FIRMST abstract 2020.75

FIRMST2020-AB75
ADDITION OF PENICILLIN TO STANDARD OF CARE IN HEALING OF ULCERS 
IN CHRONIC VENOUS HYPERTENSION


Neeraj KUMAR, Anita DHAR
All India Institute of Medical Sciences, New Delhi, India

Aim: 
To compare reduction in ulcer size, recurrence rate, pain score & improvement in quality of life (QOL) in patients receiving standard care (SoC) for chronic venous ulcer with & without concomitant treatment with in Benzathine penicillin

Keywords
chronic venous ulceration; Benzathine Penicillin
correspondence to: 
neerajkgmc@gmail.com

No conflict of interest declared


Article Information
Epub: 04.08.2020
Presented at FIRMST Conference, Moscow 2020
Peer reviewed by JS Bamrah, Ananthakrishnan Raghuraman, Soumit Dasgupta, Gopal K Mahadev & Jyothi Srinivas
Open Access- Creative Commons Licence CC-BY-ND-4.0

Background: 
Chronic ulcers are one of the most difficult diseases to treat with socioeconomic impact, due to pain, recurrence & morbidity. Compression therapy with surgical & endovascular procedure is often required for management. Venous hypertension leads to oedema followed by micro lymphangiopathy & dermato-lymphangio-adenitis (DLA), which is attributed to recurrence of symptoms & eventually ulcers. Role of Injection (Inj) Benzathine Penicillin has been well established in treating lymphangitis. However, its role in venous ulcers hasn’t been studied before. 
Objective: 
Reduction in ulcer size, recurrence rate, pain score & improvement in quality of life(QOL) in patients receiving standard care (SoC) with & without concomitant treatment with Inj. Benzathine penicillin 1.2 mega units intramuscular (IM) every 3 weekly for 6 months.
 Design and Methods: 
Present randomised, two-arm superiority trial was conducted among patients aged 18-70 years with pregnancy, Acute DVT, Peripheral Arterial Disease, T2DM, penicillin allergy, etc. excluded. Participants were randomly recruited into two arms. SoC included moist occlusive dressing, flavonoids, Short stretch bandages/ Stockings. SoC also included interventional treatment including Endovenous Laser Ablation/ Sclerotherapy/Sub-fascial Endoscopic Perforator Surgery/ Stripping & ligation, etc. Patients were followed up weekly for 1 month, followed by monthly for 6 months.
Results: 
66 patients with total 103 venous ulcers, baseline characteristics of both groups were statistically similar, however, ulcers did not follow a normal distribution at presentation & there was a significant difference between mean ulcer size among the groups(p=0.04). Compared with the control arm (N=32, 49 ulcers), the study arm (N=34, 54 ulcers) was associated with a higher number of healed ulcers. Mean size of ulcers decreased in both the arms with a statistically significant difference in study arm(p=0.03). Patients of study arm had lesser no. of recurrence. Pain control was improved in both arms, with significant difference favouring study group(p=0.001). Significant difference in various domains of QoL was noted (p=0.001). There were decreased attacks of DLA and limb swellings in both groups. With much more improved results in the study arm (p=0.001).

Conclusions: 
Inj. Benzathine Penicillin administration along with SoC among chronic venous recurrent ulcers had beneficial effects on ulcer healing, QoL, recurrence, DLA & pain.
Keyword: Venous ulcer, penicillin, venous diseases, randomised trial

Conflict of Interests: None
 

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