Mal use of long acting penicillin among schoolchildren

ABSTRACT

For more than five decades since benzathine penicillin G has been the gold standard for secondary prophylaxix of rheumatic fever. It remains the unique and has withstood the test of time. This study was designed to verify the use of benzathine penicillin G [Long acting penicillin] for cases of rheumatic fever among schoolchildren at El-Mahalla El-Kobra Province, Gharbia Governorate. It was conducted at two communities [one urban and one rural] during a period of five months from December 2004 up to the end of April 2005. A multistage random sampling was used to select both areas and schools [primary and preparatory] being studied. All children used long acting penicillin [LAP] at the studied schools were included at the study. The required data was collected through filling a pre-designed questionnaire sheet by direct interview, clinical examination together with measurement of antistreptolycin O titer [ASO] and erythrocyte sedimentation rate [ESR] to verify the importance of these test in diagnoses of acute rheumatic fever and continuation of long acting penicillin prophylaxis. Out of 4904 schoolchildren, a total of 220 children representing 44.9/1000 reported long acting penicillin intake. Their mean age was 12.3 +/- 1.9 years. The results reflected the overuse of LAP where; Females constituted 76.4% and atypical presentations reported by 65.9%, mostly knee/or leg pain [66.9%]. Residence has no significant effect on sex [p=0.216], first presentations [p=0.076] and level of ASO titer [p= 0.574], ESR; 1[st] hour [p=0.073] and 2[nd] hour [p=0.288]. On the other hand, first presentations were significantly affected by age [p=0.04] and sex [p=0.015]. Residence and type of first presentations had no significant effect on continuation of LAP intake continuation; Also, the results revealed mal use of LAP where; 26.7% of children with typical presentations discontinued their prophylaxis and 60.7% of those had atypical presentation continue LAP intake. Children with typical presentations had significantly higher levels of ASO [p=0.018] and ESR; 1[st] hour [p=0.026] and 2[nd] hour [p=0.048] at the initial presentations. This difference between typical and atypical presentations disappeared by time. Thus, ASO titer and ESR tests can help in diagnosis of the initial attack of rheumatic fever but, they are not suitable indicators for continuation of rheumatic fever prophylaxis