Materiały źródłowe

• #1 Rheumatic fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/diagnosis-treatment/drc-20354594

  The goals of treatment for rheumatic fever are to: […] Rheumatic fever is treated with medicines, including: […] Antibiotics. Penicillin or another antibiotic is usually given to kill the strep bacteria. […] After the first antibiotic treatment is fully finished, another round of antibiotics may be given. This stops the rheumatic fever from coming back. A child might need to continue taking antibiotics for 5 years or through age 21 to prevent rheumatic fever from coming back, whichever is longer. […] People who had heart inflammation during rheumatic fever might need to continue antibiotics for 10 years or longer. […] Anti-inflammatory drugs. Aspirin or naproxen (Naprosyn, Naprelan, Anaprox DS) can help reduce inflammation, fever and pain. […] If symptoms are severe or don’t improve with anti-inflammatory medicines, a corticosteroid might be prescribed.

• #1 Acute rheumatic fever – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-rheumatic-fever/

  Management of ARF involves antibiotics to treat acute GAS infection, supportive management for fever and/or arthritis, management of associated complications, and long-term antibiotic prophylaxis to prevent ARF recurrence and RHD progression. […] The following antibiotics are recommended for the eradication of GAS after pharyngitis. […] First-line: oral penicillin V or IM penicillin G. […] In patients with penicillin allergy, use: Cephalosporins (hypersensitivity without anaphylaxis) or macrolides (severe hypersensitivity to beta-lactam antibiotics). […] There is insufficient evidence to recommend specific antibiotics for the eradication of GAS and prevention of ARF after skin and soft tissue infections; follow standard recommendations for antibiotic therapy for soft tissue infection.

• #1 Acute Rheumatic Fever Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333103-treatment

  Treatment strategies for acute rheumatic fever (ARF) can be divided into the following: […] The primary goal of treating an ARF attack is to eradicate streptococcal organisms and bacterial antigens from the pharyngeal region. Penicillin is the drug of choice in persons who are not at risk of allergic reaction. A single parenteral injection of benzathine benzylpenicillin can ensure compliance. Oral cephalosporins, rather than erythromycin, are recommended as an alternative in patients who are allergic to penicillin. However, be cautious of the 20% cross-reactivity of the cephalosporins with penicillin. […] Aspirin is recommended for all patients with arthritis or mild carditis. High doses of salicylates often induce dramatic clinical improvement, with reduction in fever and pain. […] Corticosteroids should be reserved for the treatment of moderate to severe carditis. Oral prednisone is preferred. If inflammation is not controlled after 2 days, an intravenous methylprednisolone pulse may be given.

• #1 Pediatric Rheumatic Fever – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/rheumatic-fever

  Treatment includes antibiotics, anti-inflammatory medicine and bed rest. […] Your child will need to have ongoing treatment to stop the disease from coming back. […] Treatment for rheumatic fever often combines the following three things: Treatment for strep. The first step is to treat the strep infection with antibiotics. This is done even if a throat culture is negative. Your child may need to take monthly doses of antibiotics to prevent future strep infections. This is to help prevent the rheumatic fever from recurring and further damaging the body. […] Anti-inflammatory medicines. Your child may take medicines to help decrease the swelling that occurs in the heart muscle. These medicines also help ease joint pain. […] Bed rest. The length of bed rest will depend on how severe your child’s illness is. Bed rest may range from two to 12 weeks. […] Talk with your child’s healthcare provider about the risks, benefits and possible side effects of all medicines.

• #1 AHA Guidelines on Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0201/p346.html

  Group A streptococcus (GAS) infections of the pharynx are the precipitating cause of rheumatic fever. Proper diagnosis and adequate antibiotic treatment of GAS infections can prevent acute rheumatic fever in most cases. […] Primary prevention of rheumatic fever requires adequate therapy for GAS pharyngitis. In selecting a treatment regimen, physicians should consider bacteriologic and clinical effectiveness, ease of adherence to the recommended regimen (i.e., dosing frequency, duration of therapy, and palatability), cost, spectrum of activity of the selected agent, and potential adverse effects. […] Intramuscular penicillin G benzathine, oral penicillin V potassium, and oral amoxicillin are the recommended antimicrobial agents for the treatment of GAS pharyngitis in persons without penicillin allergy. GAS resistance to penicillin has never been documented, and penicillin prevents primary attacks of rheumatic fever even when started nine days after illness onset. Patients are no longer considered contagious after 24 hours of antibiotic therapy.

• #1 Clinical Guidance for Acute Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/acute-rheumatic-fever.html

  Treatment involves antibiotics, which help prevent recurrent episodes. […] Therapy for acute rheumatic fever includes salicylates and anti-inflammatory medicines to relieve inflammation and decrease fever. […] These patients should also be started on antibiotics to eliminate any residual group A strep bacteria. Treatment is indicated regardless of the presence or absence of pharyngitis at the time of diagnosis. […] Secondary prevention of rheumatic fever requires antibiotic prophylaxis to reduce the likelihood of recurrent attacks. Long-term prophylaxis duration should be individually tailored but is usually indicated at least until age 21 years. […] Prophylaxis typically involves one of the following: An intramuscular injection of benzathine penicillin every 4 weeks or Oral penicillin V twice daily.

• #1

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/rheumatic-heart-disease.aspx

  Duration of secondary prophylaxis: Minimum 10 years after most recent episode of ARF or until age 21 years (whichever is longer), then re-evaluate. If echocardiogram then shows no or mild RHD, cease secondary prophylaxis. If echo shows moderate RHD, continue until age 35. If echo shows severe RHD or valve surgery has been performed, continue until age 40 or longer.

• #1 Acute rheumatic fever – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-rheumatic-fever/

  ARF not confirmed: Acetaminophen is preferred. […] ARF confirmed: NSAIDs, Naproxen or ibuprofen are preferred for children. […] Anti-inflammatory drugs relieve ARF symptoms. There is insufficient evidence to recommend their use to prevent progression to RHD. […] Initiate antibiotic prophylaxis to prevent ARF recurrence. […] Long-term antibiotic prophylaxis to prevent ARF recurrence is essential; ARF can recur even after an asymptomatic or appropriately treated symptomatic GAS infection. […] Indication: all patients with ARF or RHD. […] Timing: immediately after completion of antibiotics for ARF. […] First-line: IM penicillin G benzathine every 4 weeks (off-label). […] Duration: Use the longest applicable course of treatment based on patient factors. […] Adherence to long-term antibiotic prophylaxis can be challenging. Address risk factors for poor adherence and, for patients who experience pain from injections, mix local anesthetic with the injectable solution to reduce pain.

