 days after injection in the 4-week regimen (p < 0.01). Of 71 patients with mitral regurgitation in the 3-week regimen, 47 (66%) no longer had the murmur; of 87 patients in the 4-week regimen, 40 (46%) no longer had the murmur (p < 0.05).
This 12-year controlled study indicates that the outcome of patients with rheumatic fever is better with a 3-week than with a 4-week penicillin prophylaxis regimen. Greater emphasis and more widespread use of the 3-week regimen should be recommended.
基于接受此类预防治疗患者的长期预后，比较每3周注射120万单位苄星青霉素G与每4周注射一次在风湿热二级预防中的疗效。
总共249例连续的风湿热患者，随机分配至3周或4周治疗方案组，每3至6个月检查一次，分别随访794和775患者年。
各治疗方案的依从性相当：3周治疗组124例患者中有83例（66.9%）、4周治疗组125例患者中有92例（73.6%）坚持治疗（p>0.05）。接受3周治疗方案的患者链球菌感染发生率较低：每100患者年分别为7.5次和12.6次（p<0.01）。3周治疗方案组有2例患者预防治疗失败，4周治疗方案组有10例患者预防治疗失败（分别为每100患者年0.25次和1.29次；p=0.015）。3周治疗方案组在青霉素注射21天后采集的179份样本中有100份（56%）血清青霉素水平充足（≥0.02微克/毫升），4周治疗方案组在注射28天后采集的155份样本中有51份（33%）血清青霉素水平充足（p<0.01）。3周治疗方案组71例二尖瓣反流患者中，47例（66%）杂音消失；4周治疗方案组87例患者中，40例（46%）杂音消失（p<0.05）。
这项为期12年的对照研究表明，风湿热患者采用3周青霉素预防方案比4周方案预后更好。应建议更加强调并更广泛地使用3周治疗方案。
