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How is Acute Rheumatic Fever prevented?
Prevention of ARF in patients without a prior history of ARF (primary prevention) centers around antimicrobial therapy for acute GAS infections. Prompt antibiotic treatment of streptococcal pharyngitis decreases the risk of subsequent ARF by 80%. Those with a prior history of ARF are at progressively increasing risk for developing recurrent ARF with each streptococcal infection, with recurrence rates as high as 50% in the 1st year. Prophylaxis to prevent intercurrent streptococcal infections (secondary prevention) is indicated to reduce this risk. Pharmacologic options based on current treatment guidelines are listed in the below table.
Acute Rheumatic Fever Secondary Prophylaxis Options
| Acute Rheumatic Fever Prophylaxis | |
| Antibiotic | Dose/Route/Frequency |
| Benzathine penicillin G | 600,000 units for patients <30 kg (or 1,200,000 units for patients >30kg), IM, every 3–4 weeks |
| Penicillin V | 250 mg twice daily |
| Sulfonamide (sulfasoxazole, sulfadiazine) | 0.5 g for patients <30 kg (or 1.0 for patients >30 kg) daily |
| (Sulfa and Penicillin-allergic) | |
| Erythromycin | 250 mg twice daily |
ARF, acute rheumatic fever; IM, intramuscularly.
