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). When the penicillin concentration wanes, the individual’s susceptibility 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 such as injection refusal, pain caused by injections or a 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)