Penicillin helps treat rheumatic heart disease in children

A regular, affordable antibiotic treatment has been found to significantly reduce the risk of underlying rheumatic heart disease progression in children and adolescents, according to new research. Until this study, it was not known if antibiotics were effective at preventing the progression of latent rheumatic heart disease.

Rheumatic heart disease is caused by damage to the valves of the heart, following a case of Strep throat. It’s considered a disease of poverty and disadvantage, yet Australia has some of the highest rates in the world; the disease disproportionately affects Indigenous Australians, with about 3–5% of those living in remote and rural areas having the condition and children aged between five and 14 years most likely to get rheumatic fever.

The new study, led by the Murdoch Children’s Research Institute (MCRI), Cincinnati Children’s Hospital Medical Center, Uganda Heart Institute and US Children’s National Hospital, is the first contemporary randomised controlled trial in rheumatic heart disease, and involved 818 Ugandan children aged 5–17 years with latent rheumatic heart disease. The participants either received four-weekly injections of penicillin for two years or no treatment. All underwent echocardiography screening, where ultrasound waves produce images of the heart, at the start and end of the trial.

The screenings found that just three (0.8%) participants who received penicillin experienced latent rheumatic heart disease progression, compared to 33 (8.3%) who didn’t receive the treatment. MCRI’s Dr Daniel Engelman said the results, published in The New England Journal of Medicine, showed a significant reduction in disease development that was more substantial than predicated.

MCRI’s Professor Andrew Steer added that screening for latent rheumatic heart disease is critical to stop progression because heart valve damage is largely untreatable. Since children with latent rheumatic heart disease have no symptoms and mild heart valve changes cannot be detected clinically, he said most patients are diagnosed when the disease is advanced and complications have already developed.

“This late diagnosis is associated with a high death rate at a young age, in part due to the missed opportunity to benefit from preventative antibiotic treatment,” Prof Steer said. “If patients can be identified early, there is an opportunity for intervention and improved health outcomes.”

The Uganda Heart Institute’s Dr Emmy Okello said the Ugandan Government should strengthen programs that promote screening of rheumatic heart disease and the availability of penicillin. In 2018, Uganda supported the World Health Organization’s resolution to make the condition a global priority.

“Our study found a cheap and easily available penicillin can prevent progression of latent rheumatic heart disease into more severe, irreversible valve damage that is commonly seen in our hospitals with little or no access to valve surgery,” Dr Okello said.

Image credit: ©stock.adobe.com/au/Adwo

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