Lue H C, Wu M H, Wang J K, Wu F F, Wu Y N
Department of Pediatrics, National Taiwan University Hospital, Taipei.
Pediatrics. 1996 Jun;97(6 Pt 2):984-8.
To investigate the effects of 3-week versus 4-week administration of benzathine penicillin G (BPG) on the incidence of Group A streptococcal infections and the recurrences of rheumatic fever (RF).
We started, in 1979, randomly allocating all patients with RF to a 3-week or 4-week BPG prophylaxis program. They were examined at the RF clinic, every 3 to 6 months, and at any time they did not feel well. During 1979 to 1989, throat cultures and sera for antistreptolysin O and streptozyme titers were obtained at each clinic visit. Chest radiographs, electrocardiogram, color Doppler echocardiograms, and acute phase reactants were obtained.
Two hundred forty-nine patients fulfilled the revised Jones criteria and were followed until December 1991: 124 in the 3-week and 125 in the 4-week program. Their age, sex, weight, percentage with history of RF, severity of cardiac involvement, follow-up duration, and compliance to program were comparable. Eight hundred eighty throat cultures were collected in the 3-week program and 770 were collected in the 4-week program. Six hundred sixteen and 627 sera were determined in each program for antistreptolysin O, and 582 and 592 sera for streptozyme titers.
True streptococcal infections occurred in both programs: 39 infections in the 3-week program, and 59 infections in the 4-week program (7.5 vs 12.7 per 100 patient-years). Four infections with no antibody response occurred in the 3-week program, and three such infections in the 4-week program. Nine RF recurrences occurred in 8 patients in the 3-week program, and 16 recurrences in 16 patients in the 4-week program. Prophylaxis failure occurred in 2 of 124 patients in the 3-week program, and in 10 of 125 patients in the 4-week program (0.25 vs 1.29 per 100 patient-years). The overall recurrences/infections rate in each program was comparable, 13.6% vs 15.5%, but the recurrences/ infections rate due to prophylaxis failure was higher in the 4-week program than in the 3-week program, 3.0% versus 9.7%.
This 12-year prospective and controlled study documented that streptococcal infections and RF recurrences occurred more often in the 4-week program than in the 3-week program. The risk of prophylaxis failure was fivefold greater in the 4-week program than in the 3-week program.
探讨苄星青霉素G（BPG）3周给药方案与4周给药方案对A组链球菌感染发病率及风湿热（RF）复发率的影响。
1979年起，我们将所有RF患者随机分配至3周或4周BPG预防方案组。患者每3至6个月在RF门诊接受检查，身体不适时随时检查。1979年至1989年期间，每次门诊就诊时均采集咽拭子培养物以及抗链球菌溶血素O和链激酶效价的血清样本。同时进行胸部X线检查、心电图检查、彩色多普勒超声心动图检查以及急性期反应物检测。
249例患者符合修订的琼斯标准，并随访至1991年12月：3周方案组124例，4周方案组125例。两组患者的年龄、性别、体重、RF病史比例、心脏受累严重程度、随访时间以及方案依从性均具有可比性。3周方案组共采集880份咽拭子培养物，4周方案组共采集770份。两组分别检测了616份和627份血清的抗链球菌溶血素O效价，以及582份和592份血清的链激酶效价。
两个方案组均发生了真正的链球菌感染：3周方案组39例感染，4周方案组59例感染（每100患者年分别为7.5例和12.7例）。3周方案组4例感染无抗体反应，4周方案组3例。3周方案组8例患者发生9次RF复发，4周方案组16例患者发生16次复发。3周方案组124例患者中有2例预防失败，4周方案组125例患者中有10例预防失败（每百患者年分别为0.25例和1.29例）。每个方案组的总体复发/感染率相当，分别为13.6%和15.5%，但4周方案组因预防失败导致的复发/感染率高于3周方案组，分别为3.0%和9.7%。
这项为期12年的前瞻性对照研究表明，4周方案组的链球菌感染和RF复发比3周方案组更常见。4周方案组预防失败的风险是3周方案组的5倍。
