To evaluate the safety and effectiveness of longer-acting penicillin to prevent recurrences of acute rheumatic fever (ARF), these researchers assessed historical data from the regional RF register for Auckland, New Zealand, in a 5–14-year-old population with ARF rates of ~40–80/100,000. Every 28 days, community nurses delivered free benzathine penicillin to consented patients; discharge was after 10 years of treatment or age 21 years, whichever was longer. First-episode and recurrent ARF cases were classified as definite (Jones criteria 1992) or probable (Jones criteria 1956). Of the 360 cases meeting the case definitions, 20 recurrences occurred in 19 people (median age 21 years). Age at first episode ranged from 2–52 years (median 21.3). After penicillin was discontinued, ARF recurred at 0–21 years; 72% of recurrent cases occurred within 5 years, and 12% between 5 years and 10 years. The 4-weekly long-acting penicillin failure rate (n=1) was 0.07/100 patient years. The programme failure rate (Auckland residents) was 1.4/100 patient years (n=20). Fifty-five percent of recurrences were attributed to patient non-adherence. Two recurrences after discharge from prophylaxis as per the New Zealand guidelines occurred after 3 years and 13 years.
