secondary prophylaxis

Last reviewed 01/2018

Secondary prevention is required because subsequent streptococcal infection may precipitate recurrences of rheumatic fever.

Prophylaxis is effective as the bacterium does not become resistant to penicillin. Possible prophylactic measures include:

• oral penicillin 125 mg b.d.
• oral sulphonamide eg. sulphadimidine 0.5 g b.d.
• monthly administration of benzathine penicillin G
• for patients who are allergic to penicillin then erythromycin 250 mg b.d. can be used

Prophylaxis is given for at least 5 years. The duration of prophylaxis is dependent on whether there was carditis in the initial attack.

If there was no carditis in the initial attack then prophylaxis should be continued for 5 years - most recurrences occur within the first 5 years after the initial attack.

If a patient did suffer cardiac involvement with the initial attack then they should continue prophylaxis until the age of 25 years. Prophylaxis may be continued past this age if environmental conditions allow.

After 5 years or age 25 patients should have antibiotics for dental and other operative procedures for life.