Rheumatic fever primary prevention: Difference between revisions
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:* Preferred regimen (2): [[Amoxicillin]] 50 mg/kg PO qd for 10 days (maximum dose 1 g) | :* Preferred regimen (2): [[Amoxicillin]] 50 mg/kg PO qd for 10 days (maximum dose 1 g) | ||
:* Preferred regimen (3): [[Penicillin G]] 0.6 MU IM single dose (≤27 kg / ≤60 lb); 1.2 MU IM single dose (>27 kg / >60 lb) | :* Preferred regimen (3): [[Penicillin G]] 0.6 MU IM single dose (≤27 kg / ≤60 lb); 1.2 MU IM single dose (>27 kg / >60 lb) | ||
:* Alternative regimen (1): [[Cephalexin]] 500 mg PO bid for 10 days | :* Alternative regimen (1): [[Cephalexin]] 500 mg PO bid for 10 days | ||
:* Alternative regimen (2): [[Cefadroxil]] 1 g PO qd for 10 days | :* Alternative regimen (2): [[Cefadroxil]] 1 g PO qd for 10 days | ||
:* Alternative regimen (3): [[Clindamycin]] 20 mg/kg/day PO tid for 10 days (maximum dose 1.8 g/day) | :* Alternative regimen (3): [[Clindamycin]] 20 mg/kg/day PO tid for 10 days (maximum dose 1.8 g/day) | ||
:* Alternative regimen (4): [[Azithromycin]] 12 mg/kg PO qd for 5 days (maximum dose 500 mg/day) | :* Alternative regimen (4): [[Azithromycin]] 12 mg/kg PO qd for 5 days (maximum dose 500 mg/day) | ||
:* Alternative regimen (5): [[Clarithromycin]] 15 mg/kg/day PO bid for 10 days (maximum 500 mg/day) | :* Alternative regimen (5): [[Clarithromycin]] 15 mg/kg/day PO bid for 10 days (maximum 500 mg/day) | ||
Revision as of 16:03, 19 August 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]
Overview
Treatment of streptococcal pharyngitis with appropriate antibiotics most often prevents development of rheumatic fever.
Primary Prevention
Most streptococcal pharyngitis when treated with appropriate antibiotics prevents acute rheumatic fever[1]. Unfortunately, at least one third of episodes of acute rheumatic fever result from inapparent streptococcal infections[2]. In addition, some symptomatic patients do not seek medical care. In these instances, rheumatic fever is not preventable. The key to primary prevention is reducing exposure to group A streptococci, which requires dramatic improvements in housing, hygiene infrastructure and access to health care for individuals in the developing countries[3].
Intramuscular benzathine penicillin G and oral penicillin V are the recommended antibiotics in treatment of group A streptococcal infection in absence of penicillin allergy. Patients who are allergic to penicillin should be treated with narrow-spectrum cephalosporin[4].
Antimicrobial Regimens
- Primary prevention of rheumatic fever[4]
- Preferred regimen (1): Penicillin V 500 mg PO q6-8h for 10 days
- Preferred regimen (2): Amoxicillin 50 mg/kg PO qd for 10 days (maximum dose 1 g)
- Preferred regimen (3): Penicillin G 0.6 MU IM single dose (≤27 kg / ≤60 lb); 1.2 MU IM single dose (>27 kg / >60 lb)
- Alternative regimen (1): Cephalexin 500 mg PO bid for 10 days
- Alternative regimen (2): Cefadroxil 1 g PO qd for 10 days
- Alternative regimen (3): Clindamycin 20 mg/kg/day PO tid for 10 days (maximum dose 1.8 g/day)
- Alternative regimen (4): Azithromycin 12 mg/kg PO qd for 5 days (maximum dose 500 mg/day)
- Alternative regimen (5): Clarithromycin 15 mg/kg/day PO bid for 10 days (maximum 500 mg/day)
References
- ↑ DENNY FW, WANNAMAKER LW, BRINK WR, RAMMELKAMP CH, CUSTER EA (1950). "Prevention of rheumatic fever; treatment of the preceding streptococcic infection". J Am Med Assoc. 143 (2): 151–3. PMID 15415234.
- ↑ Dajani AS (1991). "Current status of nonsuppurative complications of group A streptococci". Pediatr Infect Dis J. 10 (10 Suppl): S25–7. PMID 1945592.
- ↑ Robertson KA, Volmink JA, Mayosi BM (2005). "Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis". BMC Cardiovasc Disord. 5 (1): 11. doi:10.1186/1471-2261-5-11. PMC 1164408. PMID 15927077.
- ↑ 4.0 4.1 Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST; et al. (2009). "Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics". Circulation. 119 (11): 1541–51. doi:10.1161/CIRCULATIONAHA.109.191959. PMID 19246689.