Role of throat penicillin producing organisms in recurrence of rheumatic carditis

ABSTRACT

Sixty two rheumatic carditis patients two had previously one or more attacks of rheumatic fever, documented by the revised Jones criteria, were followed up for 2 years. Patients were subjected to strict prophylactic regimen of 4 and 2 weekly injection of Benzathine penicillin [BPG] during the first and second year respectively. Throat swabs were taken just before the injection and on suspicion of throat Streptococcal infections. The isolated organism [Staphylococcus aureus, H. lnfluenzae and Bacteroides species] were tested for beta-Lactamase production. Serum penicillin potency was assayed at the end of second, third and fourth week after penicillin injection. Repeated throat cultures revealed frequent association of both group A beta-hemolytic Streptococcal and penicillinase producing organism from the patients having higher rates of recurrence [P<0.001 and P<0.01 for first and second year respectively, the results also showed that adequate serum penicillin activity does not mean throat free of group A beta-hemolytic Streptococci and beta-Lactamase producing organisms [P>0.05]. From these results we can conclude that pharyngeal beta-Lactamase, producing organism can protect group A beta-hematolytic Streptococci from the lethal effect of penicillin, even if take in a regular frequent regimen. By turn this will lead to failure of penicillin prophylaxis and recurrence of rheumatic carditis. It is thus evident that throat swab is essential for detecting these organisms in every patient with subsequent use of beta-Lactamase resistance drugs either as a therapy or a prophylaxis