These are chronic sequelae of rheumatic fever consisting of valvular damage, usually involving left heart valves, with progression and complications.
Acute stage: bed rest and supportive care.
Intensive health education for prevention of sore throats.
Acute rheumatic fever
For eradication of streptococci in throat:
- Benzathine benzylpenicillin (depot formulation), IM, 1.2 million units as a single dose. OR
- Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days.
Penicillin allergy: Macrolide, e.g.:
- Erythromycin, oral, 250 mg 6 hourly for 10 days.
Prevention of recurrent rheumatic fever
All patients with confirmed rheumatic fever and no rheumatic valvular disease – treat until 21 years of age.
All patients with confirmed rheumatic fever and rheumatic valvular disease – treat until 35 years of age.
- Benzathine benzylpenicillin (depot formulation), IM, 1.2 million units every 3–4 weeks. OR
- Phenoxymethylpenicillin, oral, 250 mg 12 hourly.
- Erythromycin, oral, 250 mg 12 hourly
Prophylaxis for infective endocarditis See Endocarditis, infective.
» Where surgery is contemplated.
» Management of intractable heart failure or other non-responding complications.
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