Rheumatic fever primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Prevention
Most streptococcal pharyngitis when treated with appropriate antibiotics prevents acute rheumatic fever[1]. Unfortunately, at least one third of episodes of acute rheumatic fever result from inapparent streptococcal infections[2]. In addition, some symptomatic patients do not seek medical care. In these instances, rheumatic fever is not preventable.
| Agent | Children ≤ 27 kg (60 lb) | Adolescents and Adults > 27 kg (60 lb) | Mode | Duration | Rating |
|---|---|---|---|---|---|
| Penicillin Therapy | |||||
| Penicillin V (phenoxymethyl penicillin) | 250 mg 2 to 3 times daily | 500 mg 2 to 3 times daily | Oral | 10 days | Class I, LOE B |
| or | |||||
| Amoxicillin | 50 mg/kg once daily (maximum 1 g) | 50 mg/kg once daily (maximum 1 g) | Oral | 10 days | Class I, LOE B |
| or | |||||
| Benzathine penicillin G | 600,000 U | 1,200,000 U | Intramuscular | Once | Class I, LOE B |
| For individuals allergic to penicillin | |||||
| Cephalosporin (cephalexin, cefadroxil) | Variable | Oral | 10 days | Class I, LOE B | |
| or | |||||
| Clindamycin | 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) | Oral | 10 days | Class IIa, LOE B | |
| or | |||||
| Azithromycin | 12 mg/kg once daily (maximum 500 mg) | Oral | 5 days | Class IIa, LOE B | |
| or | |||||
| Clarithromycin | 15 mg/kg per day divided BID (maximum 250 mg BID) | Oral | 10 days | Class IIa, LOE B | |
References
- ↑ DENNY FW, WANNAMAKER LW, BRINK WR, RAMMELKAMP CH, CUSTER EA (1950). "Prevention of rheumatic fever; treatment of the preceding streptococcic infection". J Am Med Assoc. 143 (2): 151–3. PMID 15415234.
- ↑ Dajani AS (1991). "Current status of nonsuppurative complications of group A streptococci". Pediatr Infect Dis J. 10 (10 Suppl): S25–7. PMID 1945592.
- ↑ 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.