Rheumatic fever secondary prevention: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(20 intermediate revisions by 7 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Rheumatic fever}}
{{Rheumatic fever}}
{{CMG}}; Lance Christiansen, D.O.; '''Associate Editor(s)-in-Chief:''' {{VK}}; {{CZ}}
{{CMG}}; Lance Christiansen, D.O.; {{AE}} {{VK}}; {{CZ}}; {{AG}}


==Overview==
==Overview==
In order to prevent recurrent development of rheumatic fever, an antibiotic prophylaxis should be initiated immediately after the antibiotic course in treatment of rheumatic fever. Duration of prophylactic treatment varies with degree of cardiac damage secondary to rheumatic fever.
Secondary [[prevention]] strategies following rheumatic fever include [[antibiotic]] [[prophylaxis]] immediately after the [[antibiotic]] course in treatment of rheumatic fever. Duration of [[prophylactic]] treatment varies with degree of [[cardiac]] damage secondary to rheumatic fever.


==Secondary Prevention==
==Secondary Prevention==
*Secondary [[prevention]] strategies following rheumatic fever include [[antibiotic]] [[prophylaxis]] immediately after the antibiotic course in treatment of rheumatic fever. Duration of prophylactic treatment varies with degree of cardiac damage secondary to rheumatic fever. If the patient or their household contacts develop [[streptococcal pharyngitis]] during the [[prophylactic]] period, they should be evaluated and treated promptly.


If an individual does not contract a [[Streptococcus pyogenes]] infection for a long period, perhaps for five years or longer, an individual's immunological/autoimmunological responsivness will naturally decrease and, perhaps, there will be less chance of developing rheumatic fever if the individual contracts a future Streptococcus pyogenes infection.  
*Providing [[prophylactic]] [[therapy]] to individuals who have had rheumatic fever with monthly injections of [[benzathine penicillin G]] or oral [[penicillin V]] decreases the frequency of recurrent ''[[Streptococcus pyogenes]]'' [[infections]] and recurrent rheumatic fever episodes. It is estimated that the recurrence rate of rheumatic fever is decreased about 85% by providing [[prophylactic]] [[penicillin]] [[therapy]].


Prophylactic antibiotic therapy should be initiated immediately after the therapeutic antibiotic course. If the patient or their household contacts develop [[streptococcal pharyngitis]] during the prophylactic period, they should be evaluated and treated promptly.  
*Alternatives to [[benzathine penicillin G]] are available, although they are less effective and require careful monitoring. These include:<ref>[http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/DiagnosisandmanagementofacuterheumaticfeverandrheumaticheartdiseaseinAustralia/NHFA-CSANZ_ARF_RHD_2006.pdf RF/RHD Guideline Development Working Group of the National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand. Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia: an evidence-based review. Sydney (Australia): National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand; 2006 Jun]</ref>


Providing prophylactic therapy to individuals who have had rheumatic fever with monthly (or maybe every three weeks) injections of Benzathine Penicillin G, 1,200,000 units, or oral [[penicillin V]] or G, 250mg twice daily (I think 500 mg twice daily is more efficacious), decreases the frequency of recurrent Streptococcus pyogenes infections and therefore recurrent rheumatic fever episodes. It is estimated that the recurrence rate of rheumatic fever is decreased about 85% by providing prophylactic penicillin therapy.
{| class="wikitable"
 
! Patient
Alternatives to benzathine penicillin G are available, although they are less effective and require careful monitoring<ref>[http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/DiagnosisandmanagementofacuterheumaticfeverandrheumaticheartdiseaseinAustralia/NHFA-CSANZ_ARF_RHD_2006.pdf RF/RHD Guideline Development Working Group of the National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand. Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia: an evidence-based review. Sydney (Australia): National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand; 2006 Jun]</ref><ref>http://www.guideline.gov/content.aspx?id=10369</ref>.
! Alternative Secondary Preventive Thearpy
*In patients who refuse intramuscular [[benzathine penicillin G]], oral penicillin can be offered, although it is less effective than benzathine penicillin G in preventing GAS infections and subsequent recurrences of ARF. For patients taking oral penicillin, the consequences of missed doses must be emphasised, and adherence monitored.
*In patients who may be allergic to penicillin, an allergist should be consulted. The rates of allergic and [[anaphylactic reaction]]s to monthly benzathine penicillin G are low, and fatal reactions are exceptionally rare. There is no increased risk with prolonged benzathine penicillin G use.
*In patients with a confirmed, immediate, and severe allergic reaction to penicillin, a nonbeta-lactam antimicrobial (e.g., [[erythromycin]]) should be used instead of benzathine penicillin G.
*In pregnant patients, penicillin prophylaxis should continue for the duration of pregnancy to prevent recurrent ARF. There is no evidence of [[teratogenicity]]. Erythromycin is also considered safe in pregnancy, although controlled trials have not been conducted.
*In anticoagulated patients, benzathine penicillin G injections should be continued unless there is evidence of uncontrolled bleeding, or the [[INR|international normalised ratio]] is outside the defined therapeutic window. Intramuscular bleeding is rare when benzathine penicillin G injections are used in conjunction with [[anticoagulation therapy]].
 
