ArticleJournal of the American Heart Association2022
Penicillin Reactions in Patients With Severe Rheumatic Heart Disease: A Presidential Advisory From the American Heart Association.
Article in Journal of the American Heart Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Severe adverse reactions to benzathine penicillin G in rheumatic heart disease: A systematic review and meta-analysis.PloS one · 2025Pooled it
- Penicillin Allergy Testing and Delabeling for Patients Who Are Prescribed Penicillin: A Systematic Review for a World Health Organization Guideline.Clinical reviews in allergy & immunology · 2024Pooled it
- Implications for sustaining secondary prophylaxis for rheumatic heart disease in Ethiopia: Uptake and determinants in a multicentre cross-sectional study.PLoS neglected tropical diseases · 2026Article
- Medical, interventional, and surgical management of rheumatic heart disease.Lancet regional health. Americas · 2026Review
- Clinical application of benzathine penicillin G as secondary prophylaxis and vaccines for patients with acute rheumatic fever and rheumatic heart disease: A comprehensive review.International journal of cardiology. Congenital heart disease · 2026Review
- Acute rheumatic fever and rheumatic heart disease.Nature reviews. Disease primers · 2026Review
- Article
- Stakeholders Want a Menu of Choices: Findings from a Consultation Workshop on Improving Access to Secondary Prophylaxis of Rheumatic Fever and Rheumatic Heart Disease.Global heart · 2026Article
- Implementing the World Health Organization Guidelines for Rheumatic Heart Disease in Highly Endemic Settings: Balancing Evidence with Reality.Global heart · 2026Review
- Direct Single-Dose Drug-Provocation Test Is Safe for Delabelling Penicillin Low-Risk Reactions in Adults.Allergy · 2025Article
- Integrating secondary prevention of rheumatic heart disease into the primary healthcare system in Northern Uganda.BMJ global health · 2025Article
- Acceptability and Implementation Challenges of Benzathine Penicillin G Secondary Prophylaxis for Rheumatic Heart Disease in Ethiopia: A Qualitative Study.Global heart · 2025Article
- 2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease.Nature reviews. Cardiology · 2024Review
- Sudan's rheumatic fever and rheumatic heart disease guidelines: a simplified approach in an endemic country.Frontiers in cardiovascular medicine · 2024Review
- Article
- Tertiary prevention and treatment of rheumatic heart disease: a National Heart, Lung, and Blood Institute working group summary.BMJ global health · 2023Review
Corrections and comments
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Authors and funding
12 authors at 2 institutions in 1 country.
Funding
Abstract
Secondary antibiotic prophylaxis with regular intramuscular benzathine penicillin G (BPG) is the cornerstone of rheumatic heart disease management. However, there is a growing body of evidence that patients with rheumatic heart disease who have severe valvular heart disease with or without reduced ventricular function may be dying from cardiovascular compromise following BPG injections. This advisory responds to these concerns and is intended to: (1) raise awareness, (2) provide risk stratification, and (3) provide strategies for risk reduction. Based on available evidence and expert opinion, we have divided patients into low- and elevated-risk groups, based on symptoms and the severity of underlying heart disease. Patients with elevated risk include those with severe mitral stenosis, aortic stenosis, and aortic insuffiency; those with decreased left ventricular systolic dysfunction; and those with no symptoms. For these patients, we believe the risk of adverse reaction to BPG, specifically cardiovascular compromise, may outweigh its theoretical benefit. For patients with elevated risk, we newly advise that oral prophylaxis should be strongly considered. In addition, we advocate for a multifaceted strategy for vasovagal risk reduction in all patients with rheumatic heart disease receiving BPG. As current guidelines recommend, all low-risk patients without a history of penicillin allergy or anaphylaxis should continue to be prescribed BPG for secondary antibiotic prophylaxis. We publish this advisory in the hopes of saving lives and avoiding events that can have devastating effects on patient and clinician confidence in BPG.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.