• #1 Acute Rheumatic Fever : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-rheumatic-fever-2/

  Secondary prevention […] benzathine penicillin G every 4 weeks in doses of 600,000IU for children and 1.2M IU for adolescents and those ≥27kg is used. […] If oral is preferred, patients can take penicillin V 0.5g daily for children and 1g daily for adolescents and those ≥27kg. […] Duration = 5-10 years = consultant decision. […] Symptomatic Treatment […] Arthritis […] Acetaminophen until the diagnosis is established, then treatment with naproxen 10-20mg/kg/day BID can be initiated. […] Carditis […] Restrict physical activity for 4-6 weeks […] Mild to moderate: […] ASA 80-100 mg/kg PO daily […] Moderate to severe […] Consider prednisone 2 mg/kg PO daily x 2 weeks then taper off […] Lack of evidence that corticosteroids are more effective than ASA […] No evidence for IVIG changing disease outcome […] Aspirin and corticosteroids have been shown not to demonstrate improvement in cardiac outcomes at one year after diagnosis. […] Chorea treatment is supportive […] Surgery for valvopathy – aortic regurgitation initially then progresses to stenosis

• #1 Rheumatic fever and its management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1676147/

  Rheumatic heart disease is a major cause of morbidity and mortality in low and middle income countries and among underprivileged communities in high income countries. […] Primary prevention of acute rheumatic fever requires adequate antibiotic treatment of streptococcal throat infections. […] Secondary prevention entails prevention of recurrent episodes of acute rheumatic fever and is the most effective way of preventing rheumatic heart disease. […] Corticosteroids do not reduce the risk of developing heart valve lesions after one year. […] Surgery may be a life saving measure in patients with acute rheumatic fever and major valve lesions. […] Few new treatments are available for acute rheumatic fever. […] The use of corticosteroids to treat acute cardiac decompensation in patients with acute rheumatic fever is anecdotal and is not based on objective evidence.

• #1 Rheumatic fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/diagnosis-treatment/drc-20354594

  Don’t give a child aspirin unless a healthcare professional tells you to do so. […] Antiseizure drugs. Medicines such as valproic acid or carbamazepine (Carbatrol, Tegretol, others) may be used to treat severe involuntary movements caused by Sydenham chorea. […] It’s important to have regular health checkups after having rheumatic fever. Heart damage from rheumatic fever might not show up for many years even decades. Always tell your healthcare provider about any history of rheumatic fever.

• #1 Rheumatic fever: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/176648

  Corticosteroids: Prednisone may be given if the patient does not respond to first-line anti-inflammatory medications, or if there is inflammation of the heart. […] Aspirin: This is not usually recommended for children aged under 16 years because of the risk of developing Reyes syndrome, which can cause liver and brain damage, and even death, but an exception is usually made in cases of RA because the benefits are greater than the risks. […] Anticonvulsant medications: These can treat severe chorea symptoms. Examples include valproic acid (Depakene or Stavzor), carbamazepine (Carbatrol or Equetro), haloperidol (Haldol) and risperidone (Risperdal). […] Anyone who has RF as a child will need to inform their doctor as they get older because heart damage can appear many years later.

• #1 Acute Rheumatic Fever Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333103-treatment

  Mild heart failure usually responds to rest and corticosteroid therapy. In patients with congestive heart failure (CHF), additional treatment includes digoxin and diuretics, afterload reduction, supplemental oxygen, bed rest, and sodium and fluid restriction. […] Wilson et al report that treatment with hydroxychloroquine proved effective in 2 patients with rheumatic carditis and a protracted inflammatory course. […] Sydenham chorea requires long-term antimicrobial prophylaxis, even if no other manifestations of rheumatic fever evolve. […] A number of drugs have been used off label for symptomatic treatment of Sydenham chorea, including anticonvulsants (eg, valproate, carbamazepine) and neuroleptics (eg, pimozide, haloperidol, risperidone, olanzapine). […] Valve replacement should be considered in patients with active carditis, especially those with cases that are refractory to medical care or require high doses of vasodilators and diuretics.

• #1 Rheumatic Fever: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/rheumatic-fever-pro

  IM penicillin is a painful injection – reconstituting it with 1% lidocaine is recommended to reduce the pain. […] Aspirin usually relieves arthritis within a few days. High doses are required and other NSAIDs like naproxen may be safer. […] Heart failure will require usual management. If this fails, consider cardiac surgery – even in acute failure. Mitral valve repair or replacement may be life-saving. […] Chorea is often self-limiting but is likely to need suppression with diazepam. Chorea may be treated with haloperidol, although this drug can cause extrapyramidal effects. Other possible treatments include steroids, intravenous immunoglobulin and plasma exchange.

• #1 Rheumatic fever – Wikipedia

  https://en.wikipedia.org/wiki/Rheumatic_fever

  Aspirin at high doses has historically been used for treatment of rheumatic fever. […] However, due to side effects like gastritis and salicylate poisoning, necessitating serum monitoring of salicylate levels, and the risk of Reye syndrome, a serious and potentially deadly condition that may arise in children treated with aspirin or aspirin-containing products, alternatives to aspirin have been sought, especially in children. […] While evidence suggests that treatment of rheumatic fever associated arthritis with naproxen may be equally effective as with aspirin, its role in managing carditis has not been established. […] Management of carditis in acute rheumatic fever is controversial and based on dated literature. […] Corticosteroids may be considered, especially in people with allergies to NSAIDs or severe disease, although use of steroids may cause tissue atrophy, which could present challenges during future cardiac surgery for valve repair. […] Some patients develop significant carditis which manifests as congestive heart failure. This requires the usual treatment for heart failure: ACE inhibitors, diuretics, beta blockers, and digoxin. […] Unlike typical heart failure, rheumatic heart failure responds well to corticosteroids.

• #1 Rheumatic Heart Disease: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21485-rheumatic-heart-disease

  Rheumatic heart disease treatments can help you manage symptoms and may delay disease progress. But they cant cure the condition. Treatments include: […] Your provider may recommend medication to manage heart failure or an abnormal heartbeat. Anticoagulants (blood thinners) can reduce the risk of stroke or blood clots if you have a narrow mitral valve or atrial fibrillation. […] If you have severe rheumatic heart disease, you may need heart valve surgery. A surgeon repairs or replaces damaged heart valves. If they cant fix your valve, they can replace the damaged valve with an artificial valve or a tissue valve. In some cases, they may perform a Ross procedure, where a surgeon swaps one of your healthy valves for the damaged valve and then puts a new valve in place of the healthy one they relocated.

• #1 Treatment for Rheumatic Heart Disease | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/rheumatic-heart-disease/treatments.html

  Specific treatment for rheumatic heart disease will be determined by your physician based on: […] Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever from occurring. Penicillin and other antibiotics can usually treat strep throat (a streptococcus A bacterial infection) and stop acute rheumatic fever from developing. […] Persons who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of rheumatic fever and lower the risk of heart damage. […] Antibiotic therapy has sharply reduced the incidence and mortality rate of rheumatic fever/rheumatic heart disease. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given. Surgery may be necessary to repair or replace the damaged valve.

