Letters, calls and emails: Penicillin ‘abuse' aids rheumatic fever fight

Dear Editor

I do not get around to taking a swab from every sore throat. This practice may not be the best, but is the same as that of many other jobbing GPs who have been described as ‘idle’ by our academic brethren.

As a general rule, if the patient looks ill, an antibiotic is prescribed. Rebuke follows swiftly from the PCTs and pharmaceutical advisors.

It was, therefore, heartening to come across an article on rheumatic fever and its management in the BMJ (BMJ 2006; 333: 1,153–6).

The diagnosis of rheumatic fever is a challenge for the clinicians. Firstly, the possibility of the disease has to be borne in mind. Because of the nearly complete eradication of rheumatic fever from the UK and other developed nations, the disease is sometimes forgotten in the differential diagnosis of a patient with polyarthralgia and fever.
When I was a paediatric registrar in the 1960s, the paediatric ward in Bolton District general hospital almost always had a case of rheumatic fever. In 2003, when my son was a paediatric registrar in Melbourne’s children’s hospital, he didn’t encounter one case.

So what has been happening in the meantime? The GPs have been taking the Domestos-like approach and prescribing ‘inappropriate penicillin’ for throat infections.

The current article in the BMJ is a pat on the back for the grassroot GP. It states that until other strategies are developed, treating sore throats with antibiotics to prevent rheumatic fever should remain the norm.

Dr Kausar Jafri


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