Rheumatic fever primary prevention: Difference between revisions
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Intramuscular [[benzathine penicillin G]] and oral [[penicillin V]] are the recommended antibiotics in treatment of group A streptococcal infection in absence of [[penicillin allergy]]. Patients who are allergic to penicillin should be treated with narrow-spectrum [[cephalosporin]]<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>. | Intramuscular [[benzathine penicillin G]] and oral [[penicillin V]] are the recommended antibiotics in treatment of group A streptococcal infection in absence of [[penicillin allergy]]. Patients who are allergic to penicillin should be treated with narrow-spectrum [[cephalosporin]]<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>. | ||
==Treatment Regimen== | ==Treatment Regimen== | ||
Revision as of 15:30, 19 August 2015
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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]
Overview
Treatment of streptococcal pharyngitis with appropriate antibiotics most often prevents development of rheumatic fever.
Primary 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. The key to primary prevention is reducing exposure to group A streptococci, which requires dramatic improvements in housing, hygiene infrastructure and access to health care for individuals in the developing countries[3].
Intramuscular benzathine penicillin G and oral penicillin V are the recommended antibiotics in treatment of group A streptococcal infection in absence of penicillin allergy. Patients who are allergic to penicillin should be treated with narrow-spectrum cephalosporin[4].
Treatment Regimen
- Preferred regimen: Penicillin V (Phenoxymethyl penicillin) 500 mg PO 2 to 3 times daily for 10 days OR Amoxicillin 50 mg/kg PO qd (maximum 1 g) oral for 10 days OR Benzathine penicillin G IM 600 000 U for patients ≤27 kg (60 lb); 1 200 000 U for patients >27 kg (60 lb) once.
- Alternative regimen: Narrow-spectrum Cephalosporin†(Cephalexin, Cefadroxil) PO for 10 days OR Clindamycin 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) PO for 10 days OR Azithromycin 12 mg/kg PO qd (maximum 500 mg) for 5 days OR Clarithromycin 15 mg/kg per day PO bid (maximum 250 mg bid) for 10 days.[4]
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.
- ↑ Robertson KA, Volmink JA, Mayosi BM (2005). "Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis". BMC Cardiovasc Disord. 5 (1): 11. doi:10.1186/1471-2261-5-11. PMC 1164408. PMID 15927077.
- ↑ 4.0 4.1 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.