Optimising usage of the current formulation of benzathine penicillin G for rheumatic fever prevention

Joe Kado

doi:10.26182/pyj0-mk43

Optimising usage of the current formulation of benzathine penicillin G for rheumatic fever prevention

Joe Kado

UWA Medical School

Research output: Thesis › Doctoral Thesis

32 Downloads (Pure)

Abstract

This thesis uses pharmacokinetics to investigate the opportunity that subcutaneous delivery offers for secondary prophylaxis (SP) of rheumatic heart disease. Adherence to 4-weekly intramuscular injections of 1.2MU benzathine benzylpenicillin (BPG) is suboptimal. We explore opportunities for improving SP options including route, frequency, and dosing. A series of population pharmacokinetic studies and laboratory investigations, show subcutaneous delivery safety and acceptability. We demonstrate the feasibility, safety, and acceptability of larger doses of BPG, allowing less frequent dosing in lieu of longer-acting alternatives, and offer theoretical considerations for other dosing strategies. This research uses pharmacokinetic evidence to inform practice guideline changes andopportunities for patient-centric SP.

Original language	English
Qualification	Doctor of Philosophy
Awarding Institution	The University of Western Australia
Supervisors/Advisors	Carapetis, Jonathan, Supervisor Manning, Laurens, Supervisor Salman, Sam, Supervisor
Award date	14 Feb 2025
DOIs	https://doi.org/10.26182/pyj0-mk43
Publication status	Unpublished - 2025

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10.26182/pyj0-mk43

THESIS - DOCTOR OF PHILOSOPHY - KADO Joseph Hiroshi Hisanasuke - 2024_
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13 Article
1 Editorial

2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease
Rwebembera, J., Marangou, J., Mwita, J. C., Mocumbi, A. O., Mota, C., Okello, E., Nascimento, B., Thorup, L., Beaton, A., Kado, J., Kaethner, A., Kumar, R. K., Lawrenson, J., Marijon, E., Mirabel, M., Nunes, M. C. P., Piñeiro, D., Pinto, F., Ralston, K. & Sable, C. & 9 others, Sanyahumbi, A., Saxena, A., Sliwa, K., Steer, A., Viali, S., Wheaton, G., Wilson, N., Zühlke, L. & Reményi, B., Apr 2024, In: Nature Reviews Cardiology. 21, 4, p. 250-263 14 p.
Research output: Contribution to journal › Article › peer-review
41 Citations (Scopus)
Could late-latent syphilis be treated with a single subcutaneous infusion of long-acting penicillin?
Hla, T. K., Salman, S., Kado, J., Moore, B. R. & Manning, L., 26 Mar 2024, In: Sexual Health. 21, 2, 2 p., SH24003.
Research output: Contribution to journal › Editorial › peer-review

Open Access
2 Citations (Scopus)
"Hurts less, lasts longer"; a qualitative study on experiences of young people receiving high-dose subcutaneous injections of benzathine penicillin G to prevent rheumatic heart disease in New Zealand
Cooper, J., Enkel, S. L., Moodley, D., Dobinson, H., Andersen, E., Kado, J. H., Barr, R. K., Salman, S., Baker, M. G., Carapetis, J. R., Manning, L., Anderson, A. & Bennett, J., 14 May 2024, In: PLoS One. 19, 5, 11 p., e0302493.
Research output: Contribution to journal › Article › peer-review

Open Access
3 Citations (Scopus)

Cite this

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title = "Optimising usage of the current formulation of benzathine penicillin G for rheumatic fever prevention",

abstract = "This thesis uses pharmacokinetics to investigate the opportunity that subcutaneous delivery offers for secondary prophylaxis (SP) of rheumatic heart disease. Adherence to 4-weekly intramuscular injections of 1.2MU benzathine benzylpenicillin (BPG) is suboptimal. We explore opportunities for improving SP options including route, frequency, and dosing. A series of population pharmacokinetic studies and laboratory investigations, show subcutaneous delivery safety and acceptability. We demonstrate the feasibility, safety, and acceptability of larger doses of BPG, allowing less frequent dosing in lieu of longer-acting alternatives, and offer theoretical considerations for other dosing strategies. This research uses pharmacokinetic evidence to inform practice guideline changes andopportunities for patient-centric SP.",

keywords = "Benzathine penicillin G, subcutaneous injection, high-dose subcutaneous infusion, pharmacokinetics, secondary prophylaxis, rheumatic fever, Rheumatic heart disease",

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N2 - This thesis uses pharmacokinetics to investigate the opportunity that subcutaneous delivery offers for secondary prophylaxis (SP) of rheumatic heart disease. Adherence to 4-weekly intramuscular injections of 1.2MU benzathine benzylpenicillin (BPG) is suboptimal. We explore opportunities for improving SP options including route, frequency, and dosing. A series of population pharmacokinetic studies and laboratory investigations, show subcutaneous delivery safety and acceptability. We demonstrate the feasibility, safety, and acceptability of larger doses of BPG, allowing less frequent dosing in lieu of longer-acting alternatives, and offer theoretical considerations for other dosing strategies. This research uses pharmacokinetic evidence to inform practice guideline changes andopportunities for patient-centric SP.

AB - This thesis uses pharmacokinetics to investigate the opportunity that subcutaneous delivery offers for secondary prophylaxis (SP) of rheumatic heart disease. Adherence to 4-weekly intramuscular injections of 1.2MU benzathine benzylpenicillin (BPG) is suboptimal. We explore opportunities for improving SP options including route, frequency, and dosing. A series of population pharmacokinetic studies and laboratory investigations, show subcutaneous delivery safety and acceptability. We demonstrate the feasibility, safety, and acceptability of larger doses of BPG, allowing less frequent dosing in lieu of longer-acting alternatives, and offer theoretical considerations for other dosing strategies. This research uses pharmacokinetic evidence to inform practice guideline changes andopportunities for patient-centric SP.

KW - Benzathine penicillin G

KW - subcutaneous injection

KW - high-dose subcutaneous infusion

KW - pharmacokinetics

KW - secondary prophylaxis

KW - rheumatic fever

KW - Rheumatic heart disease

U2 - 10.26182/pyj0-mk43

DO - 10.26182/pyj0-mk43

M3 - Doctoral Thesis

ER -

Optimising usage of the current formulation of benzathine penicillin G for rheumatic fever prevention

Abstract

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Research output

2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease

Could late-latent syphilis be treated with a single subcutaneous infusion of long-acting penicillin?

"Hurts less, lasts longer"; a qualitative study on experiences of young people receiving high-dose subcutaneous injections of benzathine penicillin G to prevent rheumatic heart disease in New Zealand

Cite this