AHA Issues Advisory for Penicillin Reactions in Patients With Severe RHD

WEDNESDAY, Feb. 2, 2022 (HealthDay News) — For patients with rheumatic heart disease (RHD) at elevated risk for adverse reactions to intramuscular benzathine penicillin G (BPG), the risk may outweigh the theoretical benefit, according to an advisory published online Jan. 20 in the Journal of the American Heart Association.

Noting that secondary antibiotic prophylaxis with regular intramuscular BPG is the cornerstone of RHD management, Amy Sanyahumbi, M.D., from Baylor College of Medicine in Texas, and colleagues issued an advisory relating to concerns that patients with RHD with severe valvular heart disease may be dying from cardiovascular compromise following BPG injections.

Based on symptoms and the severity of underlying heart disease, the researchers divided the patients into low- and elevated-risk groups based on available evidence and expert opinion. Patients with severe mitral stenosis, aortic stenosis, and aortic insufficiency were included as patients with elevated risk, as were those with decreased left ventricular systolic dysfunction and those with no symptoms. The risk for an adverse reaction to BPG, specifically cardiovascular compromise, may outweigh the theoretical benefit for these patients. Oral prophylaxis should be strongly considered in patients with elevated risk. In addition, a multifaceted strategy has been advocated for vasovagal risk reduction in all patients with RHD receiving BPG. All low-risk patients without a history of penicillin allergy or anaphylaxis should continue to be prescribed BPG for secondary antibiotic prophylaxis, as per current guidelines.

“Given this emerging data and the questionable benefit of secondary prophylaxis in severe RHD, we strongly advise the prescription of oral antibiotic prophylaxis, preferably oral penicillin, for patients with RHD at elevated risk,” the authors write.

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