Rheumatic heart disease affects 40.5 million people globally and is detected in the early, latent stage on echocardiography. It was previously unknown whether secondary antibiotic prophylaxis was effective in its progression.

Results from a Ugandan randomized, controlled trial in 799 children and adolescents 5 to 17 years of age were recently published in the NEJM. Participants were randomly assigned to receive either injections of penicillin G benzathine (also known as benzathine benzylpenicillin) every 4 weeks for 2 years or no prophylaxis. The primary outcome was echocardiographic progression of latent rheumatic heart disease at 2 years.

A total of 3 participants (0.8%) in the prophylaxis group had echocardiographic progression at 2 years, as compared with 33 (8.2%) in the control group, showing that children and adolescents 5 to 17 years of age with latent rheumatic heart disease, secondary antibiotic prophylaxis reduced the risk of disease progression at 2 years. 

The full paper can be read on the NEJM website (subscription) or a summary can be read on Medscape (requires registration, which is free).