Prophylaxis should be given to all patients with a history of rheumatic fever and to those with heart valve lesions thought to be of rheumatic origin. When possible prophylaxis should be continued up to 30 years of age. This may be individualized in some circumstances.
Specific situations always requiring prophylaxis at least to 30 years are:
• High risk to Streptococcal infection
• Proved carditis in previous attacks
• Not more than 5 years since last attack.
Table: Antibiotics Prophylaxis after Rheumatic Fever
Antibiotic |
Children < 12 years |
Children > 12 years and adults |
Benzathine penicillin (IM) |
1.2 MU monthly |
2.4 MU monthly |
OR |
|
|
Phenoxymethylpenicillin (O) |
125-250 mg twice daily |
250 mg twice daily |
Penicillin allergy: |
Erythromycin (O) |
125-250 mg twice daily |
250 mg twice daily |
NOTE: Prophylaxis is given to prevent recurrence of rheumatic fever, and is not enough to protect against infective endocarditis. Phenoxymethylpenicillin and Erythromycin are less effective |
