Penicillin to Prevent Early Rheumatic Heart Disease in School-Aged Children

Penicillin to Prevent Early Rheumatic Heart Disease in School-Aged Children

This study will look at whether children ages 5-8 who take Penicillin V by mouth twice a day are less likely to develop rheumatic heart disease (RHD) over a 3-year period compared to children who do not take the medicine.

Inclusion Criteria:

• Age 5-8 years at enrollment
• Residence within the participating study catchment area (Gulu District or Gulu City)
• Normal study echocardiogram confirmed by the expert adjudication panel
• Parent/guardian able and willing to provide written informed consent
• Participant able to provide written assent (age 8 years)

Exclusion Criteria:

• History of prior ARF or RHD with or without cardiac involvement
• Evidence of RHD on baseline echocardiography
• Congenital heart disease (excluding small PFO, small ASD) or other cardiac abnormality at baseline echocardiography
• Self-reported known allergy to penicillin
• Medical conditions that would preclude safe participation, adherence, or follow-up
• Anticipated inability to complete 36 months of study follow-up
• Any known co-morbid condition requiring regular antibiotic prophylaxis