Poster Presentation 20th Lancefield International Symposium on Streptococci and Streptococcal Diseases 2017

The duration of rheumatic fever prophylaxis in adults in greater Auckland, New Zealand. (#226)

Briana Northey 1 , Diana Lennon 1 , Briar Peat 1
  1. University Of Auckland, Auckland, New Zealand

Rheumatic Fever (RF) remains a significant health problem in New Zealand with Maori and Pacific peoples most affected. Recurrent episodes are preventable with regular injectable penicillin prophylaxis. Recommendations for the duration of prophylaxis vary internationally.

This project reviewed the indications for duration of prophylaxis in patients over the age of 21 years in Auckland and to compare practice with the New Zealand Guidelines (2014).

303 patients were identified from clinical records. Patients were predominantly Pacific by ethnicity (71%), domiciled in one district health board (CMH, 66%) and Dep 7 or above (87%). 32% of patients had had at least one episode of cardiac surgery and 11% of the un-operated group had severe cardiac disease. Considerable variation was found in the recommendations for duration of prophylaxis from the standard 10 years to lifelong. Adherence was problematic in this age group. 10% of patients with no or mild disease were either waiting for discharge or could have been discharged according to the NZ Guidelines. Most variation in duration of prophylaxis occurred in patients with moderate or severe cardiac disease or previous valve surgery. The New Zealand Guidelines are inconsistent in their recommendations for duration of prophylaxis for these patients. Adults receiving prophylaxis for rheumatic fever on average have more severe disease than children.

Systems need to support adherence to prophylaxis and ensure timely discharge for patients. Research is required to determine the appropriate duration of prophylaxis for patients with un-operated moderate or severe cardiac disease or previous cardiac surgery.