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February 8, 1965

Prophylaxis of Recurrent Rheumatic Fever: Ineffectiveness of Intermittent "Therapeutic" Oral Penicillin

Author Affiliations

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

JAMA. 1965;191(6):451-454. doi:10.1001/jama.1965.03080060025004

To compare different modes of action of penicillin in preventing recurrences of rheumatic fever, one group of young rheumatic patients received oral penicillin repetitively in high, "therapeutic" dosage for the first ten days of each month, but no "prophylactic" dosage thereafter. The other group received monthly injections of benzathine penicillin, which acts both "therapeutically" to eradicate streptococci during the immediate period after injection, and "prophylactically" for the remainder of the month. The attack rates for streptococcal infections and rheumatic recurrences with the intermittent "therapeutic" oral regimen were significantly higher than the same rates with the injections or with previously tested oral regimens in which low, "prophylactic" doses were given daily throughout the month. The results suggest that both the intermittent "therapeutic" and the continuous "prophylactic" actions of penicillin are needed for the most effective form of antirheumatic prophylaxis.