Oral penicillin, not injectable, advised for people with high-risk rheumatic heart disease (It minimizes heart/“allergy” effects)

Medical Xpress / American Heart Association / Journal of the American Heart Association ^ | Jan. 20, 2022 | Andrea Z. Beaton, M.D. et al

[ConservativeMind]

A growing body of evidence indicates that some people thought to have an allergic response to injectable penicillin, the standard treatment for rheumatic heart disease, may instead be experiencing a cardiac reaction to the medicine. The advisory suggests oral penicillin may be a safer option for people with rheumatic heart disease who are at high risk of a cardiac reaction.

Treatment with BPG for RHD has been limited in part due to patients' and clinicians' fears of a severe allergic reaction called anaphylaxis, even though the risk of anaphylaxis following BPG injection is low.

"Until recently, deaths within the minutes and hours after BPG injection have been assumed to be due to anaphylaxis," said Chair Amy E. Sanyahumbi. "However, a growing number of reports of BPG-related deaths did not have the features of classic anaphylaxis, and, instead, point to cardiovascular reactions. This distinction is important, as it indicates the need for different strategies to prevent or stop these reactions to BPG."

Signs of a cardiovascular response often occur immediately after administration of BPG, sometimes even during injection. They include low blood pressure… On the other hand, signs of anaphylaxis after BPG injection are usually slightly delayed after the injection, even up to an hour later, and include coughing...

The advisory suggests that people who are at low risk of cardiovascular reaction and who do not have a history of being allergic to penicillin or anaphylaxis be prescribed BPG for treatment and prevention of RHD. BPG has proven to be the best treatment for prevention of recurrent rheumatic fever. For people with higher cardiovascular risks such as severe valvular heart disease or heart failure, treatment with oral penicillin should be strongly considered.

[ConservativeMind]

Please be sure to share this out to people you know who are impacted.

Their doctor likely doesn’t read every new study.

[ConservativeMind]

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[Skywise]

Feels like a dose “intensity” issue. I bet the oral doses aren’t as concentrated in the blood stream.