Safety and concerns of secondary prophylaxis for rheumatic heart disease with benzathine penicillin: A tertiary care cardiac centre experience

Abstract

Background: Rheumatic Fever (RF) and Rheumatic heart disease (RHD) are common cardiovascular diseases in developing countries. Long-term Benzathine Penicillin G (BPG) injection is being used for secondary prophylaxis of RF/RHD. Although allergic reactions to BPG are rare, there is a lot of fear and hesitancy in administering it. Objective: The objective of this study is to assess the safety of injection BPG used for secondary prophylaxis of RHD. Methods: Patients who had received secondary prophylaxis to RHD at our institute's outpatient department from January 1, 2015 to December 31, 2020, were analysed retrospectively. Results: Among 25,819 injections of BPG given to 2878 patients, eight patients had adverse events. Five patients had anaphylaxis, two had urticaria, and one had vasovagal syncope. Incidence of adverse events was 0.03% of injections and 0.28% of patients. Majority of adverse events were seen in patients more than 18 years (7 out of 8). All were treated successfully and there was no mortality. Conclusions: Life-threatening allergic reactions are very rare in patients on long-term intramuscular BPG for secondary prevention of RHD.

Keywords

• anaphylaxis
• benzathine penicillin g
• rheumatic heart disease
• urticaria