From the Guidelines
Role of Rheumatology in Treating Rheumatic Fever
Rheumatology plays a crucial role in the treatment of rheumatic fever, focusing on the prevention of long-term cardiac complications through prompt diagnosis and treatment 1.
Primary Prevention and Treatment
The primary treatment involves antibiotic therapy to eradicate group A streptococcal (GAS) infections, with penicillin being the first-line treatment due to its cost-effectiveness, narrow spectrum of activity, and proven efficacy 1. For individuals allergic to penicillin, alternatives such as narrow-spectrum oral cephalosporins, oral clindamycin, or macrolides/azalides are recommended 1.
Secondary Prevention
For patients with a history of rheumatic fever, secondary prevention is crucial to prevent recurrences, which involves continuous antimicrobial prophylaxis 1. The duration of prophylaxis depends on factors such as the number of previous attacks, time elapsed since the last attack, risk of exposure to GAS infections, patient age, and presence or absence of cardiac involvement 1.
Management and Prophylaxis
The management of rheumatic fever also includes the use of anti-inflammatory medications for symptom management, such as aspirin or naproxen, with treatment durations typically ranging from 1-3 months. Additionally, handheld echocardiography can be a valuable tool for screening and diagnosing rheumatic heart disease, especially in resource-limited settings 1, highlighting the importance of early detection and treatment to prevent long-term cardiac complications.
Key Considerations
- Prompt diagnosis and treatment are essential to prevent long-term cardiac complications.
- Penicillin is the primary antibiotic for treating GAS infections, with alternatives for penicillin-allergic individuals.
- Secondary prevention through continuous antimicrobial prophylaxis is critical for patients with a history of rheumatic fever.
- Echocardiography plays a role in diagnosing and managing rheumatic heart disease.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Bicillin L-A and other antibacterial drugs, Bicillin L-A should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria Medical Conditions in which Penicillin G Benzathine Therapy is indicated as Prophylaxis: Rheumatic fever and/or chorea—Prophylaxis with penicillin G benzathine has proven effective in preventing recurrence of these conditions. 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 role of Rheumatology in treating Rheumatic fever is to use penicillin G benzathine as prophylaxis to prevent recurrence of the condition, as well as to prevent rheumatic heart disease and acute glomerulonephritis 2, with dosing regimens including 1,200,000 units once a month or 600,000 units every 2 weeks 2.
- Key points:
- Penicillin G benzathine is used for prophylaxis
- Dosing: 1,200,000 units once a month or 600,000 units every 2 weeks
- Conditions prevented: rheumatic fever, rheumatic heart disease, and acute glomerulonephritis
From the Research
Role of Rheumatology in Treating Rheumatic Fever
- Rheumatology plays a crucial role in the treatment and management of rheumatic fever, as it is a condition that affects the joints and can lead to long-term cardiac complications 3.
- The treatment of rheumatic fever involves the use of antibiotics, such as penicillin, to prevent recurrent infections and reduce the risk of developing rheumatic heart disease (RHD) 4, 5.
- Rheumatologists work closely with cardiologists and other healthcare professionals to manage the cardiac complications of rheumatic fever, including RHD 6, 7.
Diagnosis and Management
- The diagnosis of rheumatic fever is based on the 2015 modified Jones criteria, which includes clinical signs and symptoms, as well as laboratory tests 3, 7.
- Echocardiography is an important tool in the diagnosis and management of RHD, as it can help identify valve damage and other cardiac complications 6.
- Rheumatologists use a variety of medications, including diuretics, anticoagulants, and beta-blockers, to manage the symptoms of RHD and prevent further complications 6.
Prevention and Control
- Preventing recurrent infections with group A streptococcal infections is key to reducing the risk of developing RHD 3, 5.
- Rheumatologists work to improve awareness and education about rheumatic fever and RHD, particularly in high-risk communities 5, 7.
- Secondary prophylaxis with benzathine penicillin G is an effective way to prevent recurrent ARF and reduce the risk of developing RHD 4, 7.