Pharyngitis secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Secondary prevention of pharyngitis is crucial in patients have developed acute rheumatic fever (ARF), rheumatic heart disease (RHD) or post streptococcal glomerulonephritis, as they are at high risk for recurrent ARF and progressive RHD with subsequent episodes of group A streptococcal pharyngitis. Therefore, strategies for secondary prevention of disease recurrence are necessary to reduce morbidity and mortality in patients with a history of ARF and/or RHD.

Secondary Prevention

Secondary prevention for pharyngitis is necessary to reduce morbidity and mortality in patients with a history of ARF and/or RHD. A course of antibiotic therapy should be initiated at the time of diagnosis of rheumatic fever and then a prophylactic regimen should be initiated as secondary prevention which include intramuscular benzathine penicillin G every 3–4 weeks or twice-daily oral penicillin is preferred. If the patient is penicillin-allergic, use sulfadiazine or macrolides.

Prophylaxis is continued into adulthood and the duration of prophylaxis depending on the severity of carditis, if present.[1]

Severity of Rheumatic fever with carditis Prophylactic management
Patients with ARF but without carditis Prophylaxis for at least 5 years or until 21 years of age (whichever is longer)
Patients with ARF associate with carditis but without any residual valvular disease Prophylaxis for at least 10 years or until 21 years of age (whichever is longer)
Patients with ARF associate with carditis and residual valvular disease Prophylaxis for at least until 40 years of age

Reference

  1. Kociolek LK, Shulman ST (2012) In the clinic. Pharyngitis. Ann Intern Med 157 (5):ITC3-1 - ITC3-16. DOI:10.7326/0003-4819-157-5-20120904-01003 PMID: 22944886

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