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October 14, 1968

Prophylaxis of Recurrent Rheumatic Fever: Therapeutic-Continuous Oral Penicillin vs Monthly Injections

Author Affiliations

From Irvington House, New York; and the departments of medicine of the West Haven (Conn) Veterans Administration Hospital, New York University School of Medicine, New York, and Yale University School of Medicine, New Haven, Conn.

JAMA. 1968;206(3):565-568. doi:10.1001/jama.1968.03150030021004

For preventing recurrences of rheumatic fever, a repetitive oral penicillin regimen was planned to mimic the action of monthly injections of long-acting penicillin G benzathine. The oral regimen (TCP) contained a therapeutic high level dose for the first ten days of each month, and a continuous low level dose for the remainder of the month. In 343 young rheumatic patients, observed during four calendar years, the group receiving injections had a streptococcal infection attack rate of 6.6 per 100 patient-years, and a rheumatic recurrence rate of 0.6%. For patients receiving TCP, the corresponding rates were 22.7% and 4.8%; these rates were higher than the injection rates even when assessed in a subgroup of patients who maintained TCP with excellent fidelity. The TCP results were not significantly different from those of previously tested oral regimens, in which lower doses of penicillin were used.