Pharyngitis secondary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
Secondary prevention of [[pharyngitis]] is crucial in patients who 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 of [[pharyngitis]] is crucial in patients who 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 == | ||
[[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 includes 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]]. | [[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 includes [[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.<ref name="pmid22944886">Kociolek LK, Shulman ST (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22944886 In the clinic. Pharyngitis.] ''Ann Intern Med'' 157 (5):ITC3-1 - ITC3-16. [http://dx.doi.org/10.7326/0003-4819-157-5-20120904-01003 DOI:10.7326/0003-4819-157-5-20120904-01003] PMID: [https://pubmed.gov/22944886 22944886]</ref> | [[Prophylaxis]] is continued into adulthood and the duration of [[prophylaxis]] depending on the severity of [[carditis]], if present.<ref name="pmid22944886">Kociolek LK, Shulman ST (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22944886 In the clinic. Pharyngitis.] ''Ann Intern Med'' 157 (5):ITC3-1 - ITC3-16. [http://dx.doi.org/10.7326/0003-4819-157-5-20120904-01003 DOI:10.7326/0003-4819-157-5-20120904-01003] PMID: [https://pubmed.gov/22944886 22944886]</ref> | ||
Latest revision as of 12:48, 12 December 2020
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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 who 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 includes 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
- ↑ 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