Pharyngitis secondary prevention
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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 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 GAS 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
Strategies for secondary prevention of disease recurrence are necessary to reduce morbidity and mortality in patients with a history of ARF and/or RHD. At the time of diagnosis of ARF, a course of therapy for treatment of GAS pharyngitis should be initiated. Once it is completed, a prophylaxis regimen should be initiated which include intramuscular benzathine penicillin G every 3–4 weeks or twice-daily oral penicillin is preferred, and sulfadiazine or macrolides are acceptable in the penicillin-allergic patient.
Prophylaxis is continued into adulthood, with 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 withour 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 |
Routine treatment of asymptomatic GAS carriers is not indicated, unless during a recurrent GAS outbreak among family members, outbreak of rheumatic fever , or in a patient with a personal history of acute rheumatic fever or rheumatic heart disease. Chemoprophylaxis with penicillin (or macrolides if there is penicillin allergy) should be considered for GAS carriers with a well-documented history of rheumatic fever or rheumatic heart disease. Tonsillectomy may be an option for patients with recurrent streptococcal infections. Safe sex counseling to avoid HIV, Neisseria gonorrhoeae or Chlamydia transmission.[2]
Secondary Prevention
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
- ↑ 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