Penicillin and Rheumatic Heart Disease

A publication discussing the risk of penicillin injections in people with Rheumatic Heart Disease is being released this week.

A group of clinical experts, led by Auckland and Counties Manukau Paediatric Infectious Diseases specialist Dr Rachel Webb, wrote this report. 

The report directly responds to a 2022 statement which was issued by the American Heart Association (AHA).  The AHA now recommends that people with severe Rheumatic Heart Disease have oral antibiotic prophylaxis instead of monthly penicillin injections, after a small number of case reports were received overseas, of people with end-stage Rheumatic Heart Disease who collapsed after receiving intramuscular penicillin. 

Dr Rachel Webb says: “We’ve since looked into this issue in detail to consider the impact on the Rheumatic Fever control programme in New Zealand, where there are several thousand people on the penicillin injections.

“Consultation occurred with Medsafe and with colleagues working across the sector.

“Circumstances in New Zealand are very different. All people have access to specialist medical and cardiac care, including cardiac surgery. Only a very small minority have severe heart damage. 

“We have a world-leading penicillin programme for people with Rheumatic Fever and Rheumatic Heart Disease, and penicillin injections are given by highly trained nurses. “

In New Zealand, says Dr Webb, we use a brand of injectable penicillin called LA-bicillin that is not used outside of Australasia, as it is more expensive. MedSafe, the national drug safety monitoring system, has not received any reports of sudden collapses immediately following injections of LA-bicillin.

Dr Webb says: “Our conclusion is that in New Zealand, penicillin injections remain the preferred option and there are no grounds to change practice at this time. 

“The best way for people with Rheumatic Fever or Rheumatic Heart Disease to protect their heart is to keep up with their injections every four weeks.”

She says close monitoring of Rheumatic Heart Disease patients will continue, but in the meantime, patients and their families can be reassured.

In the meantime, individuals with RHD who may have questions, are advised to consult with a trusted health provider (GP, paediatrician, physician or cardiologist experienced in RHD management.)

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