PO648 Benzathine Penicillin G pharmacokinetics in a predominately Australian Aboriginal adolescent population, a prospective observational study

R.M. Hand, A. Bowen, L. Manning, S. Salman, J. Joseph, D. Sika-Paotonu, K. Gray, V. Dolman, J. Marsh, J. Ramsay, M. Page-Sharp, K.T. Batty, J. Carapetis

Research output: Contribution to journalAbstract/Meeting Abstract

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.
Original languageEnglish
Pages (from-to)519-520
Number of pages2
JournalGlobal Heart
Volume13
Issue number4
DOIs
Publication statusPublished - 2018

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Penicillin G Benzathine
Penicillins
Observational Studies
Pharmacokinetics
Streptococcus
Prospective Studies
Pharynx
Population
Injections
Pediatric Hospitals
Penicillin G
Rheumatic Fever
Pharyngitis
Tertiary Care Centers
Nurses
Technology
Infection
streptolysin O

Cite this

Hand, R.M. ; Bowen, A. ; Manning, L. ; Salman, S. ; Joseph, J. ; Sika-Paotonu, D. ; Gray, K. ; Dolman, V. ; Marsh, J. ; Ramsay, J. ; Page-Sharp, M. ; Batty, K.T. ; Carapetis, J. / PO648 Benzathine Penicillin G pharmacokinetics in a predominately Australian Aboriginal adolescent population, a prospective observational study. In: Global Heart. 2018 ; Vol. 13, No. 4. pp. 519-520.
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title = "PO648 Benzathine Penicillin G pharmacokinetics in a predominately Australian Aboriginal adolescent population, a prospective observational study",
abstract = "IntroductionAcute 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).ObjectivesTo develope a robust population pharmacokinetic model of BPG, based on plasma penicillin levels collected using dried blood spot (DBS) technology and assess for breakthrough infectionMethodsParticipants aged 5-21, currently receiving regular Bicillin L-A{\circledR} 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{\circledR} 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.Results16 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.ConclusionWe 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.",
author = "R.M. Hand and A. Bowen and L. Manning and S. Salman and J. Joseph and D. Sika-Paotonu and K. Gray and V. Dolman and J. Marsh and J. Ramsay and M. Page-Sharp and K.T. Batty and J. Carapetis",
year = "2018",
doi = "10.1016/j.gheart.2018.09.503",
language = "English",
volume = "13",
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PO648 Benzathine Penicillin G pharmacokinetics in a predominately Australian Aboriginal adolescent population, a prospective observational study. / Hand, R.M.; Bowen, A.; Manning, L.; Salman, S.; Joseph, J.; Sika-Paotonu, D.; Gray, K.; Dolman, V.; Marsh, J.; Ramsay, J.; Page-Sharp, M.; Batty, K.T.; Carapetis, J.

In: Global Heart, Vol. 13, No. 4, 2018, p. 519-520.

Research output: Contribution to journalAbstract/Meeting Abstract

TY - JOUR

T1 - PO648 Benzathine Penicillin G pharmacokinetics in a predominately Australian Aboriginal adolescent population, a prospective observational study

AU - Hand, R.M.

AU - Bowen, A.

AU - Manning, L.

AU - Salman, S.

AU - Joseph, J.

AU - Sika-Paotonu, D.

AU - Gray, K.

AU - Dolman, V.

AU - Marsh, J.

AU - Ramsay, J.

AU - Page-Sharp, M.

AU - Batty, K.T.

AU - Carapetis, J.

PY - 2018

Y1 - 2018

N2 - IntroductionAcute 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).ObjectivesTo develope a robust population pharmacokinetic model of BPG, based on plasma penicillin levels collected using dried blood spot (DBS) technology and assess for breakthrough infectionMethodsParticipants 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.Results16 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.ConclusionWe 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.

AB - IntroductionAcute 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).ObjectivesTo develope a robust population pharmacokinetic model of BPG, based on plasma penicillin levels collected using dried blood spot (DBS) technology and assess for breakthrough infectionMethodsParticipants 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.Results16 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.ConclusionWe 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.

U2 - 10.1016/j.gheart.2018.09.503

DO - 10.1016/j.gheart.2018.09.503

M3 - Abstract/Meeting Abstract

VL - 13

SP - 519

EP - 520

JO - Global Heart

JF - Global Heart

SN - 1875-4562

IS - 4

ER -