Abstract
In 20 children (mean age 12·0±1·7 years) of rheumatic heart disease, serum penicillin was measured by a microbiological assay on days 1, 7, 14, 18, 21, 23, 25 and 28, first following an IM injection of benzathine penicillin 12 lakh units and then after 3 months of regular monthly injections. The serum penicillin levels were 0·653±0·102 units/ml, 0·063±0·019 units/ml and 0·046±0·025 units/ml on days 1, 7 and 14 respectively. These levels were much above minimum inhibitory concentration (MIC) of penicillin (0·03±·005 units) against β-hemolytic streptococci. A precipitous fall in serum penicillin was observed after day 14. As a result of this the penicillin levels reached below MIC much before the end of the third week of injection. These results are similar to those reported by us in adults and contrast strikingly against those reported by western authors. In view of our results we recommend that for secondary prophylaxis of rheumatic fever in children of RHD injections of benzathine penicillin 12 lakh units should be given once every 3 weeks in our country.
Similar content being viewed by others
References
Stollerman GH: Prophylaxis against group A streptococci in rheumatic fever. Use of single monthly injection of benzathine penicillin.New Engl J Med 252 (1955) 787.
Wood GF, Taranta A, Feinstein AR, Epstein TA, Simpson R: Rheumatic fever in children-comparison of 3 prophylaxis regimens in preventing streptococcal infections and rheumatic recurrences,Ann Internal Medicine 60 (1964) 31.
Padmawati S, Arora R: Profile of rheumatic fever and rheumatic heart disease in India. In,Progress in clinical medicine. Ahuja MMS (Ed). second series, Gulab Vazirani for Arnold Heinemann, 1978 p 218.
Prakash K: Proceedings of an Indo-US workshop on rheumatic fever in the 1980's, New Delhi, (Under publication)
Sinha N, Saran RK, Hasan M, Bhatia MC: Rheumatic fever prophylaxis in developing countries—why earlier injections needed.Indian Heart J 35 (1983) 26.
Saran RK, Hasan M, Bhatia MC, Sinha N, Mehrotra A, Jain Sunil. Evaluation of 3 weekly versus 4 weekly regimes of injection benezathine penicillin for prophylaxis of rheumatic fever in our country.Annual project report for Indian Council of Med Res (1982–83).
Grove DC, Randall WA: Microbiologic assay methods for pencillin—cylinder plate method using sarcina lutea as test organism, In,Assay methods of antibiotics-a laboratory manual, Medical Encyclopaedia, New York, 1955 p 14.
Methods for assessment of sensitivity to antimicrobials. In, Bailey and Scott'sDiagnostic microbiology by Finegold SM and Martin WJ, CV Mosby & Co., St. Louis, 1982 p 536.
Stollerman GH, Irvington P, Rusoff JH: Prophylaxis against group A streptococci infection in rheumatic fever patients.JAMA 150 (1952) 1971.
Kaplan EL, Bisno A, Derick W: Prevention of rheumatic fever (AHA committee report).Circulation 55 (1977) 1.
Taranta A: Rheumatic fever and rheumatic heart disease study group. Prevention of rheumatic fever and rheumatic heart disease,Circulation 41 (1970) suppl A1.
Bywaters EGL, Dares AM, Lucas AO, Mendoza F, Moziconnaci P, Nesterov AI, Roy SB, Rutgein in DD, Froment R: Prevention of rheumatic fever,WHO Tech Rep Ser No. 342, WHO Geneva, 1966, p 11.
Sinha N, Saran RK, Hasan M, Mehrotra A, Jain SK, Bhatia MC, Ahuja RC: Benzathine penicillin prophylaxis in juvenile rheumatic heart disease—3 weekly or 2 weekly injections.Indian Heart Journal 36 (1984) 315.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Saran, R.K., Sinha, N., Ahuja, R.C. et al. Serial serum penicillin levels following an injection of benzathine penicillin (12 lakh units) in children of rheumatic heart disease. Indian J Pediatr 53, 99–103 (1986). https://doi.org/10.1007/BF02787079
Issue Date:
DOI: https://doi.org/10.1007/BF02787079