Rheumatic fever medical therapy: Difference between revisions
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Some patients develop significant [[carditis]] which manifests as [[congestive heart failure]]. This requires the usual treatment for heart failure: [[diuretics]] and [[digoxin]]. Unlike normal heart failure, rheumatic heart failure responds well to [[corticosteroids]]. | Some patients develop significant [[carditis]] which manifests as [[congestive heart failure]]. This requires the usual treatment for heart failure: [[diuretics]] and [[digoxin]]. Unlike normal heart failure, rheumatic heart failure responds well to [[corticosteroids]]. | ||
==National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand Treatment Guidelines<ref name="pmid17547548">{{cite journal| author=Carapetis JR, Brown A, Wilson NJ, Edwards KN, Rheumatic Fever Guidelines Writing Group| title=An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline. | journal=Med J Aust | year= 2007 | volume= 186 | issue= 11 | pages= 581-6 | pmid=17547548 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17547548 }} </ref>== | |||
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'''All cases''' | |||
Single dose intramuscular benzathine [[penicillin]] G (preferable) or oral penicillin V for 10 days (intravenous penicillin not needed; oral [[erythromycin]] may be used if patient allergic to penicillin) | |||
'''[[Arthritis]] and [[fever]]''' | |||
*[[Paracetamol]] (first-line) or [[codeine]] until diagnosis confirmed | |||
*[[Aspirin]] (first-line) or [[naproxen]] once diagnosis confirmed, if [[arthritis]] or severe [[arthralgia]] present | |||
*Mild arthralgia and fever may respond to paracetamol alone | |||
*[[Influenza vaccine]] for children receiving aspirin during the influenza season (autumn/winter) | |||
'''[[Chorea]]''' | |||
*No treatment for most cases | |||
*[[Carbamazepine]] or [[valproic acid]] if treatment is necessary | |||
'''[[Carditis]]/[[heart failure]]''' | |||
*Bed-rest | |||
*Urgent echocardiogram | |||
*Anti-heart failure medication | |||
**[[Diuretics]]/fluid restriction for mild to moderate heart failure | |||
**[[ACE inhibitors]] for more severe [[heart failure]], particularly if aortic regurgitation present | |||
**[[Glucocorticoid]]s optional for severe [[carditis]] (consider treating for possible opportunistic infections) | |||
**[[Digoxin]] if atrial fibrillation present | |||
*Valve surgery for life-threatening acute carditis (rare) | |||
'''Long-term preventive measures''' | |||
*Give first dose of [[Rheumatic fever secondary prevention|secondary prophylaxis]] | |||
*Notify case for recording in ARF/RHD register, if available | |||
*Contact local health staff to ensure follow-up | |||
*Provide culturally appropriate education to patient and family | |||
*Arrange dental review and ongoing dental care to reduce risk of [[endocarditis]]}} | |||
==References== | ==References== | ||
Revision as of 18:39, 6 October 2011
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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]
Treatment
The management of acute rheumatic fever is geared toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids. Individuals with positive cultures for strep throat should also be treated with antibiotics. Another important cornerstone in treating rheumatic fever includes the continuous use of low dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.
Infection
Patients with positive cultures for streptococcus pyogenes should be treated with penicillin as long as allergy is not present. This treatment will not alter the course of the acute disease.
Inflammation
Patients with significant symptoms may require corticosteroids. Salicylates are useful for pain.
Heart failure
Some patients develop significant carditis which manifests as congestive heart failure. This requires the usual treatment for heart failure: diuretics and digoxin. Unlike normal heart failure, rheumatic heart failure responds well to corticosteroids.
National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand Treatment Guidelines[1]
| “ |
All cases Single dose intramuscular benzathine penicillin G (preferable) or oral penicillin V for 10 days (intravenous penicillin not needed; oral erythromycin may be used if patient allergic to penicillin)
Long-term preventive measures
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” |
References
- ↑ Carapetis JR, Brown A, Wilson NJ, Edwards KN, Rheumatic Fever Guidelines Writing Group (2007). "An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline". Med J Aust. 186 (11): 581–6. PMID 17547548.