Problems associated with the use of antibiotics for the prevention of primary episodes of rheumatic fever

• Published in: The American journal of cardiology Vol. 5; no. 6; pp. 777 - 780
• Main Authors: Saslaw, Milton S., Jablon, James M., Jenks, Sallie Anne
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.1960
• Subjects: Anti-Bacterial Agents - therapy; Biomedical Research; Child; Humans; Infant; Old Medline; Rheumatic Fever - prevention & control; Streptococcal Infections; STREPTOCOCCAL INFECTIONS/in infancy and childhood; RHEUMATIC FEVER/prevention and control; ANTIBIOTICS/therapy
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(60)90055-2

Based on the concept that the prevention of rheumatic fever can be attained by the early eradication of infection with the group A beta hemolytic streptococcus, the current program was devised to help evaluate its efficacy in the prevention of initial attacks of rheumatic disease. In a school with an average daily enrollment of 824, each absent child had his throat swabbed on the initial day of absence if the illness was of respiratory origin. On identification of beta hemolytic streptococci in the throat culture, the family and/or physician was notified, and antistreptococcal treatment was suggested. The investigation revealed that such an attempt to prevent rheumatic fever (1) was prohibitively costly; (2) encountered obstacles in obtaining cooperation from the lay public; (3) indicated lack of uniformity in attitude to therapy by different physicians; (4) demonstrated problems in bacteriologic technics; (5) posed difficulties in communication; and (6) ran the risk of inaccurate statistical appraisal. Because of the difficulties encountered, we believe any program of prevention of primary attacks of rheumatic fever by use of antibiotics is impractical on a community service basis and at the present time should be reserved for research only. Although primary attacks of rheumatic fever cannot yet be handled as a community-wide project, the secondary prevention program, as advocated by the American Heart Association, 5 is strongly urged, especially for those areas where rheumatic fever is known to occur frequently. According to this program, all known persons who have had one or more attacks of rheumatic fever should receive prophylactic antibiotic therapy indefinitely.