Clinical definition:
An inflammatory condition that may follow a throat infection with group A streptococci and an important cause of acquired heart disease in the acute phase of the disease and as a result of chronic valvular complications. Acute rheumatic fever is predominantly a disease of children (not infants), adolescents and young adults.
Child & Adolescent | |||
| Preferred antibiotic choice | |||
| Drug | Formulation | Dosage | Duration |
| Amoxicillin (PO) | Powder for oral liquid: 125 mg (as trihydrate)/5 mL; 250 mg (as trihydrate)/5 mL, Solid oral dosage form: 250 mg; 500 mg (as trihydrate). | 50 mg/kg once daily, maximum dose 2 g | 10 days |
| Alternative antibiotic choice(s) | |||
| Benzathine benzylpenicillin (IM)A | Powder for injection: 900 mg benzylpenicillin (=1.2 million units) in 5 mL vial; 1.44 g benzylpenicillin (=2.4 million units) in 5 mL vial | By weight: o <27 kg: 600 000 units (375 mg) as a single dose o 27 kg and above: 1.2 million units (750 mg) as a single dose | Single dose |
| In case of confirmed drug allergy or medical contraindication | |||
| Azithromycin (PO)B | Oral liquid: 200 mg/5 mL; Capsule: 250 mg; 500 mg (anhydrous). | 10 mg/kg once daily, maximum dose 500 mg daily | 3 – 5 days |
A. Painful intramuscular administration of benzathine benzylpenicillin may be reduced by dissolving benzathine benzylpenicillin 1.2 million units in 3.2 mL lidocaine 1% without adrenaline (epinephrine) and bringing the preparation to room temperature before injection
B. Significant rates of resistance of Group A Streptococcus strains to macrolides (azithromycin) and azalides (clarithromycin) have been reported in many parts of the world. Use of these antibiotics may result in treatment failure.