Background: Benzathine benzylpenicillin (BPG), delivered as an intramuscular (IM) injection every 3-4 weeks is the cornerstone of secondary prophylaxis to prevent acute rheumatic fever and rheumatic heart disease. The experiences of people receiving these secondary prophylaxis injections are a key determinant for successful delivery at an individual and programmatic level. Clinical guidelines are an important norm setting documents which scaffold clinically- and culturally-safe care. We reviewed administration guidelines for IM BPG in Australia and Aotearoa New Zealand to understand if, and how, clinical guidelines support clinically and culturally safe injection delivery. A companion review of global guidelines is also underway.
Methods: A scoping review using semi-structured google terms was used to identify clinical guidance in Australia. Similar methodology is being adapted to the global context.
Results: Seventeen administration guidelines were identified in Australasia for premixed Bicillin LA®. There was minimal variation across these 17 guidelines in terms of biomedical considerations, some variation in pain reduction strategies and significant variation in experiential and cultural considerations. Preliminary analysis of global guidelines suggest that very little attention to experiential or cultural considerations.
Conclusion: Guidelines which consider and address patient experience alongside technical details of BPG administration are likely to support better secondary prophylaxis delivery. Understanding the landscape of global guidelines is also important for planning implementation of new administration approaches and update/decommissioning of current guidelines.