Benzathine penicillin G (BPG) has been in use since the 1950s for treatment of skin infections, bacterial pharyngitis, syphilis and prevention of recurrent episodes of acute rheumatic fever (ARF). Current guidelines recommend BPG every 4 weeks for a minimum of 10 years to prevent the progression to rheumatic heart disease (RHD). Our program of work has the ultimate aims of improving quality, supply and acceptability of existing formulations of BPG, and of developing a novel long-acting penicillin formulation. Some of the substudies in this program include:
Penicillin Levels for Rheumatic Heart Disease - WA Urban Site: This recently completed cohort study involved participants at Princess Margaret Hospital who were prescribed BPG for secondary prophylaxis of RHD. Dry blood spot (DBS) samples & throat swabs were collected from each child. DBS samples were used to measure plasma penicillin levels & group A streptococcal antibody titres immediately prior to BPG administration & at pre-specified time points within each BPG cycle. Throat swabs were also cultured to determine the presence of Strep A infection.
Penicillin Levels for Rheumatic Heart Disease - Darwin Remote Site: This 6-month cohort study was also completed recently involving participants at Danila Dilba Health Service. This study followed the same process and collected the same samples as the urban study above.
Pharmacokinetics of intramuscular versus subcutaneous administration of Benzathine Penicillin G: The results of this trial will assist in:
- Determining if the route of administration of BPG has significant impact on pharmacokinetic properties of the medication.
- Ability to guide clinicians as to whether benzathine penicillin G should be delivered to an IM or SQ site, or either.
- Better understanding whether there is a difference in injection related pain between IM and SQ injections.
- Determining if a future reformulated long-acting penicillin should be delivered preferentially at an intramuscular or subcutaneous site.