Which of the following is the drug of choice for chemoprophylaxis against rheumatic fever?

JODHPUR AIIMS SNO-2018

Pharmacology

Easy

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Benzathine penicillin is a long-acting depot formulation that, when given intramuscularly, provides sustained bactericidal levels for 3-4 weeks.
This long duration of action is ideal for secondary prophylaxis of rheumatic fever, as it prevents new Group A streptococcal infections, the trigger for recurrences.
The American Heart Association and WHO recommend it as the regimen of choice due to its proven efficacy and advantage in overcoming non-adherence issues associated with daily oral medications.

Option A: Erythromycin is not the first-line drug of choice. It is a macrolide antibiotic reserved as an alternative for prophylaxis.
Option C: Procaine penicillin is a shorter-acting intramuscular penicillin. Its duration of action is only 12-24 hours, which is insufficient for long-term prophylaxis.
Option D: While Penicillin V is an acceptable alternative, it is not the drug of choice. As an oral medication, it requires twice-daily dosing, making adherence a significant challenge for the long durations required.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological prophylaxis for rheumatic fever helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The nurse's role is critical in ensuring adherence to the prophylactic regimen, which is the single most important factor in preventing recurrent rheumatic fever and subsequent rheumatic heart disease.
Patient and family education about the disease, the purpose of long-term injections, and the risk of non-adherence is a key nursing responsibility.
What if? If a patient on Benzathine penicillin prophylaxis develops a sore throat and fever, the nurse should advise them to see a healthcare provider immediately. While prophylaxis is effective, breakthrough infections can occur and must be treated promptly to prevent a rheumatic fever recurrence.

How to Approach the Question

First, identify the key terms in the question: "drug of choice," "chemoprophylaxis," and "rheumatic fever."
Understand that "chemoprophylaxis" implies long-term prevention, not acute treatment.
For long-term prevention of a recurrent disease, a long-acting medication or a regimen that ensures high compliance is usually preferred.
Evaluate the options. All are antibiotics. Three are forms of penicillin.
Differentiate between the penicillin types: Benzathine is very long-acting (weeks), Procaine is short-acting (hours), and Penicillin V is oral (requiring daily doses).
Conclude that the long-acting formulation, Benzathine penicillin, is the most suitable "drug of choice" for long-term prophylaxis to ensure sustained protection and overcome potential non-adherence with daily pills.

Concept Tested & Keywords

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