• #1 Rheumatic Fever: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/rheumatic-fever-pro

  Rheumatic fever treatment and management […] The main aims of management are to: […] Eradicate the streptococcal infection if infection is still present (usually a pharyngitis). […] Suppress inflammation arising from the autoimmune response. […] Provide supportive treatment, particularly for cardiac complications such as congestive cardiac failure. […] This is one of the very few conditions in which bed rest is enforced even if the patient feels well enough to be up and about. Full activity should not be resumed until markers for inflammation and infection (acute-phase reactants) have returned to normal. […] The initial infection should be treated with appropriate antibiotics – IM benzathine penicillin is usually recommended. Azithromycin is recommended in cases of true penicillin allergy and it may also be worth discussing with your local microbiology team.

• #1 Acute rheumatic fever: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/acute-rheumatic-fever-treatment-and-prevention/print

  Acute rheumatic fever: Treatment and prevention […] Treatment and secondary prevention of rheumatic fever are reviewed here. […] Treatment of ARF consists of antibiotic therapy, antiinflammatory therapy, heart failure management, and commencement of ongoing care (secondary prevention and provision of education). […] Hospitalization is advisable for optimal management of ARF, especially for an initial episode, so that all tests can be completed, response to therapy can be observed, and long-term preventative measures can be started with appropriate education for the patient and their caregivers. […] The six major goals of treatment are: […] Eradication of group A beta-hemolytic Streptococcus (GAS).

• #1 Rheumatic Fever In Children & Young People | KidsHealth New Zealand’s Trusted Voice On Children’s Health

  https://www.kidshealth.org.nz/rheumatic-fever/rheumatic-fever

  Rheumatic fever is a serious illness. […] Without treatment, the strep throat can cause rheumatic fever. […] The treatment for sore joints is rest and pain relief. […] Your child will have penicillin to get rid of the strep bacteria. […] It’s very important that your child doesn’t get rheumatic fever again. This can cause more damage to their heart. […] With proper care and regular penicillin injections, most people who have had rheumatic fever lead a normal life. Penicillin is the best antibiotic to prevent rheumatic fever. […] The best way to prevent rheumatic fever is to make sure your child has regular penicillin injections on time. Penicillin kills the strep bacteria that trigger rheumatic fever, stopping any further damage to your child’s heart valves. […] Your child will need to have injections, usually every 28 days, for at least 10 years, or until they are 21 years old, whichever is longer.

• #1 Rheumatic Fever In Children & Young People | KidsHealth New Zealand’s Trusted Voice On Children’s Health

  https://www.kidshealth.org.nz/rheumatic-fever/rheumatic-fever

  Never stop penicillin treatment without discussing it first with your child’s doctor, as your child could get rheumatic fever again. […] Tell every health professional, dentist or dental therapist that your child has had rheumatic fever. […] Your child can look after their teeth and help to avoid any infection by: having their own toothbrush – don’t let them share with anyone, brushing their teeth twice a day with fluoride toothpaste, not having sweet food and drinks too often, having dental checks every 6 months. […] It’s important for your child 5 years and over to have the COVID-19 vaccine. It’s especially important for those with underlying health conditions such as rheumatic heart disease.

• #1 Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rheumatic-heart-disease

  Treatment of ARF involves giving antibiotics to treat the responsible group A streptococcal infection. Symptoms can be treated with medicines for pain, fever, and inflammation. […] Treatment of RHD can manage symptoms and prevent complications. Management for someone diagnosed with RHD may involve: Regular check-ups with a cardiologist (heart specialist) to monitor the heart, Surgery to repair or replace damaged heart valves, Giving medication to treat heart failure, which may involve admission to hospital, Blood-thinning medicine to prevent stroke after valve replacement, or if an abnormal heart rhythm develops, Good antenatal care, as pregnancy can make rheumatic heart disease worse, Regular (preventive) antibiotics to prevent further group A streptococcal infections, Early treatment of possible group A streptococcal infections, Vaccinations (influenza and pneumococcal) to prevent other illnesses that may put strain on the heart, Good dental hygiene (tooth brushing and flossing) and regular dental check-ups, to stop mouth bacteria getting into the blood and causing infection of damaged heart valves, Antibiotics are given before some dental or surgical procedures to prevent infection of the heart.

• #1 Therapeutics for rheumatic fever and rheumatic heart disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9427630/

  The goals of acute rheumatic fever therapy are to relieve symptoms, mitigate cardiac valve damage and eradicate streptococcal infection. Preventing future recurrences requires long-term secondary antibiotic prophylaxis and ongoing prevention of Streptococcus pyogenes (group A streptococcus) infections. […] The recommended regimen for secondary prophylaxis comprises benzathine benzylpenicillin G intramuscular injections every four weeks. For patients with non-severe or immediate penicillin hypersensitivity, use erythromycin orally twice daily. […] The goals of therapy for rheumatic heart disease are to prevent progression and optimise cardiac function. Secondary antibiotic prophylaxis can reduce the long-term severity of rheumatic heart disease. […] Patients with rheumatic heart disease, including those receiving benzathine benzylpenicillin G prophylaxis, should receive amoxicillin prophylaxis before undergoing high-risk dental or surgical procedures. If they have recently been treated with a course of penicillin or amoxicillin, or have immediate penicillin hypersensitivity, clindamycin is recommended.

• #1 Rheumatic Fever: Causes, Symptoms, Treatment, Diagnostic Criteria

  https://www.medicinenet.com/rheumatic_fever/article.htm

  What is the treatment for rheumatic fever? Patients with rheumatic fever can survive and recover with appropriate treatment. Early diagnosis and treatment are essential to prevent the development of serious complications. […] With prompt and effective treatment, most people with rheumatic fever recover completely within a few weeks to several months. However, in some cases, the damage to the heart valves caused by rheumatic fever may be permanent, leading to long-term complications such as rheumatic heart disease. […] The first step in treating rheumatic fever is to eradicate the bacteria (usually with penicillin) that initially caused the immunologic response. For penicillin-allergic patients, there are other options such as erythromycin, azithromycin, or a member of the cephalosporin family.

• #1 Rheumatic Fever And Post-streptococcal Reactive Arthritis

  https://www.printo.it/pediatric-rheumatology/GB/info/10/Rheumatic-Fever-And-Post-streptococcal-Reactive-Arthritis

  There are many complementary and alternative therapies available and this can be confusing for patients and their families. […] Regular check-ups and periodic tests may be required during long-term disease course. […] Acute symptoms of the disease recede over several days to weeks. However, the risk of recurrent attacks of acute rheumatic fever persists and heart involvement can cause life-long symptoms. […] Complete recovery is possible, unless carditis resulted in severe heart valve damage.

