Rheumatic fever, prophylaxis

Sulfadiazine, a sulfonamide antibiotic, is used in rheumatic fever prophylaxis, as an alternative to penicillin, as an adjunctive regimen in treatment of toxoplasmosis, and in uncomplicated attacks of malaria (see also Figure 90). 

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

Benzathine benzylpenicillin is a depot form of benzylpenicillin, mainly indicated for prophylaxis against rheumatic fever. 

Prophylaxis against relapses of rheumatic fever (secondary prevention of rheumatic heart disease) is discussed in Section II of this chapter. In most developed countries, national vaccination programs with vaccines against diphteria and Haemophilus influenzae type b have virtually eliminated the complications of diphteria and acute epiglottitis. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

Sulfadiazine and sulfisoxazole still play a useful role in the prophylaxis of group A streptococcal infections in patients with rheumatic fever who are hypersensitive to penicillin. This is tempered with the potential for toxicity and infection with resistant Streptococcus pyogenes. 

Bone infections, prophylaxis of rheumatic fever, follow-up to parenteral therapy PO... 

Penicillins are also used in the prophylaxis of rheumatic fever, sexually transmitted diseases e.g. gonorrhoea and syphilis and bacterial endocarditis. 

It is used in tonsillitis, otitis media, erysipelas, prophylaxis of rheumatic fever and pneumococcal infections. 

The International Rheumatic Fever Study, a prospective multicenter study that recorded allergic reactions, defined as hypotension, dyspnea, pruritus, urticaria, angioedema, arthralgia, and maculopapular rash in 1790 patients treated with monthly intramuscular benzathine penicillin for prophylaxis of rheumatic fever (32 430 injections during 2736 patient years). There was a 3.2% case incidence of allergic reactions and a 0.2% case incidence of anaphylaxis (12/100000 injections), including one death (0.05%, equivalent to 3.1/ 100000 injections) (233). 

International Rheumatic Fever Study Group. Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. Lancet 1991 337(8753) 1308-10. 

Penicillin is the drug of choice for the prophylaxis of recurrences of rheumatic fever. Erythromycin is an effective alternative for individuals who are allergic to penicillin. 

Penicillin, a naturally occurring antibiotic, is indicated in the treatment of group A streptococcal upper respiratory infections, prophylaxis of poststreptococcal rheumatic fever, syphihs of less than one year s duration, moderate to severe systemic infections, uncomphcated gonorrhea, pneumococcal pneumonia, and endocarditis prophylaxis for dental surgery (see Table 23). 

Prior to 1997, erythromycin was an alternative antibiotic choice to amoxicillin for prophylaxis prior to dental, oral, esophageal, and respiratory procedures to prevent infective endocarditis (IE). Erythromycin is an alternative choice for treating a recurrence of acute rheumatic fever in patients allergic to penicillin [12]. Recently updated recommendations by the American Heart Association for IE... 

Used as a prophylactic agent for rheumatic fever, 150 mg roxithromycin taken once daily was found to be a suitable alternative to penicillin and erythromycin [179]. In neutropenic patients with acute leukemia and in bone marrow transplant recipients receiving ofloxacin prophylaxis, the addition of roxithromycin resulted in less bacteremia due to viridans group streptococci (0% vs. 9% in ofloxacin alone). However, incidences of bacteremia caused by other organisms, febrile episodes from any cause, infection-associated complications, and antimicrobial usage for therapy were similar between the two groups [180]. 

The oral administration of 200,000 units of penicillin G or penicillin V every 12 hours markedly decreases the incidence of recurrences of rheumatic fever in susceptible individuals. Intramuscular injection of 1.2 million units of penicillin G benzathine once monthly also yields excellent results. Because acute rheumatic fever has been observed in the fifth decade, some advocate that prophylaxis should be continued for life. 

Infedions due to susceptible microorganisms, philis prophylaxis of rheumatic fever or chorea Infedions due to susceptible organisms Infedions due to susceptible... 

Resistance to sulfonamides is now common for N. meningitidiSy as well as in cases of bacillary dysentery. Antibiotics have generally replaced the sulfonamides for these purposes. Sulfonamides, particulady sulfisoxazole and sulfadiazine, are of value in treatment of infections due to Nocardia species, and sulfonamides are effective for trachoma. Inclusion conjunctivitis is also treated with sulfacetamide ointment. Oral administration of a sulfonamide, eg, sulfisoxazole, has been successful for treatment of lymphogranuloma venereum and chancroid Dapsone and sulfonamides have also been used for treatment of the skin disorder dermatitis herpetiformis. Sulfonamides have been used for long term prophylaxis of rheumatic fever, but are being replaced by penicillin for this purpose, except in cases of hypersensitivity to penicillin (19). 

It is effective against most coccus infections. It is better tolerated than sulfanilamide or sulfathiazole. In fact, it is as potent as sulfathiazole and possesses fewer side reactions. It has also been used in the treatment of chancroid due to Haemophilus ducreyi. It may also be used for the prophylaxis of recurrences of rheumatic fever. 

Sulfadiazine Competes with PABA (para amino benzoic acid) for incorporation into folate. When sulfonamide becomes incorporated, it inhibits enzymes (Fig. 7.14). Susceptibie bacteria rely on self-produced folate, while human cells are able to utilize exogenous foiate. Broad spectrum covers both Gram-positives and Gram-negatives. Infrequently used for treatment of uncomplicated urinary tract infections, nocardiasis, chancroid, prophylaxis against rheumatic fever. 

Natural penicillin Infections like streptococcal pneumonia, enterococcal and nonenterococcal group D endocarditis, diphtheria, anthrax, meningitis, tetanus, botulism, actinomycosis, syphilis, and relapsing fever, Lyme disease prophylaxis against pneumococcal infections, rheumatic fever, bacterial endocarditis... 

At the present time, the largest use of sulfonamide antibacterials is as urinary antiseptics, e.g. those caused by E. coli and Proteus mirabilis. They are also used in treating nocardiosis (of lungs or foot), trachoma (eye), lymphogranuloma venereum, dermatitis herpatiformis, and valued for the prophylaxis of streptococcal infections in those prone to them, and in preventing recurrence of rheumatic fever. 

Rheumatic fever has been controlled in the western world by a vigorous program of primary and secondary prophylaxis, particularly in susceptible communities but the ravages of subtle infections and uncontrolled epidemics in the third world countries makes scarred valves a common problem in adult life. Valve repair is usually inadequate, since valvular tissue is thickened, fibrosed and often calcified pericardium, dacron and dura mater are inadequate valve tissue substitutes, while homograft and heterograft valves have not proved durable. There is the need for new durable and pliable plastic substances to replace valve tissue, substances that do not need anticoagulants or subsequent replacement. 

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