What is the treatment for rheumatic fever?

From the Guidelines

The treatment for rheumatic fever involves a comprehensive approach targeting both the acute infection and preventing long-term complications, with antibiotics being the cornerstone of treatment, and long-term prophylactic antibiotics are crucial to prevent recurrence, typically continuing until adulthood or for at least 10 years after the last episode, or until the patient is 40 years of age, whichever is longer, as recommended by the most recent guidelines 1.

Key Components of Treatment

• Antibiotics: penicillin is the first-line therapy to eradicate group A streptococcal infection, with a 10-day course of oral penicillin V or a single intramuscular injection of benzathine penicillin G being recommended 1.
• Alternative antibiotics for penicillin-allergic patients: erythromycin or azithromycin are appropriate alternatives 1.
• Anti-inflammatory medications: aspirin or other NSAIDs are used to reduce inflammation and manage symptoms such as joint pain and fever 1.
• Corticosteroids: may be prescribed for severe carditis 1.

Long-term Prophylaxis

• The duration of rheumatic fever prophylaxis should be at least 10 years or until the patient is 40 years of age, whichever is longer, in patients with documented valvular heart disease 1.
• Lifelong prophylaxis may be recommended in high-risk patients according to the severity of valvular heart disease and exposure to group A streptococcus 1.

Important Considerations

• The treatment regimen should be individualized based on the patient's specific needs and circumstances, taking into account factors such as the severity of the disease, the presence of valvular heart disease, and the risk of recurrence 1.
• Regular follow-up and monitoring are essential to ensure the effectiveness of the treatment regimen and to prevent long-term complications 1.

From the FDA Drug Label

Prevention of Initial Attacks of Rheumatic Fever Penicillin is considered by the American Heart Association to be the drug of choice in the prevention of initial attacks of rheumatic fever (treatment of Streptococcus pyogenes infections of the upper respiratory tract e.g., tonsillitis, or pharyngitis). Erythromycin tablets are indicated for the treatment of penicillin-allergic patients. The therapeutic dose should be administered for ten days. Prevention of Recurrent Attacks of Rheumatic Fever Penicillin or sulfonamides are considered by the American Heart Association to be the drugs of choice in the prevention of recurrent attacks of rheumatic fever In patients who are allergic to penicillin and sulfonamides, oral erythromycin is recommended by the American Heart Association in the long-term prophylaxis of streptococcal pharyngitis (for the prevention of recurrent attacks of rheumatic fever).1

The treatment for rheumatic fever involves the use of penicillin as the drug of choice for the prevention of initial attacks, and penicillin or sulfonamides for the prevention of recurrent attacks. For patients allergic to penicillin, erythromycin is indicated, and for those allergic to both penicillin and sulfonamides, oral erythromycin is recommended for long-term prophylaxis 2.

• Initial attacks: Penicillin is the preferred treatment, with erythromycin as an alternative for penicillin-allergic patients.
• Recurrent attacks: Penicillin or sulfonamides are the preferred treatments, with oral erythromycin as an alternative for patients allergic to both.

From the Research

Treatment for Rheumatic Fever

The treatment for rheumatic fever typically involves a combination of medications and prophylactic measures to prevent recurrence and progression to rheumatic heart disease. Some key aspects of treatment include:

• Antibiotic prophylaxis: Long-term antibiotic prophylaxis is recommended to prevent recurrence of rheumatic fever and progression to rheumatic heart disease 3.
• Benzathine penicillin G: Intramuscular injections of benzathine penicillin G every 3-4 weeks are commonly used for prophylaxis 4, 5.
• Oral antibiotics: Oral antibiotics may be used as an alternative to intramuscular benzathine penicillin G, but the evidence suggests that intramuscular benzathine penicillin G is more effective 3, 6.
• Steroids: Steroids may be used to treat acute rheumatic fever, particularly in cases with carditis 6, 7.
• Aspirin: Aspirin may be used to treat acute rheumatic arthritis, but it is not recommended for cases with carditis 6.

Prophylaxis Regimens

Different prophylaxis regimens have been studied, including:

• 3-week regimen: A 3-week regimen of benzathine penicillin G injections has been shown to be more effective than a 4-week regimen in preventing recurrence of rheumatic fever 4, 5.
• 4-week regimen: A 4-week regimen of benzathine penicillin G injections is also effective, but may not be as effective as a 3-week regimen 4, 5.
• Oral antibiotic prophylaxis: Oral antibiotic prophylaxis may be used as an alternative to intramuscular benzathine penicillin G, but the evidence suggests that intramuscular benzathine penicillin G is more effective 3, 6.

Important Considerations

Some important considerations in the treatment and prophylaxis of rheumatic fever include:

• Compliance: Compliance with prophylaxis regimens is crucial to prevent recurrence of rheumatic fever and progression to rheumatic heart disease 6.
• Side effects: Prophylaxis regimens can have side effects, such as hypersensitivity reactions and local reactions to injections 3.
• Cost and accessibility: The cost and accessibility of prophylaxis regimens can be a barrier to treatment, particularly in low-resource settings 3.