Q: I am a 24 years old boy who suffered with knee joint pain 7 years back with no swelling. The doctor diagnosed it as rheumatic fever after taking a blood test. He prescribed Penidure injection once a week. After few months, the doctor suggested taking the injection once in 3 weeks and I did the same for 2 years. Later he asked to take it once a month. I continued the same penidure 12 lacs injection once a month for another 3 years. In between these 5 years my pain was gone. Now I am not able to see the doctor because I have come to another state for further studies. But I continued the injection in the 6th year too once in every 6 months because the doctor suggested me to continue it but I have to slowly increase the intervals of dosage. Now I have slowly discontinued the injection and for the last two and a half years I am not taking the injection. Recently I experienced some pain in my knee joints. Is it advisable to start the injection at least once a year? Are there any side effects of continuing the penidure (penicillin) injection?

A:Penidura prophylaxis for rheumatic fever is given every three weeks at least for five years from the last attack. This is because the risk for occurrence is the highest in the first five years of the attack. After the five-year period the decision to continue is based on whether the patient has documented rheumatic heart disease or is vulnerable to Streptococcal infection and its exposure. These are people who are likely to be in the midst of a group of people (example; class rooms) or those that have public dealings. Some even recommend this to be for a lifetime (as recommended in the Text Book of Internal Medicine – Harrisons Principles of Internal Medicine 16th Edn.). This decision is normally taken by a physician and I would recommend that you meet your physician and then plan accordingly.