Prophylaxis against group a streptococcal infections in rheumatic fever patients

TLDR: Treatment of the initiating streptococcal pharyngitis with penicillin to prevent the subsequent development of rheumatic fever usually requires repeated intramuscular injections or large orally administered doses of Penicillin for about 10 days, and there would be considerable practical advantage in a prepara¬ tion with which successful treatment of strePTococcal respiratory infection could be obtained by a single intra- muscular injection.

Abstract: There are two effective methods now available for the prevention of rheumatic fever or its recurrences. Prompt and vigorous treatment of the initiating streptococcal infection with one of the antibiotic drugs may prevent the complication of rheumatic fever, or the maintenance of continuous antibiotic therapy in the rheumatic subject may prevent recurrences by affording protection against infection by group A streptococci.1 Penicillin promises to be the antibiotic of choice for the prevention of rheumatic fever by either of the above methods for several reasons: its action is bactericidal rather than bacteriostatic 2; the streptococcal pharyngeal carrier state is eliminated most effectively by treatment with adequate doses of penicillin 3; strains of group A streptococci resistant to penicillin have not emerged, despite the widespread use of this drug 4; and fatal or serious toxic reactions are relatively rare. The problem of employing penicillin as a prophylactic agent is largely a practical one. Current methods for maintaining continuous prophylaxis with penicillin in¬ volve oral administration of relatively large doses, once to three times daily, with the patient in the fasting state.le The success of such treatment depends largely on the pa¬ tient's strict adherence to this regimen without interrup¬ tion. In addition, only a fraction (about one-fifth) of the dose of penicillin administered is absorbed and the oral route is, consequently, costly and wasteful. Parenteral administration of available repository procaine penicillin preparations has not been employed for continuous pro¬ phylaxis because of the frequency with which injections would be required. If, however, penicillin could be main¬ tained in the tissues for protracted periods by means of single injections given at infrequent intervals, parenteral administration should prove economical and practical. Treatment of the initiating streptococcal pharyngitis with penicillin to prevent the subsequent development of rheumatic fever usually requires repeated intramuscular injections or large orally administered doses of penicillin for about 10 days." In routine medical practice, bacterio¬ logical confirmation of the streptococcal etiology of pharyngitis is rarely obtained, and penicillin often is not administered for an adequate period. There would, there¬ fore, be considerable practical advantage in a prepara¬ tion with which successful treatment of streptococcal respiratory infection could be obtained by a single intra¬ muscular injection. Recently, a new repository penicillin compound was synthesized that provides detectable levels of penicillin in the blood of humans for prolonged periods following single intramuscular injections.7 N,N' dibenzylethylenediamine dipenicillin G ("bicillin") is a sparingly soluble