Chances are you’ve heard of penicillin: it is the main antibiotic used to treat rheumatic fever (RF), and in fact was the very first antibiotic used in the history of medicine! Today we’ll explore how penicillin’s appropriate and timely use can prevent simple RF from developing into potentially fatal heart disease.
How was penicillin discovered?
It’s an interesting story! Penicillin was discovered in 1928 in London by Dr. Alexander Fleming, who had just returned from vacation and was confronted with the messy lab he’d left behind. He found that a dirty dish in the sink containing the bacteria staph aureus was open, and a blue-green mold had formed in it. Fleming performed further research on the mold, penicillium notatum, and discovered that its presence had inhibited the growth of the staph aureus bacteria. Fleming realized this mold could become one of the most powerful inventions in medical history – a drug to fight infections.
Penicillin was used widely in World War II, where the number of deaths from bacterial pneumonia consequently fell to fewer than 1% of cases, compared to 18% in World War I. Though newer antibiotics have been developed since, penicillin is still widely used for many diseases.
How is penicillin used to treat RF?
All patients with acute RF require antibiotic treatment to reduce the risk of spreading streptococcal virus.
Primary treatment is given upon confirmation of strep throat infection. A single injection of penicillin is the most effective treatment in eradicating the bacteria (streptococci); oral penicillin is then continued for 10 days.
Secondary treatment is a critical step in management of acute RF. Depending on the diagnosis, penicillin can be given as an injection once every four weeks, or as a daily oral tablet.
- If rheumatic fever is present with carditis (inflammation of the heart) and residual heart disease, penicillin is given for life.
- If rheumatic fever is present with carditis but without residual heart disease other than mild mitral regurgitation, penicillin is given for 10 years after diagnosis, or until the age of 25 years.
- If rheumatic fever is present without carditis, penicillin is given for five years after diagnosis, or until the age of 18-21 years.
Can patients develop an allergy to penicillin?
Yes. In 1% of users, allergic reactions are seen, usually in the form of hives, wheezing, and swelling, particularly of the face. Life-threatening allergy, however, is observed in only 0.03 % of cases. Any allergic reaction should be evaluated immediately by the doctor.
Are there alternatives to penicillin in case of allergy?
Yes; two examples your doctor may prescribe are oral sulfonamide or erythromycin.
Under what conditions should penicillin not be used?
Penicillin may be avoided when conditions like breastfeeding, bleeding disorders, cystic fibrosis, kidney disease, phenylketonuria, stomach ulcer, or other intestinal diseases exist. When taking penicillin, be sure to discuss with your doctor the use of drugs like oral contraceptives, other antibiotics, methotrexate, metronidazole, and tinidazole.
Can a patient drink alcohol while taking penicillin?
It is advisable that penicillin users do not drink alcohol, as it can alter the effectiveness of the drug and worsen the side effects.
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