Rheumatic fever, acute

I00/I01.0-2/I01.8-9

Note: notifiable condition.

DESCRIPTION

A condition in which the body develops antibodies against its own tissues, following a streptococcal throat infection. Effective treatment of streptococcal pharyngitis can markedly reduce the occurrence of this disease.
Commonly occurs in children, 3–15 years of age.
Recurrences are frequent.
Clinical signs and symptoms include:

  • arthralgia or arthritis that may shift from one joint to another
  • carditis including cardiac failure
  • heart murmurs
  • subcutaneous nodules
  • erythema marginatum
  • chorea (involuntary movements of limbs or face)
  • other complaints indicating a systemic illness e.g. fever

MEDICINE TREATMENT

Eradication of streptococci in throat:

Children: 18 months–11 years of age

  • Phenoxymethylpenicillin, oral, 250 mg 12 hourly for 10 days.

Children > 11 years of age and adults

  • Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days.

OR

Children

  • Amoxicillin, oral, 50 mg/kg daily for 10 days.
Weight
kg 		Dose
mg 		Use one of the following Age
Months/years
Susp Susp Capsule Capsule
125 mg/5mL 250 mg/5mL 250 mg 500 mg
>2–2.5 kg 100 mg 4 mL 2 mL – – >34–36 weeks
>2.5–3.5 kg 150 mg 6 mL 3 mL – – >36 weeks–1 month
>3.5–5 kg 200 mg 8 mL 4 mL – – >1–3 months
>5–7 kg 275 mg 11 mL 5.5 mL – – >3–6 months
>7–11 kg 400 mg – 8 mL – – >6–18 months
>11–17.5 kg 575 mg – 11.5 mL – – >18 months–5 years
>17.5–25 kg 750 mg – 15 mL 3 – >5–7 years
>25–35 kg 1000 mg – 20 mL 4 2 >7–11 years
>35 kg 2000 mg – – 4 >11years

LoEI [49]

Adults

  • Amoxicillin, oral, 1 000 mg 12 hourly for 10 days. LoEIII [50]

OR

  • Benzathine benzylpenicillin, IM , single dose.
    • Children < 30 kg: 600 000 IU.
    • Children ≥ 30 kg and adults: 1.2 MU.
    • Dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine) or 3 mL water for injection.

Severe penicillin allergy: Z88.0

Children

Children > 35 kg and adults

  • Macrolide, e.g.:
  • Azithromycin, oral, 500 mg daily for 3 days.

Prophylaxis for rheumatic fever: (Z29.2)

All patients with confirmed rheumatic fever and no persistent rheumatic valvular disease:

  • Treat for 10 years or until the age of 21 years, whichever is longer.

All patients with confirmed rheumatic fever and persistent rheumatic valvular disease:

  • Phenoxymethylpenicillin, oral, 12 hourly.
    • Children: 125 mg
    • Adults: 250 mg

OR

  • Amoxicillin, oral, daily.
    • Children <30 kg: 125 mg
    • Children ≥30 kg and adults: 250 mg

LoEIII

OR

  • Benzathine benzylpenicillin, IM, every 21–28 days (3–4 weeks).
    • Children < 30 kg: 600 000 IU
    • Children ≥ 30 kg and adults: 1.2 MU
    • For benzathine benzylpenicillin, IM injection, dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine).

CAUTION
Avoid IM injections if patients are on warfarin.

Severe penicillin allergy: Z88.0

Children < 11 years

LoEIII [51]

Children > 11 years of age and adults

  • Macrolide, e.g.:
  • Azithromycin, oral, 250 mg daily.

LoEIII [52]

REFERRAL

All patients for diagnosis and management.