{| width="70%" class="wikitable" border="1"
|+ Secondary Prevention of Rheumatic Fever<ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172  }} </ref><ref name="pmid19246689">{{cite journal| author=Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al.| title=Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. | journal=Circulation | year= 2009 | volume= 119 | issue= 11 | pages= 1541-51 | pmid=19246689 | doi=10.1161/CIRCULATIONAHA.109.191959 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19246689  }} </ref>
! Agent !! Dosage !! Mode !! Rating
|-
|-
| [[Benzathine penicillin G]] || 1,200,000 Units every 4 weeks (every 3 weeks for high-risk patients such as those with residual [[carditis]]) || Intramuscular || Class I, LOE A
| Refuses intramuscular [[benzathine penicillin G]]
| Oral [[penicillin]]
|-
|-
! colspan="4" |or
| Allergic to [[penicillin]]
| A non beta-lactam antimicrobial (e.g., [[erythromycin]])
|-
|-
| [[Penicillin V]] || 250 mg twice daily || Oral || Class I, LOE B
| [[Pregnant]]
| Penicillin prophylaxis should continue for the duration of pregnancy, as there is no evidence of [[teratogenicity]]. [[Erythromycin]] is also considered safe in pregnancy.
|-
|-
! colspan="4" |or
| [[Anticoagulation|Anticoagulated]]
| Benzathine penicillin G injections should continue unless there is evidence of uncontrolled bleeding, or the [[international normalized ratio]] is outside the defined therapeutic window
|-
|-
| [[Sulfadiazine]] || 0.5 g once daily for patients ≤ 27 kg (60 lb); 1.0 g once daily for patients > 27 kg (60 lb) || Oral || Class I, LOE B
|-
! colspan="4" |or
|-
| [[Erythromycin]] among patients with [[penicillin allergy]] || 250 mg twice daily || Oral || Class I, LOE C
|}
|}


*Recurrence of rheumatic fever is higher among [[patients]] receiving oral [[prophylaxis]] than those receiving [[intramuscular]] [[benzathine penicillin G]]. This may be attributed to [[patient]] [[compliance]].<ref name="pmid13644570">{{cite journal| author=FEINSTEIN AR, WOOD HF, EPSTEIN JA, TARANTA A, SIMPSON R, TURSKY E| title=A controlled study of three methods of prophylaxis against streptococcal infection in a population of rheumatic children. II. Results of the first three years of the study, including methods for evaluating the maintenance of oral prophylaxis. | journal=N Engl J Med | year= 1959 | volume= 260 | issue= 14 | pages= 697-702 | pmid=13644570 | doi=10.1056/NEJM195904022601405 | pmc= | url= }} </ref>


{| width="70%" class="wikitable" border="1"
*Secondary [[prophylaxis]] for 1 year among patients with post [[streptococcal]] [[reactive arthritis]] (PSRA) is recommended.<ref name="pmid9627020">{{cite journal| author=Ahmed S, Ayoub EM, Scornik JC, Wang CY, She JX| title=Poststreptococcal reactive arthritis: clinical characteristics and association with HLA-DR alleles. | journal=Arthritis Rheum | year= 1998 | volume= 41 | issue= 6 | pages= 1096-102 | pmid=9627020 | doi=10.1002/1529-0131(199806)41:6<1096::AID-ART17>3.0.CO;2-Y | pmc= | url= }} </ref><ref name="pmid19246689">{{cite journal| author=Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al.| title=Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. | journal=Circulation | year= 2009 | volume= 119 | issue= 11 | pages= 1541-51 | pmid=19246689 | doi=10.1161/CIRCULATIONAHA.109.191959 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19246689  }} </ref>
|+ Duration of Secondary Rheumatic Fever Prophylaxis<ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172  }} </ref><ref name="pmid19246689">{{cite journal| author=Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al.| title=Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. | journal=Circulation | year= 2009 | volume= 119 | issue= 11 | pages= 1541-51 | pmid=19246689 | doi=10.1161/CIRCULATIONAHA.109.191959 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19246689  }} </ref>
! Category!! Duration !! Rating
|-
| Rheumatic fever with [[carditis]] and residual heart disease (persistent valvular disease) || ≥ 10 years since last episode and at least until age 40 years; sometimes lifelong prophylaxis in high risk patients || Class I, LOE C
|-
| Rheumatic fever with carditis but no residual heart disease (no valvular disease) || 10 years or well into adulthood, whichever is longer || Class I, LOE C
|-
| Rheumatic fever without carditis || 5 years or until age 21 years, whichever is longer || Class I, LOE C
|}