• #1 Therapeutics for rheumatic fever and rheumatic heart disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9427630/

  Secondary antibiotic prophylaxis is the mainstay of treatment for acute rheumatic fever and rheumatic heart disease globally to prevent recurrences of rheumatic fever and thereby prevent cumulative valve damage with the development or progression of rheumatic heart disease. The recommended regimen is intramuscular injections of benzathine benzylpenicillin G every four weeks for a minimum of five years (if there is no cardiac involvement) or 10 years (if there is cardiac involvement) after the last acute rheumatic fever episode or until 21 years of age, whichever is longer. […] The duration of treatment is guided by the disease severity, clinical response and concentrations of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate). Most episodes of acute rheumatic fever resolve within six weeks and 90% resolve within 12 weeks. A rebound in inflammatory symptoms can occur on ceasing treatment, requiring the drugs to be re-introduced. […] Secondary antibiotic prophylaxis is the only treatment confirmed to be associated with a long-term reduction in the severity of rheumatic heart disease. Patients with moderate to severe rheumatic heart disease require cardiology services and regular echocardiographic follow-up.

• #1 Rheumatic fever – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/syc-20354588

  Rheumatic fever can cause long-lasting heart damage, including heart valve problems and heart failure. Treatment includes medicines to kill the strep bacteria. Other medicines are used to treat pain and prevent complications. […] The best way to prevent rheumatic fever is to treat strep throat infections or scarlet fever right away. It’s also important to finish all of the prescribed antibiotics as directed.

• #1 Primary prevention of acute rheumatic fever

  https://www1.racgp.org.au/ajgp/2021/may/primary-prevention-of-acute-rheumatic-fever

  Primary prevention involves the identification of Strep A infections and delivery of appropriate antibiotic treatment to prevent ARF (as distinct from antibiotic treatment to shorten the duration of infection, heal the sores or provide symptomatic relief). The evidence that treatment of Strep A throat infections can prevent ARF is strong, albeit based on historic studies. Prompt treatment with oral penicillin is reported to reduce the attack rate of ARF following Strep A throat infection by approximately 70%, increasing to 80% if a single intramuscular injection of benzathine benzylpenicillin G (BPG) is given. […] People who may be at high risk of ARF require primary prevention antibiotic treatment for sore throat. First-line treatment is a single immediate dose of intramuscular BPG delivered according to evidence-based guidance to minimise the pain of injection delivery.

• #1 Primary prevention of acute rheumatic fever

  https://www1.racgp.org.au/ajgp/2021/may/primary-prevention-of-acute-rheumatic-fever

  There is also a range of guidelines for treatment of Strep A skin infection, including the National healthy skin guideline: For the prevention, treatment and public health control of impetigo, scabies, crusted scabies and tinea for Indigenous populations and communities in Australia. Skin infections are generally not caused by viruses, and the decision to initiate antibiotics for skin infection is usually clearer than for sore throat. […] Systemic treatment with oral cotrimoxazole is more appropriate as primary prevention for people at risk of ARF. A three-day course of twice-daily trimethoprim/sulfamethoxazole should be offered; where injectable therapy is preferred, a single dose of BPG may be given. […] Development of ARF can be prevented by early detection and appropriate antibiotic treatment of sore throats and skin sores for higher-risk groups.

• #1 Rheumatic fever

  https://info.health.nz/conditions-treatments/infectious-diseases/rheumatic-fever

  If tamariki and rangatahi have a sore throat which could be strep throat, they will be given antibiotics to clear up the infection before it can develop into rheumatic fever. A full course of antibiotics is 10 days. It is important they take the full course of antibiotics, even if they feel better. This makes it much less likely that strep throat will lead to rheumatic fever, which can cause serious complications and typically requires hospital treatment. […] To prevent more episodes of rheumatic fever that can lead to rheumatic heart disease, it is important to stop further strep throat infections. This requires penicillin injections every 28 days for at least 10 years. These injections may be needed into adulthood. […] Your local health district will have services to help coordinate care if you need antibiotics to help prevent acute rheumatic fever occurring again, or rheumatic heart disease.

• #1 Rheumatic fever and its management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1676147/

  Occasionally, costly open heart surgery may be the only option to manage severe heart valve lesions that occur in patients with rheumatic heart disease. […] Prevention of recurrent attacks of rheumatic fever is the most cost effective way of preventing rheumatic heart disease. […] Penicillin remains the antibiotic of choice. […] The occurrence of numerous M protein serotypes that are rheumatogenic has complicated the development of vaccines, and research is ongoing. […] Appropriate public health control programmes and optimal medical care do reduce the burden of acute rheumatic fever.

• #2 Acute Rheumatic Fever Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333103-treatment

  Treatment strategies for acute rheumatic fever (ARF) can be divided into the following: […] The primary goal of treating an ARF attack is to eradicate streptococcal organisms and bacterial antigens from the pharyngeal region. Penicillin is the drug of choice in persons who are not at risk of allergic reaction. A single parenteral injection of benzathine benzylpenicillin can ensure compliance. Oral cephalosporins, rather than erythromycin, are recommended as an alternative in patients who are allergic to penicillin. However, be cautious of the 20% cross-reactivity of the cephalosporins with penicillin. […] Aspirin is recommended for all patients with arthritis or mild carditis. High doses of salicylates often induce dramatic clinical improvement, with reduction in fever and pain. […] Corticosteroids should be reserved for the treatment of moderate to severe carditis. Oral prednisone is preferred. If inflammation is not controlled after 2 days, an intravenous methylprednisolone pulse may be given.

• #2 Clinical Guidance for Acute Rheumatic Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/acute-rheumatic-fever.html

  Treatment involves antibiotics, which help prevent recurrent episodes. […] Therapy for acute rheumatic fever includes salicylates and anti-inflammatory medicines to relieve inflammation and decrease fever. […] These patients should also be started on antibiotics to eliminate any residual group A strep bacteria. Treatment is indicated regardless of the presence or absence of pharyngitis at the time of diagnosis. […] Secondary prevention of rheumatic fever requires antibiotic prophylaxis to reduce the likelihood of recurrent attacks. Long-term prophylaxis duration should be individually tailored but is usually indicated at least until age 21 years. […] Prophylaxis typically involves one of the following: An intramuscular injection of benzathine penicillin every 4 weeks or Oral penicillin V twice daily.

• #2 Acute Rheumatic Fever : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-rheumatic-fever-2/

  Recommended Treatment […] Treatment is divided into primary treatment, secondary prevention and symptomatic treatment […] Treat inciting GAS infection […] Symptomatic treatment (e.g. arthritis, carditis, and chorea) […] Prevent progression to chronic RHD […] GAS infection should be treated regardless of presence of pharyngitis […] Single IM dose of Penicillin G benzathine is preferred – avoids noncompliance and is first dose in secondary prophylaxis. […] Benzathine penicillin G 600,000 IU for children and 1.2M IU for adolescents and those ≥27kg. […] OR […] 10 days of penicillin V 250mg BID for children and 500mg BID for adolescents or those ≥27kg. […] Patients with carditis causing heart failure or rheumatic heart disease will require additional cardiac treatment which will not be discussed in this clinical summary.

