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

dc.contributor.authorRobertson, Katharineen_ZA
dc.contributor.authorVolmink, Jimmyen_ZA
dc.contributor.authorMayosi, Bonganien_ZA
dc.date.accessioned2015-10-12T10:48:12Z
dc.date.available2015-10-12T10:48:12Z
dc.date.issued2005en_ZA
dc.description.abstractBACKGROUND: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.identifier.apacitationRobertson, K., Volmink, J., & Mayosi, B. (2005). Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. <i>BMC Cardiovascular Disorders</i>, http://hdl.handle.net/11427/14161en_ZA
dc.identifier.chicagocitationRobertson, Katharine, Jimmy Volmink, and Bongani Mayosi "Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis." <i>BMC Cardiovascular Disorders</i> (2005) http://hdl.handle.net/11427/14161en_ZA
dc.identifier.citationRobertson, 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.ris TY - Journal Article AU - Robertson, Katharine AU - Volmink, Jimmy AU - Mayosi, Bongani AB - 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. DA - 2005 DB - OpenUCT DO - 10.1186/1471-2261-5-11 DP - University of Cape Town J1 - BMC Cardiovascular Disorders LK - https://open.uct.ac.za PB - University of Cape Town PY - 2005 T1 - Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis TI - Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis UR - http://hdl.handle.net/11427/14161 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14161
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2261-5-11
dc.identifier.vancouvercitationRobertson K, Volmink J, Mayosi B. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovascular Disorders. 2005; http://hdl.handle.net/11427/14161.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentPrimary Health Care Directorateen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Cardiovascular Disordersen_ZA
dc.source.urihttp://www.biomedcentral.com/1471-2261en_ZA
dc.subject.otherPrimary Health Careen_ZA
dc.titleAntibiotics for the primary prevention of acute rheumatic fever: a meta-analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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