"Hurts less, lasts longer"; a qualitative study on experiences of young people receiving high-dose subcutaneous injections of benzathine penicillin G to prevent rheumatic heart disease in New Zealand.

Abstract

BACKGROUND:

Four-weekly intramuscular (IM) benzathine penicillin G (BPG) injections to prevent acute rheumatic fever (ARF) progression have remained unchanged since 1955. A Phase-I trial in healthy volunteers demonstrated the safety and tolerability of high-dose subcutaneous infusions of BPG which resulted in a much longer effective penicillin exposure, and fewer injections. Here we describe the experiences of young people living with ARF participating in a Phase-II trial of SubCutaneous Injections of BPG (SCIP).

METHODOLOGY:

Participants (n = 20) attended a clinic in Wellington, New Zealand (NZ). After a physical examination, participants received 2% lignocaine followed by 13.8mL to 20.7mL of BPG (Bicillin-LA®; determined by weight), into the abdominal subcutaneous tissue. A Kaupapa Māori consistent methodology was used to explore experiences of SCIP, through semi-structured interviews and observations taken during/after the injection, and on days 28 and 70. All interviews were recorded, transcribed verbatim, and thematically analysed.

PRINCIPAL FINDINGS:

Low levels of pain were reported on needle insertion, during and following the injection. Some participants experienced discomfort and bruising on days one and two post dose; however, the pain was reported to be less severe than their usual IM BPG. Participants were 'relieved' to only need injections quarterly and the majority (95%) reported a preference for SCIP over IM BPG.

CONCLUSIONS:

Participants preferred SCIP over their usual regimen, reporting less pain and a preference for the longer time gap between treatments. Recommending SCIP as standard of care for most patients needing long-term prophylaxis has the potential to transform secondary prophylaxis of ARF/RHD in NZ and globally.

• Authors: Julie Cooper, Stephanie L Enkel, Dhevindri Moodley, Hazel Dobinson, Erik Andersen, Joseph H Kado, Renae K Barr, Sam Salman, Michael G Baker, Jonathan R Carapetis, Laurens Manning, Anneka Anderson, Julie Bennett
• Journal: PloS one (PLoS One) Vol. 19 Issue 5 Pg. e0302493 ( 2024) ISSN: 1932-6203 [Electronic] United States
• PMID: 38743745 (Publication Type: Journal Article, Clinical Trial, Phase II)
• Copyright: Copyright: © 2024 Cooper et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Topics

• Humans
• Penicillin G Benzathine (administration & dosage, therapeutic use)
• Male
• Female
• New Zealand
• Injections, Subcutaneous
• Rheumatic Heart Disease (prevention & control, drug therapy)
• Adult
• Adolescent
• Young Adult
• Pain (drug therapy, prevention & control)
• Qualitative Research
• Rheumatic Fever (prevention & control, drug therapy)
• Anti-Bacterial Agents (administration & dosage, therapeutic use)