• #2 Acute rheumatic fever – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-rheumatic-fever/

  Management of ARF involves antibiotics to treat acute GAS infection, supportive management for fever and/or arthritis, management of associated complications, and long-term antibiotic prophylaxis to prevent ARF recurrence and RHD progression. […] The following antibiotics are recommended for the eradication of GAS after pharyngitis. […] First-line: oral penicillin V or IM penicillin G. […] In patients with penicillin allergy, use: Cephalosporins (hypersensitivity without anaphylaxis) or macrolides (severe hypersensitivity to beta-lactam antibiotics). […] There is insufficient evidence to recommend specific antibiotics for the eradication of GAS and prevention of ARF after skin and soft tissue infections; follow standard recommendations for antibiotic therapy for soft tissue infection.

• #2 Therapeutics for rheumatic fever and rheumatic heart disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9427630/

  Secondary antibiotic prophylaxis is the mainstay of treatment for acute rheumatic fever and rheumatic heart disease globally to prevent recurrences of rheumatic fever and thereby prevent cumulative valve damage with the development or progression of rheumatic heart disease. The recommended regimen is intramuscular injections of benzathine benzylpenicillin G every four weeks for a minimum of five years (if there is no cardiac involvement) or 10 years (if there is cardiac involvement) after the last acute rheumatic fever episode or until 21 years of age, whichever is longer. […] The duration of treatment is guided by the disease severity, clinical response and concentrations of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate). Most episodes of acute rheumatic fever resolve within six weeks and 90% resolve within 12 weeks. A rebound in inflammatory symptoms can occur on ceasing treatment, requiring the drugs to be re-introduced. […] Secondary antibiotic prophylaxis is the only treatment confirmed to be associated with a long-term reduction in the severity of rheumatic heart disease. Patients with moderate to severe rheumatic heart disease require cardiology services and regular echocardiographic follow-up.

• #2 Rheumatic Fever: Causes, Symptoms (Rash) & Treatment

  https://my.clevelandclinic.org/health/diseases/16616-rheumatic-fever

  Rheumatic fever treatment first focuses on getting rid of the bacterial infection. Treatments then address inflammation inside your childs body. […] Treatment for rheumatic fever may include: […] Antibiotics: Healthcare providers prescribe antibiotics to treat the underlying bacterial infection. Some antibiotics are one injection (shot). Others your child takes by mouth for a week or more. […] Anti-inflammatory medications: Your childs provider will likely recommend a medication to reduce inflammation throughout your childs body. This medication may also relieve symptoms such as joint pain. For severe symptoms, your childs provider may prescribe a stronger medication (corticosteroids). […] Other therapies: Rheumatic fever can affect people in different ways. Your childs provider may recommend other treatments based on how the condition affects them. In severe cases, your child may need heart surgery or joint treatments to treat serious complications.

• #2 Therapeutics for rheumatic fever and heart disease

  https://australianprescriber.tg.org.au/articles/therapeutics-for-rheumatic-fever-and-rheumatic-heart-disease.html

  Symptom management is critical to reduce morbidity and return children home and to school. The goals of acute rheumatic fever therapy are to: relieve symptoms, mitigate cardiac damage, eradicate the inciting streptococcal infection, prevent future recurrences. […] Naproxen and ibuprofen are the recommended first-line anti-inflammatory analgesics for rheumatic arthritis. Aspirin is now used second line due to its less favourable safety profile. […] The duration of treatment is guided by the disease severity, clinical response and concentrations of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate). Most episodes of acute rheumatic fever resolve within six weeks and 90% resolve within 12 weeks. […] Secondary antibiotic prophylaxis is the mainstay of treatment for acute rheumatic fever and rheumatic heart disease globally to prevent recurrences of rheumatic fever and thereby prevent cumulative valve damage with the development or progression of rheumatic heart disease. The recommended regimen is intramuscular injections of benzathine benzylpenicillin G every four weeks for a minimum of five years (if there is no cardiac involvement) or 10 years (if there is cardiac involvement) after the last acute rheumatic fever episode or until 21 years of age, whichever is longer. […] Secondary antibiotic prophylaxis is the only treatment confirmed to be associated with a long-term reduction in the severity of rheumatic heart disease.

• #2 Rheumatic Fever

  https://www.arthritis.org/diseases/rheumatic-fever

  Proper treatment of strep throat can prevent this life-threatening disease. […] The goals of treatment are to destroy bacteria, relieve symptoms and prevent recurrences. Treatment often include: […] Antibiotics, such as penicillin, to eliminate any remaining strep bacteria. […] Long-term antibiotic treatment to prevent recurrence. […] Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, to reduce inflammation and pain. […] Corticosteroids, such as prednisone, may be used if inflammation is severe. […] Other medications may be given to reduce severe involuntary movements.

• #2 Acute Rheumatic Fever : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-rheumatic-fever-2/

  Secondary prevention […] benzathine penicillin G every 4 weeks in doses of 600,000IU for children and 1.2M IU for adolescents and those ≥27kg is used. […] If oral is preferred, patients can take penicillin V 0.5g daily for children and 1g daily for adolescents and those ≥27kg. […] Duration = 5-10 years = consultant decision. […] Symptomatic Treatment […] Arthritis […] Acetaminophen until the diagnosis is established, then treatment with naproxen 10-20mg/kg/day BID can be initiated. […] Carditis […] Restrict physical activity for 4-6 weeks […] Mild to moderate: […] ASA 80-100 mg/kg PO daily […] Moderate to severe […] Consider prednisone 2 mg/kg PO daily x 2 weeks then taper off […] Lack of evidence that corticosteroids are more effective than ASA […] No evidence for IVIG changing disease outcome […] Aspirin and corticosteroids have been shown not to demonstrate improvement in cardiac outcomes at one year after diagnosis. […] Chorea treatment is supportive […] Surgery for valvopathy – aortic regurgitation initially then progresses to stenosis

• #2 Acute Rheumatic Fever Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333103-treatment

  Mild heart failure usually responds to rest and corticosteroid therapy. In patients with congestive heart failure (CHF), additional treatment includes digoxin and diuretics, afterload reduction, supplemental oxygen, bed rest, and sodium and fluid restriction. […] Wilson et al report that treatment with hydroxychloroquine proved effective in 2 patients with rheumatic carditis and a protracted inflammatory course. […] Sydenham chorea requires long-term antimicrobial prophylaxis, even if no other manifestations of rheumatic fever evolve. […] A number of drugs have been used off label for symptomatic treatment of Sydenham chorea, including anticonvulsants (eg, valproate, carbamazepine) and neuroleptics (eg, pimozide, haloperidol, risperidone, olanzapine). […] Valve replacement should be considered in patients with active carditis, especially those with cases that are refractory to medical care or require high doses of vasodilators and diuretics.

