Clinical application of benzathine penicillin G as secondary prophylaxis and vaccines for patients with acute rheumatic fever and rheumatic heart disease: A comprehensive review

Acute Rheumatic fever (ARF) is caused by an abnormal immune reaction to group A streptococcal infection which appears after 2-3 weeks, high fevers, and chorea form movements that impair activities of daily living. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF which can cause stroke, heart failure and atrial fibrillation are common complications of RHD. Secondary prophylaxis with antibiotics is recommended for people after their initial episode of rheumatic fever to prevent recurrent group A streptococcal infections, recurrences of rheumatic fever, and progression to rheumatic heart disease. Secondary antibiotic prophylaxis is the cornerstone of the management of rheumatic fever and rheumatic heart disease. Although ARF and RHD are arguably the most preventable of all cardiovascular diseases, they continue to pose a significant threat to world health, and adherence to suggested secondary prophylaxis regimens is a problem everywhere. Benzathine penicillin G is the first-line antibiotic for secondary prophylaxis, delivered intramuscularly every 2 to 4 weeks for both ARF and RHD. In this review, the definition, epidemiology, risk factors, and pathophysiology of ARF and RHD were each covered independently. Also, we discussed the challenges and clinical utilization of Benzathine Penicillin G as primary and secondary prophylaxis for ARF and RHD.