UGANDA – The findings of a large-scale trial completed in Uganda and published in the New England Journal of Medicine, on November 12, has shown that penicillin, a widely available, low-cost antibiotic is effective in treating acute pediatric rheumatic fever and its recurrence.
“Our study found penicillin can prevent progression of latent rheumatic heart disease into more severe, irreversible valve damage that is commonly seen in our hospitals with little or no access to valve surgery,” said chief of Cardiology at the Uganda Heart Institute, Dr Emmy Okello.
“This study is the first large-scale clinical trial to show that early detection coupled with prophylactic treatment of penicillin is feasible and can prevent rheumatic heart disease from progressing and causing further damage to a child’s heart,” she added.
Though widely eradicated in the developed world through the quick and successful treatment of streptococcus bacteria, also known as strep throat, which causes rheumatic fever, the disease remains prevalent in sub-Saharan Africa.
“We know from previous studies that sub-Saharan Africa continues to have the highest numbers of people with rheumatic heart disease, and the highest numbers of people dying from it,” said Craig Sable associate chief of Cardiology at Children’s National Hospital in Washington, DC and co-senior author of the study.
This is the first contemporary randomized controlled trial in rheumatic heart disease. “The results are incredibly important on their own, but also demonstrate that high-quality clinical trials are feasible to address this neglected cardiovascular disease,” said Andrea Beaton, associate professor of Cardiology at Cincinnati Children’s hospital.
The trial nicknamed Gwoko Adunu pa Lutino, which means “protect the heart of a child” enrolled 818 Ugandan children and adolescents aged five to 17 who were diagnosed with latent rheumatic heart disease to see if an injection of penicillin was effective in preventing their heart conditions from worsening.
“There are many challenges with recruitment and retention of trial participants in areas like our study region in Uganda. But it is critical to overcome barriers, because we must study these treatments in those most affected by the condition to understand how they, and others like them, may benefit from the findings,” said Dr Sable.
The study was led by an international panel of pediatric cardiac experts from the Cincinnati Children’s Medical Center, the Uganda Heart Institute and Murdoch Children’s Research Institute in Melbourne, Australia.
Of the 799 participants that completed the trial, those receiving a prophylactic injection of penicillin (399 volunteers) had three participants show evidence of worsened rheumatic heart disease.
In contrast, 33 of the 400 volunteers in the control group, who received no treatment, showed similar progression on echocardiogram results.
The results were shared in a special presentation at the American Heart Association’s Scientific Sessions same day that the findings were published in the New England Journal of Medicine.