In many parts of the world, a key antibiotic is out of reach for patients with rheumatic fever or rheumatic heart disease because of supply and quality problems, according to a review published today in Global Heart, a journal of the World Heart Federation.
Infections with group A streptococcus bacteria in the developed world typically lead to common conditions such as “strep throat” or skin infections that usually can be easily treated with antibiotics. But inadequate treatment can lead to the development of more serious conditions, such as rheumatic fever or rheumatic heart disease, which may be life threatening. According to the authors, there are an estimated 471 000 cases of rheumatic fever and 230 000 deaths globally each year, with cases disproportionately concentrated in countries with high poverty rates or in disadvantaged subpopulations in wealthy countries.
For decades, benzathine penicillin G has been an important antibiotic for treating these more serious complications of group A strep infections. (It was also once a first-line treatment for syphilis, yaws, Lyme disease, and the prophylaxis of pneumonia in patients with sickle cell disease, but there are now more treatment options for these conditions.) As rheumatic fever and rheumatic heart disease have become less prevalent in developed countries, the general demand for benzathine penicillin G has declined as new antibiotics emerged. But this has led to growing concerns about the supply of the drug and its availability to populations in need, according to the review authors.
A survey of physicians treating rheumatic fever and rheumatic heart disease in 24 nations in Africa, Asia, and Central and South America, conducted by the World Heart Federation, found that many report limited access to benzathine penicillin G. Shortages have also been reported in North America. The authors also noted concerns about the quality and safety of the supply.
Resolving these issues will take international collaboration, the authors said. “Making this essential medicine available to vulnerable populations is the most important step in reducing death and disability from [rheumatic heart disease],” they said. “Researchers, industry, governments, and communities need to commit to delivering this low-cost, life-changing intervention.”