Study finds hope in penicillin treatment for children with latent rheumatic heart disease

Penicillin prophylaxis could have a positive, regressive effect on young patients diagnosed with latent rheumatic heart disease (RHD), one study of Ugandan children has found.

The study, led by Andrea Beaton, MD, and published in the American Heart Association’s journal Circulation, focused on a cohort of 227 Ugandan children with latent RHD—164 cases that were classified as borderline, and 63 classified as definite. Of the 63, Beaton’s team identified 42 mild and 21 moderate-to-severe cases of the heart condition in the children, who were an average age of 12 at the time.

RHD is the most common heart disease in people under the age of 25, the World Heart Federation reports. If untreated, the condition can lead to comorbidities like stroke, heart valve damage, heart failure and mortality, but in young children usually first presents itself as strep throat. While, according to the WHF, RHD is “virtually eliminated” in Northern America and Europe, it’s still common in underdeveloped regions like the Middle East, Africa, the South Pacific and Central and South Asia. In these areas, it’s hard to find access to the costly surgeries required to treat RHD, let alone the cost of the treatment itself.

Beaton and co-authors wrote in their study that screening echocardiography (echo) has become a powerful tool for early diagnosis of RHD. The team used echo to analyze the rate of RHD progression in the study population, as well as the effectiveness of penicillin prophylaxis in improving the patients’ outcomes.

Penicillin treatment was prescribed to nearly 50 percent of the study group, Beaton and colleagues wrote, with an overall adherence rate of 84.7 percent. Echos were reviewed by experts, who found unfavorable results in children with moderate-to-severe definite RHD. Of that subgroup, 47.6 percent saw echo progression, including two fatalities. Just 9.5 percent saw regression.

Children with mild definite and borderline RHD received more positive results. Twenty-six percent and 9.8 percent of mild definite and borderline cases, respectively, still showed echo progression, but 45.2 percent and 46.3 percent saw echo improvement.

Beaton’s team also found that younger patients, more advanced disease category and morphological mitral valve features were all risk factors for unfavorable results.

“Children with moderate-to-severe latent RHD have poor outcomes,” Beaton and co-authors wrote. “Children with both borderline and mild definite RHD are at substantial risk of progression. While long-term outcome remains unclear, the initial change in latent RHD may be evident during the first one to two years following diagnosis. Natural history data is inherently limited and a randomized clinical trial is needed to definitively determine the impact of penicillin prophylaxis on the trajectory of latent RHD.”