• #2 Rheumatic fever: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/176648

  Corticosteroids: Prednisone may be given if the patient does not respond to first-line anti-inflammatory medications, or if there is inflammation of the heart. […] Aspirin: This is not usually recommended for children aged under 16 years because of the risk of developing Reyes syndrome, which can cause liver and brain damage, and even death, but an exception is usually made in cases of RA because the benefits are greater than the risks. […] Anticonvulsant medications: These can treat severe chorea symptoms. Examples include valproic acid (Depakene or Stavzor), carbamazepine (Carbatrol or Equetro), haloperidol (Haldol) and risperidone (Risperdal). […] Anyone who has RF as a child will need to inform their doctor as they get older because heart damage can appear many years later.

• #2 Rheumatic Fever | Causes, Symptoms and Treatment

  https://patient.info/infections/rheumatic-fever-leaflet

  Rheumatic fever treatment depends on which part of the body is affected. […] For the joint pains, usually aspirin or ibuprofen is sufficient to reduce inflammation. The pains settle in a few weeks. […] For heart problems, a specialist doctor may need to prescribe medicines that relieve the strain on the heart. These are medicines like 'water’ tablets (diuretics), angiotensin-converting enzyme (ACE) inhibitors and digoxin. Sometimes the damage to the heart valves is so bad that urgent heart surgery is needed. […] The jerky movements (chorea) are sometimes difficult to treat. Generally sedatives are used like diazepam. If the chorea is very severe and lasts several weeks then specialist procedures like plasmapheresis are used: this is a way of 'cleaning’ your blood by pumping it through a special machine and back into your body.

• #2 Rheumatic Heart Disease: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21485-rheumatic-heart-disease

  Rheumatic heart disease treatments can help you manage symptoms and may delay disease progress. But they cant cure the condition. Treatments include: […] Your provider may recommend medication to manage heart failure or an abnormal heartbeat. Anticoagulants (blood thinners) can reduce the risk of stroke or blood clots if you have a narrow mitral valve or atrial fibrillation. […] If you have severe rheumatic heart disease, you may need heart valve surgery. A surgeon repairs or replaces damaged heart valves. If they cant fix your valve, they can replace the damaged valve with an artificial valve or a tissue valve. In some cases, they may perform a Ross procedure, where a surgeon swaps one of your healthy valves for the damaged valve and then puts a new valve in place of the healthy one they relocated.

• #2 Rheumatic fever and its management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1676147/

  Rheumatic heart disease is a major cause of morbidity and mortality in low and middle income countries and among underprivileged communities in high income countries. […] Primary prevention of acute rheumatic fever requires adequate antibiotic treatment of streptococcal throat infections. […] Secondary prevention entails prevention of recurrent episodes of acute rheumatic fever and is the most effective way of preventing rheumatic heart disease. […] Corticosteroids do not reduce the risk of developing heart valve lesions after one year. […] Surgery may be a life saving measure in patients with acute rheumatic fever and major valve lesions. […] Few new treatments are available for acute rheumatic fever. […] The use of corticosteroids to treat acute cardiac decompensation in patients with acute rheumatic fever is anecdotal and is not based on objective evidence.

• #2 Rheumatic Heart Disease | Symptoms and Treatment | MedStar Health

  https://www.medstarhealth.org/services/rheumatic-heart-disease

  Treatment for rheumatic heart disease will depend on the extent of damage done to the heart valves. Mild damage may not need treatment, while more severe damage may require surgery to replace or repair the valve. […] Heart surgery is an option to treat many heart conditions. You may need heart surgery either as a lifesaving procedure or when other treatments haven’t worked. […] Valve sparing surgery is a procedure to repair an aortic root aneurysm without replacing the aortic valve.

• #2 Rheumatic Fever | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/rheumatic-fever

  How do we treat rheumatic fever? Treatments vary based on your child’s age, health, and medical history, the extent of your child’s disease, his tolerance for specific medications, procedures, and therapies, and, of course, your own opinions and preference will be considered. Treatment in most cases combines the following three approaches: […] Antibiotic treatment: Your child may continue to receive monthly doses of antibiotics to help prevent further complications. […] Anti-inflammatory medication: To help decrease the swelling that occurs in the heart muscle, as well as to relieve joint pain. […] Bed rest: Often for between two and twelve weeks, depending on the severity of your child’s disease and the involvement of the heart and joints. […] After having rheumatic fever, your child will need medications on a monthly basis to help decrease the chance of developing rheumatic fever again. Usually by the time your child is 18 and your child’s physician feels he/she isn’t at risk for developing heart disease, the antibiotic therapy may be stopped. Close follow-up with your child’s physician is needed. […] Your child’s treatment may include a course of antibiotics, anti-inflammatory medications, and a period of bed rest (often between two and 12 weeks).

• #2 Rheumatic Fever | Causes, Symptoms and Treatment

  https://patient.info/infections/rheumatic-fever-leaflet

  Usually the antibiotic penicillin is given for ten days to make sure that none of the original bacterium, the streptococcus, is still in the body. […] If the heart problems are particularly bad, some people recommend penicillin until the age of 21 years at least. […] Rheumatic fever is one of the few conditions where bed rest is recommended, even if the person feels well enough to be up and about. They should rest until the blood tests for inflammation return to normal and prevent recurrence.

• #2 Acute rheumatic fever and rheumatic heart disease

  https://healthywa.wa.gov.au/Articles/A_E/Acute-rheumatic-fever-and-rheumatic-heart-disease

  If doctors think you have ARF you will most likely be sent to hospital for admission while they run more tests. […] In most cases your treatment will involve: Benzathine benzylpenicillin G injections. These are antibiotic injections given into the muscle to help prevent further Group A Streptoccocus infections, and therefore further episodes of ARF. It is the only available treatment known to reduce the risk of permanent heart damage (RHD). Injections are given at least every 21 to 28 days, for potentially many years depending on the severity of the disease. Your heart doctor (cardiologist) will determine how long you should continue to receive penicillin injections. […] While you have ARF or RHD, it is important to have your benzathine benzylpenicillin G injections every 21 to 28 days until your doctor says you can stop. You must keep your appointments with specialist doctors who will monitor the effects of the disease on your heart.

• #2 Rheumatic Fever and Rheumatic Heart Disease | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/rheumatic-fever-and-rheumatic-heart-disease

  Penicillin, aspirin and other medicines are used to treat rheumatic fever. Children will also have to stay on a low dose of penicillin for years to reduce the risk of recurrence. It’s very important to prevent a recurrence because of the risk of more damage to the heart. […] For children who do develop severe carditis, the inflammation leads to scarring and permanent damage to the heart, and particularly to the heart valves. The mitral valve, which controls the flow of blood between the upper left chamber and the lower left chamber of the heart, is most often damaged. The aortic valve, which sends the blood from the lower left chamber out to the body, is the next most commonly affected heart valve. Leakage of the heart valves is the most common finding. […] If either valve starts to leak severely, surgery to repair or replace it may be necessary. Usually this isnt necessary before adulthood, but in severe cases, surgery during youth is necessary.

