Publication:

Revolutionizing rheumatic heart disease prevention: the potential of high-dose subcutaneous benzathine penicillin G: a narrative review

Rheumatic heart disease (RHD) is a severe, chronic condition arising from acute rheumatic fever (ARF), a complication of untreated group A - Streptococcus infections. RHD results in progressive damage to the heart valves, leading to significant morbidity and mortality. While RHD has declined in high-income countries due to effective prophylaxis, it remains a major health issue in developing regions. Approximately 15 million people worldwide are affected by RHD, impacting quality of life and healthcare systems. This narrative review evaluates the efficacy and safety of high-dose subcutaneous benzathine penicillin G (BPG) injections as a preventive strategy for RHD. Traditionally administered intramuscularly, the review explores the subcutaneous route’s benefits. Subcutaneous BPG is effective in preventing ARF recurrences and managing RHD progression. It maintains therapeutic penicillin levels over extended periods, potentially reducing injection frequency. This method is associated with less pain and improved patient adherence compared to intramuscular injections. However, subcutaneous BPG administration has challenges. Adverse effects, such as allergic reactions and anaphylaxis, though infrequent, require careful management. Consistent drug supply is also essential. Future research should explore innovative delivery methods, such as implantable devices or transdermal systems, to further improve patient outcomes. In conclusion, high-dose subcutaneous BPG injections offer a promising option for RHD prophylaxis, combining efficacy with a favorable safety profile. Addressing administration and side effect challenges is crucial for optimizing treatment effectiveness.