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Taking penidure injection for 12 years. Advised to take it forever. Having occassional jointpain. Continue injection?

Hi, I am 35 Year old now. I am taking penidure injection on every 3 weeks from last 12 years as per Doctor instruction.And doctor informed to continue this injection for life time. I had started this injection after the attack of Rhumetic fever . Now I am facing the joint pain issue once in a while. Please let me know, if it is safe to continue this injection? Any alternate if I need to stop this.
Asked On : Sun, 24 Feb 2013
Answers:  1 Views:  482
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Critical Care Specialist 's  Response
Dear patient , the duration of antimicrobial prophylaxis for rheumatic fever in the form of penidura-la injection third weekely after an attack of rheumatic fever depends up on three main things,
1 wheather the intial or subsequent episode of rheumatic fever was associated with rheumatic carditis or not
2 wheather the patient had developed rheumatic heart disease in the form of valvular lessions or not
3 what is the risk of patient of contacting streptococcal (Group A) infection , this depends upon socioeconomic status of the patient, wheather the patient lives in over crowded conditions, wheather he or she has small kids who can have streptococcal infection in their throat, wheather the patient has increased risk of exposure through his or her profession in schools, military or hospital settings
It is recommended that if a patient has an attack of rheumatic fevr associated with rheumatic carditis and residual disease in the form of rheumatic heart disease ,then he or she should receive antimicrobial prophylaxis in the form of penidura-la third weekely for 10 years or up to the age of 40 years, which ever comes later after the last attack. If the patient had rheumatic fever associated with rheumatic carditis but no rheumatic heart disease then he/she should receive antimicrobial prophylaxis for 10 years 0r up to the age of 21 years ,which ever comes later after the last attack. Finally if a patient had rheumatic fever with out rheumatic carditis and rheumatic heart disease then he/she should receive antimicrobial prophylaxis for 5 years or up to the age of 21 years , which ever comes later after the last attack . Now in your case i don't know wheather you have rheumatic heart disease or not and wheather your last attack of rheumatic fever was associated with carditis or not ,so it is difficult to say for how long should you continue it but as you say that you still continue to have joint pains now and rhen , it means that your last attack of rheumatic fever is not too far in the past unless joint pain is attributed to some other cause other than rheumatic fever and also keeping in veiw the consequences of rheumatic fever upon heart which is generally described by the famous qoutation that rheumatic fever licks the joints but bites the heart , it will be justified for you to continue with the prophylaxis even if your doctor says it is required for life long . There are alternative oral medicatins available for prophylaaxis like azithromycin, clindamycin. cephaclor ,cephalixin and sulphadiazine but their efficasy is not as good as intramuscular penidura-la ,more over they need to be taken on daily bases , so compliance becomes difficult , cause mor gastric up set and diarrhoea and are not suited for life long use, hence you better continue with penidura-la only
Answered: Sun, 24 Feb 2013
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