From the Guidelines
Management of Rheumatic Fever
The management of rheumatic fever involves a multi-faceted approach, including the administration of benzathine penicillin G (Bicillin) at a dose of 1.2 million units intramuscularly every 3-4 weeks for a minimum of 10 years, or alternatively, oral penicillin V (Penicillin VK) at a dose of 250-500 mg twice daily for 10 years 1.
- Secondary prophylaxis is recommended for patients with a history of rheumatic fever to prevent recurrences, with the duration of prophylaxis depending on the number of previous attacks, time elapsed since the last attack, risk of exposure to GAS infections, age of the patient, and presence or absence of cardiac involvement 1.
- Anti-inflammatory medications such as aspirin (81-100 mg/kg/day) or naproxen (10-20 mg/kg/day) may be used to manage symptoms of arthritis and carditis 1.
- For patients with severe carditis, corticosteroids such as prednisone (1-2 mg/kg/day) may be prescribed for a duration of 2-3 weeks, followed by a gradual taper 1.
Duration of Secondary Prophylaxis
The duration of secondary prophylaxis varies depending on the category of rheumatic fever:
- Rheumatic fever with carditis and residual heart disease: 10 years or until 40 years of age (whichever is longer), sometimes lifelong prophylaxis 1.
- Rheumatic fever with carditis but no residual heart disease: 10 years or until 21 years of age (whichever is longer) 1.
- Rheumatic fever without carditis: 5 years or until 21 years of age (whichever is longer) 1.
Alternative Antibiotics
For patients allergic to penicillin, alternative antibiotics such as sulfadiazine, macrolide, or azalide may be used for secondary prophylaxis 1.
From the FDA Drug Label
Following an acute attack, penicillin G benzathine (parenteral) may be given in doses of 1,200,000 units once a month or 600,000 units every 2 weeks. The guidelines for Rheumatic (Rheumatoid) fever management using penicillin G benzathine include:
- Prophylaxis: 1,200,000 units once a month or 600,000 units every 2 weeks, administered via deep intramuscular injection 2 Note that the term "Rheumatoid" is not used in the label, the correct term is "Rheumatic" fever.
From the Research
Rheumatic Fever Management Guidelines
There are no specific guidelines for Rheumatic (Rheumatoid) fever management mentioned in the provided studies. However, some studies discuss the management of related conditions, such as Juvenile Idiopathic Arthritis (JIA) and autoinflammatory diseases.
Related Conditions Management
- The management of JIA involves the use of non-steroidal anti-inflammatory drugs, intra-articular and systemic corticosteroids, disease-modifying anti-rheumatic drugs, and biologic agents 3.
- The treatment of severe refractory Systemic Lupus Erythematosus (SLE) requires prompt and adequate treatment, but evidence from well-designed randomized controlled trials is limited 4.
- A multifaceted intervention, including participatory ergonomics, health promotion activities, and case management, can be effective in preventing and managing musculoskeletal pain in nursing staff 5.
- Autoinflammatory diseases, such as familial Mediterranean fever and systemic juvenile idiopathic arthritis, require a detailed history-taking, precise physical examinations, and cytokine profiling, as well as extensive mutation analysis of candidate genes for diagnosis 6.
Treatment Approaches
- Methotrexate remains the first-line long-term therapy for most children with polyarticular JIA 3.
- Tumor necrosis factor-α inhibitors have shown tremendous benefit in children with refractory non-systemic JIA 3.
- Multifaceted interventions may not always be more effective than single-component interventions in changing health-care professionals' behaviors 7.