Underuse of Injectable Penicillin in Secondary Prophylaxis of Rheumatic Heart Disease in Nepal

Background and Aims: Secondary prophylaxis has remained the mainstay of rheumatic fever and rheumatic heart disease management. Despite the proven efficacy and superiority of injectable penicillin in rheumatic heart disease patients, it has been underused in Nepal. Materials and Methods: This is a hospital based cross-sectional study during June 2014 to October 2018 over a period of 52 months at College of Medical Sciences-Bharatpur including 350 patients with clinical and/or echocardiographic evidence of definite rheumatic heart disease. Data was collected from both cardiology outpatients and inpatients (admitted in cardio ward/coronary care unit). Relevant data and information were entered into the pre-structured proforma and then analyzed by SPSS-16 software. Results: The age of the patients ranged from 6 to 80 years with mean age 36.76±4.6years with female preponderance (F:M=1.26:1). The predominantly involved isolated valve was mitral in 152 patients (44.43 %) followed by aortic valve in 70 patients (20.00 %) and rest 90 (25.71 %) had dual valvular involvement. The common complications encountered were heart failure in 200(57.14 %) and arrhythmias in 155(44.29 %) patients. Two hundred ten (60.00 %) of the patients received penicillin (oral and injectable) and erythromycin. Majority (180/210=85.71 %) were prescribed on oral penicillin whereas only 46/210=21.90 % received injectable penicillin; the ratio being 3.35:1. Conclusion: RHD is a leading cause of heart failure and death among young population. There is underuse of penicillin with very minimal focus on use of injectable penicillins currently. Hence, Nepal government and other non-governmental organizations should consider implementation of use of penicillin broadly and moreover focus on use and adherence of injectable penicillin. *Correspondence: Dr. Shankar Laudari, MD, DM, FESC, FACC Cardiology, Consultant Cardiologist, Department of Cardiology, College of Medical Sciences-TH, Bharatpur, Nepal, Tel: 977-9845112909. Received: 20 November 2020; Accepted: 02 December 2020