Acute Rheumatic Fever

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
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 g10 days
Alternative antibiotic choice(s)
Benzathine benzylpenicillin (IM)APowder for injection: 900 mg benzylpenicillin (=1.2 million units) in 5 mL vial; 1.44 g benzylpenicillin (=2.4 million units) in 5 mL vialBy 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)BOral liquid: 200 mg/5 mL; Capsule: 250 mg; 500 mg (anhydrous).10 mg/kg once daily, maximum dose 500 mg daily3 – 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.