Secondary prophylaxis

Secondary prophylaxis with regular benzathine penicillin G (BPG) is the only RHD control strategy shown to be both clinically and cost effective at community and individual levels (RHD Australia 2012). The recommended regimen to prevent recurrences of ARF and progression of RHD involves regular intramuscular injections of BPG every 21 to 28 days, for a minimum of 10 years. This treatment aims to provide penicillin in the blood over a period of 3 to 4 weeks, providing protection against GAS infections (Wyber 2013). As the penicillin concentration wanes, the individual’s susceptibility to subsequent GAS infection and to recurrent ARF will increase. 

Delivery of BPG every 28 days is challenging for health services, affected individuals and their families. In remote Indigenous communities, a major factor contributing to low levels of prophylaxis delivery is the availability and acceptability of health services. Personal factors include such as injection refusal, pain caused by injections. Lack of knowledge and understanding of ARF and RHD may negatively influence adherence to secondary prophylaxis but are often not the major contributing factors (Parnaby & Carapetis 2010).


Parnaby M & Carapetis J 2010. Rheumatic fever in Indigenous Australian children. Journal of Paediatrics and Child Health 46:527–33.

RHD Australia (ARF/RHD writing group), National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand 2012. The Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edn). Northern Territory: RHD Australia, Menzies School of Health Research.

Wyber R, Taubert K, Marko S & Kaplan EL 2013. Benzathine penicillin G for the management of RHD, concerns about quality and access, and opportunities for intervention and improvement. Global Heart 8(3):227–234.