Context-The government is now planning to procure penicillin centrally for three years and give it to all children between 5-15 years who have a sore throat, at least once.

Reason for penicillin revival

• Penicillin, discovered in 1928, is still the first line antibiotic in many western countries, but it gradually went out of the Indian market even though some of its more expensive derivatives continue to be prescribed.
• Penicillin is one of the oldest antibiotics and in many western countries still remains the first antibiotic. Yet in India it has almost gone out of the market because of price control.The prices were kept so low that manufacturers stopped making the drug.
• On the other hand, India has a high burden of rheumatic fever and rheumatic heart disease — the latter often goes undiagnosed and leads to many maternal deaths at the time of childbirth. The first presentation often is a sore throat, so we are looking at giving a course of penicillin to all children between 5-15 years once.”
• Penicillin went out of production in India because of unrealistic price control. The government is now planning to procure penicillin centrally for three years and give it to all children between 5-15 years who have a sore throat, at least once. The drug will be dispensed through primary health centres or administered by ASHAs.
• Government is  looking at a plan to deal with rheumatic fever and rheumatic heart disease load and are trying to revive penicillin availability because it is the cheapest option for rheumatic fever treatment.
• Government is exploring various options including talking to the National Pharmaceutical Pricing Authority to take it off the price control list. Also, to kickstart production, government is looking at procuring the medicine centrally — enough stock for three years so that manufacturers are encouraged to restart production.

Rheumatic fever

• rheumatic fever is a complication of untreated strep throat caused by bacteria called group A streptococcus.

What Causes Rheumatic Fever?

• Rheumatic fever results from an inflammatory reaction to certain group A streptococcus bacteria. The body produces antibodies to fight the bacteria, but instead the antibodies attack a different target: the body's own tissues. The antibodies begin with the joints and often move on to the heart and surrounding tissues. Because only a small fraction (fewer than 0.3%) of people with strep throat ever contract rheumatic fever, medical experts say that other factors, such as a weakened immune system, must also be involved in the development of the disease.

What Are the Symptoms of Rheumatic Fever?

• Swollen, tender, red, and extremely painful joints -- particularly the knees or ankles
• Fever
• A red, raised, lattice-like rash, usually on the chest, back, and abdomen
• Nodules, or small protuberances, over the swollen joints
• Sometimes, weakness and shortness of breath caused by heart involvement

Rheumatic Fever Treatment

Rheumatic fever, once diagnosed, should be treated as soon as possible. Luckily, rheumatic fever treatment is pretty easy to maintain but you may be maintaining it for a period of time.

1. Antibiotics

• Antibiotics will be used to help clean out the bacteria causing the rheumatic fever. Unfortunately, due to the possible severity of the fever and bacteria, after the initial course is done, an additional course of antibiotics may be prescribed to help prevent its reoccurrence. This course of antibiotics can last for a few years. In the case of children, it could last from the initial date of the rheumatic fever until the age of 21.

2. Anti-Inflammatory Medication

• As rheumatic fever often comes with pain and inflammation of the joints, an anti-inflammatory medication is often prescribed in order to reduce the swelling as well as to help reduce the fever itself.

3. Anticonvulsant Medications

• In cases of rheumatic fever where there is uncontrollable movement of the limbs and/or face, the doctor may prescribe anticonvulsant medication to try and control the spasms.

4. Long-Term Care

• As we previously noted, the possible heart damage that rheumatic fever can cause may not appear until years after the initial fever. To this end, rheumatic fever should be mentioned as part of a patient’s medical history for a number of years after the initial fever.

Prevalence of Rheumatic fever in india

• Population-based studies indicate the prevalence of rheumatic heart disease in India to be about 2/1000 population. However, surveys conducted in school children in the age group of 5-16 years by ICMR gives overall prevalence of 6/1000.
• Rheumatic fever is endemic in India and remains one of the major causes of cardiovascular disease, accounting for nearly 25-45% of acquired heart disease.
• Not all sore throats go on to become rheumatic fever with severe joint pain or affect the heart in a disease that eventually leaves no option but to replace the heart valves — a condition known as rheumatic heart disease. However, doctors say, it is better to give an antibiotic dose and nip the possibility in the bud