• #2 Rheumatic Fever In Children & Young People | KidsHealth New Zealand’s Trusted Voice On Children’s Health

  https://www.kidshealth.org.nz/rheumatic-fever/rheumatic-fever

  Never stop penicillin treatment without discussing it first with your child’s doctor, as your child could get rheumatic fever again. […] Tell every health professional, dentist or dental therapist that your child has had rheumatic fever. […] Your child can look after their teeth and help to avoid any infection by: having their own toothbrush – don’t let them share with anyone, brushing their teeth twice a day with fluoride toothpaste, not having sweet food and drinks too often, having dental checks every 6 months. […] It’s important for your child 5 years and over to have the COVID-19 vaccine. It’s especially important for those with underlying health conditions such as rheumatic heart disease.

• #2 Rheumatic fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/diagnosis-treatment/drc-20354594

  Don’t give a child aspirin unless a healthcare professional tells you to do so. […] Antiseizure drugs. Medicines such as valproic acid or carbamazepine (Carbatrol, Tegretol, others) may be used to treat severe involuntary movements caused by Sydenham chorea. […] It’s important to have regular health checkups after having rheumatic fever. Heart damage from rheumatic fever might not show up for many years even decades. Always tell your healthcare provider about any history of rheumatic fever.

• #2 Acute rheumatic fever and rheumatic heart disease

  https://healthywa.wa.gov.au/Articles/A_E/Acute-rheumatic-fever-and-rheumatic-heart-disease

  Once you have had ARF, having regular penicillin injections at least every 21 to 28 days is the best way to prevent repeat episodes of ARF. This will also help to prevent long-term damage to the heart valves. […] Regular medicine can also prevent any existing damage to the heart valves (RHD) from getting worse. Have regular heart scans (echocardiogram) to check your heart valves.

• #2 Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rheumatic-heart-disease

  Treatment of ARF involves giving antibiotics to treat the responsible group A streptococcal infection. Symptoms can be treated with medicines for pain, fever, and inflammation. […] Treatment of RHD can manage symptoms and prevent complications. Management for someone diagnosed with RHD may involve: Regular check-ups with a cardiologist (heart specialist) to monitor the heart, Surgery to repair or replace damaged heart valves, Giving medication to treat heart failure, which may involve admission to hospital, Blood-thinning medicine to prevent stroke after valve replacement, or if an abnormal heart rhythm develops, Good antenatal care, as pregnancy can make rheumatic heart disease worse, Regular (preventive) antibiotics to prevent further group A streptococcal infections, Early treatment of possible group A streptococcal infections, Vaccinations (influenza and pneumococcal) to prevent other illnesses that may put strain on the heart, Good dental hygiene (tooth brushing and flossing) and regular dental check-ups, to stop mouth bacteria getting into the blood and causing infection of damaged heart valves, Antibiotics are given before some dental or surgical procedures to prevent infection of the heart.

• #2 Rheumatic Fever And Post-streptococcal Reactive Arthritis

  https://www.printo.it/pediatric-rheumatology/GB/info/10/Rheumatic-Fever-And-Post-streptococcal-Reactive-Arthritis

  There are many complementary and alternative therapies available and this can be confusing for patients and their families. […] Regular check-ups and periodic tests may be required during long-term disease course. […] Acute symptoms of the disease recede over several days to weeks. However, the risk of recurrent attacks of acute rheumatic fever persists and heart involvement can cause life-long symptoms. […] Complete recovery is possible, unless carditis resulted in severe heart valve damage.

• #2 Rheumatic Fever Symptoms & Treatments – BuzzRx

  https://www.buzzrx.com/blog/rheumatic-fever-symptoms-treatments

  Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and naproxen (Naprelan, Naprosyn, Aleve) are used to treat fever, pain, and inflammation. […] If severe rheumatic fever symptoms do not get better with over-the-counter anti-inflammatory drugs, corticosteroids may be prescribed to reduce inflammation. […] Carbamazepine (Tegretol, Carbatrol), valproic acid, and other antiepileptic drugs are used to control severe involuntary jerky movements (Sydenham chorea). […] If rheumatic fever develops after strep throat or scarlet fever, your childs healthcare provider will recommend long-term follow-up care to evaluate for heart damage (rheumatic heart disease). This can develop many years, even decades, after an episode of rheumatic fever. […] Rheumatic fever will not go away on its own. There is no cure for this serious condition, but treatments can help to manage the symptoms. […] Timely treatment can limit the permanent damage caused by rheumatic fever.

• #2 Primary prevention of acute rheumatic fever

  https://www1.racgp.org.au/ajgp/2021/may/primary-prevention-of-acute-rheumatic-fever

  There is also a range of guidelines for treatment of Strep A skin infection, including the National healthy skin guideline: For the prevention, treatment and public health control of impetigo, scabies, crusted scabies and tinea for Indigenous populations and communities in Australia. Skin infections are generally not caused by viruses, and the decision to initiate antibiotics for skin infection is usually clearer than for sore throat. […] Systemic treatment with oral cotrimoxazole is more appropriate as primary prevention for people at risk of ARF. A three-day course of twice-daily trimethoprim/sulfamethoxazole should be offered; where injectable therapy is preferred, a single dose of BPG may be given. […] Development of ARF can be prevented by early detection and appropriate antibiotic treatment of sore throats and skin sores for higher-risk groups.

• #2 Rheumatic fever – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/syc-20354588

  Rheumatic fever can cause long-lasting heart damage, including heart valve problems and heart failure. Treatment includes medicines to kill the strep bacteria. Other medicines are used to treat pain and prevent complications. […] The best way to prevent rheumatic fever is to treat strep throat infections or scarlet fever right away. It’s also important to finish all of the prescribed antibiotics as directed.

• #2 Acute Rheumatic Fever

  https://pedemmorsels.com/acute-rheumatic-fever-dont-forget-about-it/

  Weve discussed Strep Pharyngitis (12/3/2010) and how in treating it we are primarily focusing on preventing Rheumatic Heart Disease. […] Acute Management […] Treat the Infection […] Penicillin (Pen V for 10 days or Pen G IM) […] Alleviate Symptoms […] Salicylates are particularly effective for migratory arthritis […] High Dose ASA (80-100mg/kg/Day for several weeks, and then taper) […] NSAIDs for those who cannot tolerate ASA […] Steroids reserved for moderate to severe carditis. […] Primary prevention of acute rheumatic fever is accomplished by proper identification and adequate antibiotic treatment of group A beta-hemolytic streptococcal (GAS) tonsillopharyngitis. […] Penicillin (either oral penicillin V or injectable benzathine penicillin) is the treatment of choice.

• #3 Acute Rheumatic Fever Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333103-treatment

  Primary prevention involves eradication of Streptococcus from the pharynx, which generally entails administering a single intramuscular injection of benzathine benzylpenicillin. […] For secondary prevention, the American Heart Association (AHA) Committee on Acute Rheumatic Fever recommends a regimen consisting of benzathine benzylpenicillin at 1.2 million units intramuscularly every 4 weeks. […] The principles of treatment include the following: The risk of rheumatic fever recurrence is greatest during the first 3-5 years following the attack. […] The decision to withdraw antibacterial treatment should be individualized after carefully assessing the risk of repetitive exposures.

