Benzathine penicillin G (BPG) has been a significant antibiotic for the prevention & treatment of group ‘A streptococcal’ infections associated with rheumatic fever and rheumatic heart disease since its clinical introduction in the early 1950s. However, as rheumatic heart disease has subsided as a public health priority in most high-income settings, attention to the manufacture, supply and accessibility of BPG has shown noticeable slump. Concerns about the efficacy, tolerability, pharmacology and novelty of the drug have appeared following plasma assessment and anecdotal reports from low-resource settings.
This review undertaken by Gian Maria Pacifici, the Associate Professor of Pharmacology, Italy, collects central issues in delivery of BPG as a substructure for collaborative efforts to enhance worldwide quality and accessibility.
Highlighting the current issues surrounding BPG for the management of diseases like gonococcal, meningococcal, pneumococcal, syphilitic, and aerobic and anaerobic streptococcal infections, this review presents an overview of opportunities for intervention and augmentation explored. These issues were scrutinized utilizing targeted searches of public records disclosing patent details, commercial information, and correspondence.
This systematic search of peer-reviewed literature identified pharmacokinetic conduct of the penicillins that may be of particular interest to the clinician.
While ensuing the purpose of preventing colonization or infection of the group A hemolytic streptococci and upper respiratory tract as well as the development of recurrent attacks of rheumatic fever”, Gian revealed the resistance to penicillins which is due to 3 main mechanisms. The 1st being reorganization in antibiotic target positions” penicillin-binding proteins; the 2nd is inactivation of the penicillin by pathogenically induced enzymes (beta-lactamases); and the 3rd is declined penetrability of the cell wall to penicillins. Of these 3 mechanisms, production of beta-lactamase is the most common and the most crucial.
Collecting evidence from the second large RCT that compared the current reference treatment for PSBI of injectable procaine benzylpenicillin–gentamicin for 7 days (group A) with a streamlined systematic plan in young infants (≤59 days old, n = 3564) in a randomised, open-label, equivalence trial when referral is not possible. Inspecting the following simplified regimens: (i) oral amoxicillin and injectable gentamicin for 7 days (group B), (ii) injectable procaine BPG–gentamicin for 2 days, then oral amoxicillin for 5 days (group C), (iii) or injectable gentamicin for 2 days and oral amoxicillin for 7 days in comparison with injectable procaine benzylpenicillin plus gentamicin for treatment of newborns and young infants with clinical signs of possible serious bacterial infection, revealed that the three simplified regimens were as effective as injectable procaine benzylpenicillin–gentamicin for 7 days on an outpatient basis in young infants with signs of severe infection, without signs of critical contagion, and whose custodians could not accept referral for hospital admittance.
From the data demonstrated in Studies by Rusoff and Stollerman, Gian Maria uncovered that the repository form of penicillin provided sufficient serum levels for both management of GAS as well as for prophylaxis of accumulation of group A streptococci for 3 weeks or longer subsequent to injection at recommended BPG doses.
Gian sheds a light on the fundamental advantages of the BPG that includes enhanced adherence over oral preparations, and improved optimality even when adherence has been reported, making it an integral part of most recommended management of GAS upper respiratory tract infections.
With reference to BPG as an essential medicine, Gian exhibits the efficacy of the antibiotic in both endemic and epidemic GAS disease, particularly in military populations where streptococcal infections have chronically been and remain protruding medical and public health issues.
Having said that, Professor Gian, directs towards the importance of dose-dependency in order to attain sufficient serum penicillin levels for GAS; the greater the dose of BPG, the larger the serum concentration for longer span of time. Thus, as per Gian, following a regimen of medically accepted dose and optimum frequency of administration will help prevent streptococcal treatment failures that were also highly reported recently with BPG treated streptococcal pharyngitis cases.
Addressing the concern and Considerations about drug penetration in the central nervous system (CNS), the researcher clarifies that the drug penetration is persuaded by the characteristic and extent of the infection (i.e. the presence of meningeal inflammation). Successful treatment of CNS infections is dependent upon the competency to obtain antimicrobial concentrations of adequate magnitude, or for ample periods of time, to dwindle the burden of pathogen by various orders of magnitude.
Further adding, she says that an estimated 12 million people are infected with Syphillis. A number of studies emerge to suggest that procaine-benzylpenicillin or benzathine-benzylpenicillin administered intramuscularly could achieve cerebrospinal fluid concentrations markedly lower than those of benzylpenicillin. However, from the published reports, relationship between dose and cerebrospinal fluid concentration for the intramuscular benzylpenicillin formulations could not be established due to data being inexplicit — adds Gian. Nevertheless, benzylpenicillin concentrations remain distinguishable in the cerebrospinal fluid for 12-24 hours after intramuscular dose.
T. Palladium, a bacterium causing the disease syphilis is found to be specifically responsive to penicillin in the form of BPG – says Prof. Gian Maria. The dosage as per recommendations/guidelines is double the RF/RHD prevention dose at 1.44 g (2.4 million IU) as a single immediate dose for initial syphilis or 3 doses for matured syphilis. From the evidence obtained from the comparative analysis of oral azithromycin in relation to a single dose of BPG for treatment of early syphilis, BPG remains the only agent appropriate and acceptable for treating pregnant women to prevent transmission to the fetus and forestalling congenital syphilli in newborns.
These findings have important implications for the use of BPG in the prevention and treatment for a variety of other conditions, but problems are of practical clinical and public health importance, thus, current recommendations for infection, particularly respiratory tract infection, should be re-examined not only in adults, but also when treating congenital syphilis in infants.
Media Contact
Company Name: The Scientific News
Contact Person: Barbara E. Hancock
Email: Send Email
Phone: +16467518810
Country: United States
Website: https://www.thescientificnews.com/