Rheumatic fever medical therapy
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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
Antibiotic treatment in patients with rheumatic fever is aimed at eradication of group A streptococcus from the body. Patients with positive cultures for streptococcus pyogenes and even those suspected to have strep infection should be treated with penicillin as long as allergy is not present. This treatment will not alter the course of the acute disease. Oral penicillin V is the drug of choice, but ampicillin and amoxicillin are equally effective. Intramuscular benzathine penicillin is an alternative when oral penicillin is not feasible.
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.
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]
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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)
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.