Abstracts
Journal: Annals of the Rheumatic Diseases (1950)

A study of the effect of oral penicillin in preventing recurrences of rheumatic fever was carried out on 126 children in a special school in Chicago for cases of rheumatic heart disease.The subjects were divided into two groups, comparable as to sex, race, age, and economic level, one being used as a control.A further control group of eighty children at another similar school were selected in the same manner but were not in contact with those undergoing prophylactic treatment.Penicillin was given in the hope that it might be possible thus to eliminate haemolytic streptococci and so to prevent or lower the incidence of rheumatic fever.For the former purpose, throat swabs from all the groups of children were examined at intervals during the course of treatment.At the end of 4 months' treatment with 50,000 units of penicillin twice daily, throat swabs showed no improvement in the treated group.As it was thought that this dosage might be causing penicillin-resistance in the organisms the dosage of penicillin was changed to 1 mega unit daily for 5 days, repeated five times in the school year.This was found to cause a maximum reduction in streptococci in throat swabs from the treated children lasting for at least 3 weeks after the short course.As a result, in the third year of the experiment, treat- ment was given in the first week of each calendar month throughout the school year and consisted of 200,000 units four times, or 250,000 units thrice daily for 7 days.With this dosage the penicillin-treated group showed a consistently lower infection rate than did the control group from the same school.Owing probably to the lessened cross-infection risk, the latter group showed a markedly lower infection rate than did the group from the second school, in which the rate was similar, on the one occasion of comparison, to the rate among children in an ordinary school.The recurrence rate of rheumatic fever in each of the 3 years remained steady at about 20 per cent. in the school where there was no prophylaxis.In the school with prophylaxis the rate among those given penicillin was consistently less than in the control group, though of doubtful significance in the first and second years.In the third year, however, there were no recurrences among the treated children, as compared with 11 per cent.among the untreated.This is regarded as a highly promising result.During the second and third years, while penicillin was being given in larger doses for short periods, there was no evidence of the development of penicillin resistance among haemolytic streptococci of groups A, B, or C, in a total of 274 strains examined.Reginald St. A. Heathcote. 93per cent.Of the 350 cases without clinical activity there was correlation in 98-1 per cent. of Weltmann reactions and in 85-9 per cent. of E.S.R. estimations.Statistical analysis of these figures proved that a dis- proportionately large number of those estimations of the E.S.R. showing a discrepancy were confined to a few patients.When 22 patients with four or more abnormal readings of the E.S.R. were excluded, the correlation became 92-2 per cent.No persistent discrepancies with the Weltmann reaction were noted.The authors conclude that the Weltmann reaction is of great value in the assessment of activity of the rheumatic process, especially when there is no correlation between the E.S.R. and the clinical opinion.[It is perhaps unfortunate that the authors have used as one of their yardsticks their own modification of the Cutler technique, the test they describe being almost a 260 by copyright.