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Glob Heart. 2013 Sep;8(3):227-34. doi: 10.1016/j.gheart.2013.08.011. Epub 2013 Sep 26.

Benzathine Penicillin G for the Management of RHD: Concerns About Quality and Access, and Opportunities for Intervention and Improvement.

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Telethon Institute for Child Health Research, Perth, Western Australia, Australia.. Electronic address:
World Heart Federation, Geneva, Switzerland.
University of Connecticut School of Medicine, Farmington, CT, USA.
University of Minnesota Medical School, Minneapolis, MN, USA.


Benzathine penicillin G is an important antibiotic for the treatment and prevention of group A streptococcal infections associated with rheumatic fever and rheumatic heart disease. However, as rheumatic heart disease has receded as a public health priority in most high-income settings, attention to the supply, manufacture, and accessibility of benzathine penicillin G has declined. Concerns about the quality, efficacy, and innovation of the drug have emerged following plasma analysis and anecdotal reports from low-resource settings. This review collates core issues in supply and delivery of benzathine penicillin G as a foundation for concerted efforts to improve global quality and access. Opportunities for intervention and improvement are explored.

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