Abstract
Introduction
Acute rheumatic fever (ARF) is an immune mediated reaction against Group A Streptococcus (GAS). In Australia, Aboriginal and Torres Strait Islander people are disproportionately affected, with some of the highest rates of ARF in the world. BPG is effective for secondary prophylaxis, although significant variance in plasma concentrations are well documented. Variability in penicillin levels in Australian Aboriginal children receiving BPG has not been assessed previously. We undertook a six-month prospective observational study, in an urban cohort through a tertiary paediatric hospital to gather data on plasma penicillin levels and anti-streptolysin O titres (ASOT).
Objectives
To develope a robust population pharmacokinetic model of BPG, based on plasma penicillin levels collected using dried blood spot (DBS) technology and assess for breakthrough infection
Methods
Participants aged 5-21, currently receiving regular Bicillin L-A® injections for ARF and/or RHD were identified by clinic staff and referred to the study team nurse. Throat swabs were routinely collected prior to 4-weekly Bicillin L-A® injections and additional swabs were obtained if a participant developed symptoms throughout the study. DBS were collected at Day 0,1,3,6,12,21 during intensive months and Day 0 +/- 21 during surveillance (4 of 6) months.
Results
16 of 20 participants provided full data sets for analysis, a total of 273 DBS were collected for analysis of penicillin G levels and ASOT. There were eight episodes of symptomatic sore throat. There were four positive throat cultures, no GAS was cultured.
Conclusion
We did not find any evidence of GAS breakthrough infection, the data from this observational study will be used to develop a population pharmacokinetic model, specific to Aboriginal populations, assisting in reformulation of a more tolerable long acting penicillin.
Acute rheumatic fever (ARF) is an immune mediated reaction against Group A Streptococcus (GAS). In Australia, Aboriginal and Torres Strait Islander people are disproportionately affected, with some of the highest rates of ARF in the world. BPG is effective for secondary prophylaxis, although significant variance in plasma concentrations are well documented. Variability in penicillin levels in Australian Aboriginal children receiving BPG has not been assessed previously. We undertook a six-month prospective observational study, in an urban cohort through a tertiary paediatric hospital to gather data on plasma penicillin levels and anti-streptolysin O titres (ASOT).
Objectives
To develope a robust population pharmacokinetic model of BPG, based on plasma penicillin levels collected using dried blood spot (DBS) technology and assess for breakthrough infection
Methods
Participants aged 5-21, currently receiving regular Bicillin L-A® injections for ARF and/or RHD were identified by clinic staff and referred to the study team nurse. Throat swabs were routinely collected prior to 4-weekly Bicillin L-A® injections and additional swabs were obtained if a participant developed symptoms throughout the study. DBS were collected at Day 0,1,3,6,12,21 during intensive months and Day 0 +/- 21 during surveillance (4 of 6) months.
Results
16 of 20 participants provided full data sets for analysis, a total of 273 DBS were collected for analysis of penicillin G levels and ASOT. There were eight episodes of symptomatic sore throat. There were four positive throat cultures, no GAS was cultured.
Conclusion
We did not find any evidence of GAS breakthrough infection, the data from this observational study will be used to develop a population pharmacokinetic model, specific to Aboriginal populations, assisting in reformulation of a more tolerable long acting penicillin.
Original language | English |
---|---|
Pages (from-to) | 519-520 |
Number of pages | 2 |
Journal | Global Heart |
Volume | 13 |
Issue number | 4 |
DOIs | |
Publication status | Published - 2018 |