5
Rheumatic Fever
Table 6. Secondary Prevention of Rheumatic Fever
Recommendations COR LOE
Secondary prevention of rheumatic fever is indicated in
patients with rheumatic heart disease, specifically MS
(Tables 7-8).
I C
Table 7. Agents for Secondary Prevention of Rheumatic Fever
Agent Dosage
Penicillin G benzathine 1.2 million units IM every 4 wk
a
Penicillin V potassium 250 mg orally BID
Sulfadiazine 1 g orally QD
Macrolide or azalide antibiotic (for patients
allergic to penicillin and sulfadiazine)
b
Varies
a
Administration every 3 wk is recommended in certain high-risk situations.
b
Macrolide antibiotics should not be used in persons taking other medications that inhibit
cytochrome P450 3A, such as azole antifungal agents, HIV protease inhibitors, and some selective
serotonin reuptake inhibitors.
Adapted with permission from Gerber et al. Circulation. 2009;119:1541-1551.
Table 8. Duration of Secondary Prophylaxis for
Rheumatic Fever
Type Duration After Last Attack
Rheumatic fever with carditis and residual
heart disease (persistent VHD
a
)
10 y or until patient is 40 y of age
(whichever is longer)
Rheumatic fever with carditis but no
residual heart disease (no valvular disease
a
)
10 y or until patient is 21 y of age
(whichever is longer)
Rheumatic fever without carditis 5 y or until patient is 21 y of age
(whichever is longer)
a
Clinical or echocardiographic evidence.
Adapted with permission from Gerber et al. Circulation. 2009;119:1541-1551.
