Evaluating the use of penicillin to control outbreaks of acute poststreptococcal glomerulonephritis

Introduction. Outbreaks of acute poststreptococcal glomerulonephritis (APSG N), occur every few years in remote Australian Aboriginal communities. Inte rvention with benzathine penicillin G (BPG) to all children is effective in reducing streptococcal carriage in a community, but its effectiveness in a rresting outbreaks of APSGN has not been established. Objective. To study nine recent community outbreaks of APSGN in Australia's Northern Territory and compare them with outbreaks reported in the literat ure to assess the impact of intervention with BPG. Methods. Because randomized controlled trials have not been conducted for t his purpose, we assessed data from published observational studies and rele vant experiences in the Northern Territory (NT), Eight of the nine outbreak s in the NT were studied prospectively. An outbreak was defined as two or m ore clinical cases of APSGN occurring within 1 week in a single community. Three intervention methods were used: intramuscular BPG to all children age s 3 to 15 years; BPG only to children with skin lesions; and BPG only to ch ild contacts of clinical cases. The attack rates, number of clinical cases before and after the interventions were documented and the coverage of chil dren with penicillin were estimated. Results. A review of the literature found very little evidence either for o r against the effectiveness of intervention with BPG, In our study four com munities used the first method of intervention. The community with the lowe st uptake of penicillin continued to have cases in untreated children for 9 further weeks, two communities had no new cases from 3 weeks after the int ervention and the fourth had a single further case after 4 weeks. The one c ommunity that used the second method had a high initial attack rate but no further cases from 1 week after the intervention. Three communities used th e third method and in one community no intervention was attempted. Conclusion. Our observational study supports the use of BPG in the communit y to prevent new cases of APSGN, It suggests that targeted treatment of chi ldren with skin sores and household contacts of cases, rather than attempte d treatment of all children in the community, could be an effective method of intervention.