Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis

 

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dc.contributor.author Robertson, Katharine en_ZA
dc.contributor.author Volmink, Jimmy en_ZA
dc.contributor.author Mayosi, Bongani en_ZA
dc.date.accessioned 2015-10-12T10:48:12Z
dc.date.available 2015-10-12T10:48:12Z
dc.date.issued 2005 en_ZA
dc.identifier.citation Robertson, K. A., Volmink, J. A., & Mayosi, B. M. (2005). Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovascular Disorders, 5(1), 11. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14161
dc.identifier.uri http://dx.doi.org/10.1186/1471-2261-5-11
dc.description.abstract BACKGROUND:Rheumatic fever continues to put a significant burden on the health of low socio-economic populations in low and middle-income countries despite the near disappearance of the disease in the developed world over the past century. Antibiotics have long been thought of as an effective method for preventing the onset of acute rheumatic fever following a Group-A streptococcal (GAS) throat infection; however, their use has not been widely adopted in developing countries for the treatment of sore throats. We have used the tools of systematic review and meta-analysis to quantify the effectiveness of antibiotic treatment for sore throat, with symptoms suggestive of group A streptococcal (GAS) infection, for the primary prevention of acute rheumatic fever. METHODS: Trials were identified through a systematic search of titles and abstracts found in the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 4, 2003), MEDLINE (1966-2003), EMBASE (1966-2003), and the reference lists of identified studies. The selection criteria included randomised or quasi-randomised controlled trials comparing the effectiveness of antibiotics versus no antibiotics for the prevention of rheumatic fever in patients presenting with a sore throat, with or without confirmation of GAS infection, and no history of rheumatic fever. RESULTS: Ten trials (n = 7665) were eligible for inclusion in this review. The methodological quality of the studies, in general, was poor. All of the included trials were conducted during the period of 1950 and 1961 and in 8 of the 10 trials the study population consisted of young adult males living on United States military bases. Fixed effects, meta-analysis revealed an overall protective effect for the use of antibiotics against acute rheumatic fever of 70% (RR = 0.32; 95% CI = 0.21-0.48). The absolute risk reduction was 1.67% with an NNT of 53. When meta-analysis was restricted to include only trials evaluating penicillin, a protective effect of 80% was found (Fixed effect RR = 0.20, 95% CI = 0.11-0.36) with an NNT of 60. The marginal cost of preventing one case of rheumatic fever by a single intramuscular injection of penicillin is approximately US$46 in South Africa. CONCLUSION: Antibiotics appear to be effective in reducing the incidence of acute rheumatic fever following an episode of suspected GAS pharyngitis. This effect may be achieved at relatively low cost if a single intramuscular penicillin injection is administered. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Cardiovascular Disorders en_ZA
dc.source.uri http://www.biomedcentral.com/1471-2261 en_ZA
dc.subject.other Primary Health Care en_ZA
dc.title Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis en_ZA
dc.type Journal Article en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Primary Health Care Directorate en_ZA
uct.type.filetype Text
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