• #3 Acute Rheumatic Fever : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-rheumatic-fever-2/

  Secondary prevention […] benzathine penicillin G every 4 weeks in doses of 600,000IU for children and 1.2M IU for adolescents and those ≥27kg is used. […] If oral is preferred, patients can take penicillin V 0.5g daily for children and 1g daily for adolescents and those ≥27kg. […] Duration = 5-10 years = consultant decision. […] Symptomatic Treatment […] Arthritis […] Acetaminophen until the diagnosis is established, then treatment with naproxen 10-20mg/kg/day BID can be initiated. […] Carditis […] Restrict physical activity for 4-6 weeks […] Mild to moderate: […] ASA 80-100 mg/kg PO daily […] Moderate to severe […] Consider prednisone 2 mg/kg PO daily x 2 weeks then taper off […] Lack of evidence that corticosteroids are more effective than ASA […] No evidence for IVIG changing disease outcome […] Aspirin and corticosteroids have been shown not to demonstrate improvement in cardiac outcomes at one year after diagnosis. […] Chorea treatment is supportive […] Surgery for valvopathy – aortic regurgitation initially then progresses to stenosis

• #3 Rheumatic fever – Wikipedia

  https://en.wikipedia.org/wiki/Rheumatic_fever

  Aspirin at high doses has historically been used for treatment of rheumatic fever. […] However, due to side effects like gastritis and salicylate poisoning, necessitating serum monitoring of salicylate levels, and the risk of Reye syndrome, a serious and potentially deadly condition that may arise in children treated with aspirin or aspirin-containing products, alternatives to aspirin have been sought, especially in children. […] While evidence suggests that treatment of rheumatic fever associated arthritis with naproxen may be equally effective as with aspirin, its role in managing carditis has not been established. […] Management of carditis in acute rheumatic fever is controversial and based on dated literature. […] Corticosteroids may be considered, especially in people with allergies to NSAIDs or severe disease, although use of steroids may cause tissue atrophy, which could present challenges during future cardiac surgery for valve repair. […] Some patients develop significant carditis which manifests as congestive heart failure. This requires the usual treatment for heart failure: ACE inhibitors, diuretics, beta blockers, and digoxin. […] Unlike typical heart failure, rheumatic heart failure responds well to corticosteroids.

• #3 Rheumatic Fever – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/miscellaneous-bacterial-infections-in-infants-and-children/rheumatic-fever

  Treatment includes aspirin or other nonsteroidal anti-inflammatory drugs, corticosteroids during severe carditis, and antimicrobials to eradicate residual streptococcal infection and prevent reinfection. […] The primary goals of rheumatic fever treatment are eradication of group A streptococcal infection, relief of acute symptoms, suppression of inflammation, and prophylaxis against future infection to prevent recurrent heart disease. […] Although poststreptococcal inflammation is well developed by the time ARF is detected, a 10-day course of oral penicillin or amoxicillin, or a single injection of penicillin G benzathine, is used to eradicate any lingering organisms and prevent reinfection. […] Aspirin controls fever and pain and should be given to all patients with arthritis and/or mild carditis. […] Oral prednisone is recommended instead of aspirin for patients with moderate to severe carditis. […] Antistreptococcal prophylaxis should be maintained continuously after the initial episode of ARF to prevent recurrences.

• #3 Rheumatic fever and its management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1676147/

  Occasionally, costly open heart surgery may be the only option to manage severe heart valve lesions that occur in patients with rheumatic heart disease. […] Prevention of recurrent attacks of rheumatic fever is the most cost effective way of preventing rheumatic heart disease. […] Penicillin remains the antibiotic of choice. […] The occurrence of numerous M protein serotypes that are rheumatogenic has complicated the development of vaccines, and research is ongoing. […] Appropriate public health control programmes and optimal medical care do reduce the burden of acute rheumatic fever.

• #3 Rheumatic Fever (in Children & Babies) – Symptoms & Treatment | Carle.org

  https://carle.org/conditions/pediatric-conditions/rheumatic-heart-disease

  Children must limit their activity until symptoms are gone, which could take 2 to 5 weeks. […] Antibiotics for the bacteria will be given for several days. Tell your health care provider if your child is allergic to penicillin. […] Aspirin or other antiinflammatory drugs are given for muscle and joint pain.

• #3 Therapeutics for rheumatic fever and rheumatic heart disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9427630/

  Secondary antibiotic prophylaxis is the mainstay of treatment for acute rheumatic fever and rheumatic heart disease globally to prevent recurrences of rheumatic fever and thereby prevent cumulative valve damage with the development or progression of rheumatic heart disease. The recommended regimen is intramuscular injections of benzathine benzylpenicillin G every four weeks for a minimum of five years (if there is no cardiac involvement) or 10 years (if there is cardiac involvement) after the last acute rheumatic fever episode or until 21 years of age, whichever is longer. […] The duration of treatment is guided by the disease severity, clinical response and concentrations of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate). Most episodes of acute rheumatic fever resolve within six weeks and 90% resolve within 12 weeks. A rebound in inflammatory symptoms can occur on ceasing treatment, requiring the drugs to be re-introduced. […] Secondary antibiotic prophylaxis is the only treatment confirmed to be associated with a long-term reduction in the severity of rheumatic heart disease. Patients with moderate to severe rheumatic heart disease require cardiology services and regular echocardiographic follow-up.

• #4 Therapeutics for rheumatic fever and heart disease

  https://australianprescriber.tg.org.au/articles/therapeutics-for-rheumatic-fever-and-rheumatic-heart-disease.html

  Symptom management is critical to reduce morbidity and return children home and to school. The goals of acute rheumatic fever therapy are to: relieve symptoms, mitigate cardiac damage, eradicate the inciting streptococcal infection, prevent future recurrences. […] Naproxen and ibuprofen are the recommended first-line anti-inflammatory analgesics for rheumatic arthritis. Aspirin is now used second line due to its less favourable safety profile. […] The duration of treatment is guided by the disease severity, clinical response and concentrations of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate). Most episodes of acute rheumatic fever resolve within six weeks and 90% resolve within 12 weeks. […] Secondary antibiotic prophylaxis is the mainstay of treatment for acute rheumatic fever and rheumatic heart disease globally to prevent recurrences of rheumatic fever and thereby prevent cumulative valve damage with the development or progression of rheumatic heart disease. The recommended regimen is intramuscular injections of benzathine benzylpenicillin G every four weeks for a minimum of five years (if there is no cardiac involvement) or 10 years (if there is cardiac involvement) after the last acute rheumatic fever episode or until 21 years of age, whichever is longer. […] Secondary antibiotic prophylaxis is the only treatment confirmed to be associated with a long-term reduction in the severity of rheumatic heart disease.

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