Recurrence of rheumatic fever is higher among patients receiving oral prophylaxis than those receiving intramuscular benzathine [[penicillin G]]. This may be attributed to patient compliance i.e. patients prefer injection once in 4weeks over taking medicines daily. This observation was made in a study involving 405 children and adolescents with rheumatic fever assigned to receive 4 weeks of intramuscular benzathine penicillin G, oral penicillin G or oral sulfadiazine. Recurrence of rheumatic fever was observed in 0%, 4.8%, and 2.7% of the patients, respectively<ref name="pmid13644570">{{cite journal| author=FEINSTEIN AR, WOOD HF, EPSTEIN JA, TARANTA A, SIMPSON R, TURSKY E| title=A controlled study of three methods of prophylaxis against streptococcal infection in a population of rheumatic children. II. Results of the first three years of the study, including methods for evaluating the maintenance of oral prophylaxis. | journal=N Engl J Med | year= 1959 | volume= 260 | issue= 14 | pages= 697-702 | pmid=13644570 | doi=10.1056/NEJM195904022601405 | pmc= | url= }} </ref>. Therefore parenteral prophylaxis is recommended over oral prophylaxis
===Antimicrobial Regimen===
* '''Secondary [[prevention]] of rheumatic fever''':<ref name="pmid24939033">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 1 | pages= e1-e132 | pmid=24939033 | doi=10.1016/j.jtcvs.2014.05.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24939033  }} </ref>


Secondary prophylaxis for 1 year among patients with post streptococcal reactive arthritis (PSRA) is recommended by some as few PSRA patients have been observed to develop valvular heart disease<ref name="pmid9627020">{{cite journal| author=Ahmed S, Ayoub EM, Scornik JC, Wang CY, She JX| title=Poststreptococcal reactive arthritis: clinical characteristics and association with HLA-DR alleles. | journal=Arthritis Rheum | year= 1998 | volume= 41 | issue= 6 | pages= 1096-102 | pmid=9627020 | doi=10.1002/1529-0131(199806)41:6<1096::AID-ART17>3.0.CO;2-Y | pmc= | url= }} </ref><ref name="pmid19246689">{{cite journal| author=Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al.| title=Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. | journal=Circulation | year= 2009 | volume= 119 | issue= 11 | pages= 1541-51 | pmid=19246689 | doi=10.1161/CIRCULATIONAHA.109.191959 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19246689  }} </ref>.
:* Preferred regimen (1): [[Penicillin G benzathine]] 1.2 MU IM single dose q4w
:* Preferred regimen (2): [[Penicillin V potassium]] 250 mg PO bid
:* Preferred regimen (3): [[Sulfadiazine]] 1 g PO qd
:* Alternative regimen: [[Erythromycin]] 250 mg PO bid
:* Note: Duration of secondary [[prophylaxis]] for [[rheumatic fever]] differs for different scenarios. For [[rheumatic fever]] with [[carditis]] and residual heart disease (persistent VHD) 10 y or until patient is 40 y of age (whichever is longer). For [[rheumatic fever]] with [[carditis]] but no residual [[heart]] disease (no [[valvular disease]]) 10 y or until patient is 21 y of age (whichever is longer). For [[rheumatic fever]] without [[carditis]] 5 y or until [[patient]] is 21 y of age (whichever is longer).


