Trends in rheumatic fever: clinical aspects and perspectives in prophylactic treatments.
BACKGROUND
Rheumatic fever (RF), a systemic illness that may occur following Group A beta-hemolytic streptococcal (GABHS) pharyngitis in children, is a major problem in countries with limited resources. Because of its long track record and low cost, an injection of benzathine penicillin G (BPG) suspension every 3 or 4 weeks has been used as secondary prophylaxis. Despite its excellent in vitro efficacy, the inability of BPG to eradicate GABHS has been frequently reported.


METHODS
This work reviews the possible causes of failure, as well as the inconvenience of the current prophylactic treatment of acute RF and suggests a new pharmacotherapeutic system that could replace the current one.


CONCLUSIONS
RF is a major problem concerning only countries with limited resources and could be considered as a neglected disease. The dose regimen using BPG suspension results in failures, which could be avoided by the use of nanocarrier-based systems. To meet this ultimate goal, the research should be transposed from the laboratory scale to an industrial and clinical application level. This research should be conducted to produce a pharmaceutical dosage form that will be commercially available, consumed by and affordable for patients. However, health, environmental and socioeconomic hazards should be considered.
Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Rua Cel. Gustavo Cordeiro de Farias, s/n, Petrópolis, CEP 59010-180, Natal-RN, Brazil.
Kattya Gyselle
KG
De Holanda E Silva
Gillian
G
Barratt
Anselmo Gomes
AG
De Oliveira
Eryvaldo Socrates Tabosa
ES
Do Egito
D000208:Acute Disease; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D004334:Drug Administration Schedule; D016503:Drug Delivery Systems; D006801:Humans; D010401:Penicillin G Benzathine / Q000627:therapeutic use*; D012213:Rheumatic Fever / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D013297:Streptococcus pyogenes / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine