Discontinuation of antistreptococcal prophylaxis. A double-blind study in rheumatic patients free of heart disease

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Abstract
Antistreptococcal prophylaxis was discontinued, by double-blind techniques, in selected adolescents without heart disease, who had remained free of recurrent rheumatic fever for 3 to 5 years after an unequivocal episode. In 138 patient-years of observation, the group receiving oral potassium penicillin G, 200,000 units daily, developed 30 streptococcal infections (attack rate, 22%) and 1 rheumatic recurrence (attack rate, 0.7%). During 140 patient-years, the placebo group developed 30 streptococcal infections (attack rate, 21%) and 2 rheumatic recurrences (attack rate, 1.4%). None of the attack rate differences was statistically significant, and no overt new cardiac damage appeared in the 3 patients who developed rheumatic recurrences. Further studies would be desirable to determine the value of maintaining (or discontinuing) prophylaxis in the particular type of patient described here.