==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
==2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid24939033">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 1 | pages= e1-e132 | pmid=24939033 | doi=10.1016/j.jtcvs.2014.05.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24939033  }} </ref>==


===Secondary Prevention (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===
===Secondary Prevention (DO NOT EDIT) <ref name="pmid24939033">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 1 | pages= e1-e132 | pmid=24939033 | doi=10.1016/j.jtcvs.2014.05.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24939033  }} </ref>===


{|class="wikitable"
{|class="wikitable"
Line 65: Line 53:
|-
|-
| bgcolor="LightGreen"|
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''1.''' Patients who have had rheumatic fever with or without [[carditis]] (including patients with [[MS]]) should receive [[prophylaxis]] for recurrent rheumatic fever.([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki>
<nowiki>"</nowiki>'''1.''' Secondary prevention of rheumatic fever is indicated in patients with rheumatic heart disease, specifically [[mitral stenosis]] (MS).([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}
==Sources==
*2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.<ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172  }} </ref>
*http://www.guideline.gov/content.aspx?id=10369


==References==
==References==
{{reflist|2}}
{{Reflist|2}}


{{WH}}
[[Category:Cardiology]]
{{WS}}
[[Category:Rheumatology]]

Latest revision as of 00:00, 30 July 2020

Rheumatic fever Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Rheumatic Fever from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Jones Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Rheumatic fever secondary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Rheumatic fever secondary prevention

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Rheumatic fever secondary prevention

CDC on Rheumatic fever secondary prevention

Rheumatic fever secondary prevention in the news

Blogs on Rheumatic fever secondary prevention

Directions to Hospitals Treating Rheumatic fever

Risk calculators and risk factors for Rheumatic fever secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Anthony Gallo, B.S. [4]

Overview

Secondary prevention strategies following rheumatic fever include antibiotic prophylaxis immediately after the antibiotic course in treatment of rheumatic fever. Duration of prophylactic treatment varies with degree of cardiac damage secondary to rheumatic fever.

Secondary Prevention

  • Secondary prevention strategies following rheumatic fever include antibiotic prophylaxis immediately after the antibiotic course in treatment of rheumatic fever. Duration of prophylactic treatment varies with degree of cardiac damage secondary to rheumatic fever. If the patient or their household contacts develop streptococcal pharyngitis during the prophylactic period, they should be evaluated and treated promptly.
  • Alternatives to benzathine penicillin G are available, although they are less effective and require careful monitoring. These include:[1]
Patient Alternative Secondary Preventive Thearpy
Refuses intramuscular benzathine penicillin G Oral penicillin
Allergic to penicillin A non beta-lactam antimicrobial (e.g., erythromycin)
Pregnant Penicillin prophylaxis should continue for the duration of pregnancy, as there is no evidence of teratogenicity. Erythromycin is also considered safe in pregnancy.
Anticoagulated Benzathine penicillin G injections should continue unless there is evidence of uncontrolled bleeding, or the international normalized ratio is outside the defined therapeutic window

Antimicrobial Regimen

2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [5]

Secondary Prevention (DO NOT EDIT) [5]

Class I

"1. Secondary prevention of rheumatic fever is indicated in patients with rheumatic heart disease, specifically mitral stenosis (MS).(Level of Evidence: C)"

References

  1. ↑ RF/RHD Guideline Development Working Group of the National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand. Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia: an evidence-based review. Sydney (Australia): National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand; 2006 Jun
  2. ↑ FEINSTEIN AR, WOOD HF, EPSTEIN JA, TARANTA A, SIMPSON R, TURSKY E (1959). "A controlled study of three methods of prophylaxis against streptococcal infection in a population of rheumatic children. II. Results of the first three years of the study, including methods for evaluating the maintenance of oral prophylaxis". N Engl J Med. 260 (14): 697–702. doi:10.1056/NEJM195904022601405. PMID 13644570.
  3. ↑ Ahmed S, Ayoub EM, Scornik JC, Wang CY, She JX (1998). "Poststreptococcal reactive arthritis: clinical characteristics and association with HLA-DR alleles". Arthritis Rheum. 41 (6): 1096–102. doi:10.1002/1529-0131(199806)41:6<1096::AID-ART17>3.0.CO;2-Y. PMID 9627020.
  4. ↑ Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST; et al. (2009). "Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics". Circulation. 119 (11): 1541–51. doi:10.1161/CIRCULATIONAHA.109.191959. PMID 19246689.
  5. ↑ 5.0 5.1 5.2 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Thorac Cardiovasc Surg. 148 (1): e1–e132. doi:10.1016/j.jtcvs.2014.05.014. PMID 24939033.
Retrieved from "https://www.wikidoc.org/index.php?title=Rheumatic_fever_secondary_prevention&oldid=1642895"