Secondary prophylaxis

People with acute rheumatic fever (ARF) and/or rheumatic heart disease (RHD) are given regular antibiotics to prevent future group A streptococcus (Strep A) infections. This is referred to as ‘secondary prophylaxis’. This reduces the risk of developing ARF again and prevents developing or worsening RHD. The most effective antibiotic is benzathine benzylpenicillin G (BPG) which is administered as an intramuscular injection. For people who are unable to use intramuscular penicillin, oral antibiotics may be offered. Secondary prophylaxis with regular BPG is the only RHD control strategy shown to be both clinically and cost effective at community and individual levels (Webb et al. 2015; Wyber & Carapetis 2015; RHDAustralia 2020) and needs to be complemented with other primordial and primary prevention activities to eliminate RHD.

Benzathine benzylpenicillin G treatment recommendations

BPG is routinely recommended every 28 days to maintain prolonged, low-level benzylpenicillin concentrations. A 21-day antibiotic regimen may be considered by a medical specialist for a small proportion of patients who have breakthrough ARF despite receiving the 28-day regimen, or are at high risk of adverse consequences if ARF reoccurs. The regimen lasts 5 to 10 years, depending on cardiac involvement or not, or until age 21, whichever comes later (RHDAustralia 2020).

In New South Wales, details of patients prescribed or administered prophylaxis are recorded on the register only if they have consented to be included. At 31 December 2022, 44% (37 people) of First Nations patients had consented to have their prophylaxis data recorded on the register (Supplementary Table 4.6a). This means the NSW data are not comparable to data from the other 4 jurisdictions and are reported separately below. Due to the COVID-19 pandemic, NSW was not able to consistently follow-up with all providers of secondary prophylaxis in 2021 and 2022, so adherence in those years may be under-reported.