{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:34:09Z","timestamp":1786649649025,"version":"build-2736575974"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Acute rheumatic fever and rheumatic heart disease (RHD) are serious complications of untreated Group A Streptococcal infections. Given that India bears the highest global burden of RHD, optimizing secondary prophylaxis is a public health priority. Concerns regarding the adequacy of the current 3-weekly benzathine penicillin G (BPG) regimen and the lack of pharmacokinetic data in Indian children prompted this study. The objective of the study was to quantify serum penicillin levels in Indian children (aged 5\u201318 years) with RHD receiving 3-weekly BPG prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Children (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 23) with confirmed RHD and compliant with BPG prophylaxis for at least 6 months were enrolled. Intramuscular BPG was administered on day 0, and blood samples were collected at baseline, at 48 h, on day 6, and on day 14 postinjection. Serum penicillin concentrations were measured using a validated assay. A one-compartment pharmacokinetic model was used to estimate concentration\u2013time profiles and duration of protective drug levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age of participants was 12.87 \u00b1 2.1 years; 52.2% were female. Mean serum penicillin concentrations were 5.21 \u00b1 6.41 ng\/mL (day 0), 22.16 \u00b1 22.62 ng\/mL (day 2), 20.22 \u00b1 18.11 ng\/mL (day 6), and 10.15 \u00b1 7.26 ng\/mL (day 14). Levels were significantly higher at all postinjection time points compared to baseline (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). However, only 1\/3 of patients maintained serum concentrations above the protective threshold (20 ng\/mL) on days 2 and 6, and just one patient (6.2%) did so by day 14. No patient maintained therapeutic levels throughout the 21-day interval. Median duration above 20 ng\/mL was 144 h (6 days), and above 10 ng\/mL was 336 h (14 days).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Most Indian children receiving 3-weekly BPG prophylaxis for RHD do not maintain therapeutic serum penicillin concentrations for &gt;1 week postinjection. These findings highlight the limitations of the current prophylaxis strategy and underscore the need to reassess injection intervals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_194_25","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T07:00:20Z","timestamp":1776236420000},"page":"31-36","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Serum penicillin levels in Indian children and adolescents with rheumatic heart disease receiving benzathine penicillin G prophylaxis"],"prefix":"10.4103","volume":"19","author":[{"given":"Kawaldeep","family":"Kaur","sequence":"first","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr. RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakshi","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr. RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr. RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thirumurthy","family":"Velpandian","sequence":"additional","affiliation":[{"name":"Department of Ocular Pharmacology and Pharmacy, Dr. RP Centre, All India Institute of Medial Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheeraj Deo","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ABVIMS and Dr. RML Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260420","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1056\/NEJMoa1603693","article-title":"Global, regional, and national burden of 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penicillin G in children with rheumatic heart disease: A randomized, double-blind crossover study","volume":"17","author":"Yantie","year":"2024","journal-title":"Ann Pediatr Cardiol"},{"key":"R20-20260420","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4103\/apc.apc_371_25","article-title":"Challenges in managing pediatric heart failure, especially in resource-limited settings","volume":"18","author":"Kadiyani","year":"2025","journal-title":"Ann Pediatr Cardiol"}],"container-title":["Annals of Pediatric 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