The current prophylactic treatment to prevent rheumatic heart disease requires four-weekly intramuscular injection of a suspension of the poorly soluble benzathine salt form of penicillin G (BPG) often for more than 10 years. In seeking to reduce the frequency of administration to improve adherence, biodegradable polymer matrices have been investigated. Poly(lactide-co-glycolide) (PLGA)-based in situ forming precursor systems containing N-methyl-2-pyrrolidone as solvent and PLGA-based monolithic implants for surgical implantation containing BPG were developed. Long-term release studies indicated low and plateaued release of penicillin G, but continual favourable release profiles for the benzathine counterion, indicating degradation of the polymer and generation of acidic microenvironment being detrimental to penicillin stability. In order to avoid the issue of the acidic product, poly(caprolactone)(PCL) implants were also investigated, with favourable penicillin G release behaviour being achieved, and slow release over 180 days. However, when taking into account the mass of polymer, and the total dose of drug calculated from literature pharmacokinetic parameters for penicillin G, we concluded that an implant size of over 7 g would still be required. This may preclude clinical deployment of a polymer matrix type delivery system for this indication in children and adolescents. Therefore, we have learned that biodegradable PLGA-type systems are not suitable for development of sustained release BPG treatments and that although the PCL system provides favourable release behaviour, the total size of the implant may still present a hurdle for future development.
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The authors wish to thank Charlotte Mulder, Errol Malta and Mark Sullivan from Medicines Development Ltd. (MDL) for their helpful discussions on this work. The authors would also like to thank Corbion Purac for providing samples of PLA/PLGA copolymers free of charge.
Jonathan Carapetis and Ben Boyd have received funding from the Telethon New Children’s Hospital Research Fund to explore new formulations of benzathine penicillin G (Grant number: F55541).
Conflict of interest
Jonathan Carapetis and Meru Sheel are investigators on a BPG projected funded by Novartis Institutes for BioMedical Research. Rosemary Wyber has provided technical advice to Pfizer on BPG but has not received funding.
The original version of this article was revised: Jürgen B. Bulitta’s name was misspelled in the original version of the article.
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Montagnat, O.D., Webster, G.R., Bulitta, J.B. et al. Lessons learned in the development of sustained release penicillin drug delivery systems for the prophylactic treatment of rheumatic heart disease (RHD). Drug Deliv. and Transl. Res. 8, 729–739 (2018). https://doi.org/10.1007/s13346-018-0482-z
- Rheumatic fever
- Sustained release
- Drug delivery
- Therapeutic implant