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Benzathine penicillin is the drug of choice for prophylaxis in rheumatic heart disease. It is given intramuscularly, every 21–30 days after test dose and gives excellent results. But it has the side effects of hypersensitivity and fatal anaphylactic reaction even when patient had received it in past since long without any problem. Fatal anaphylaxis may be under reported due to under diagnosis by health care professionals, insensitive and nonspecific laboratory test and the absence of clear post mortem findings.
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Kalani et al. (2016) studied this question.
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