How is Acute Rheumatic Fever treated
Treatment with antibiotics to eradicate the pharyngeal carriage of GAS is indicated, even in patients without symptoms of pharyngitis. Salicylates are first-line therapy for arthritis symptoms, frequently at doses of 80 to 100 mg/kg per day (divided in doses every 4–6 hours), although lower doses of 50 mg/kg per day should be tried initially in children (to reduce the risk of salicylate toxicity). Naproxen has been proven in small studies to be similar in efficacy to aspirin and may be safer and more practical to use for dosing purposes. Steroids may be considered in cardiac involvement or severe arthritis symptoms. Finally, household contacts must also be tested and treated for GAS carriage.
A reasonable initial treatment algorithm based on guidelines published by the American Heart Association (AHA), World Health Organization, and others is detailed below, noting the important considerations around beta-lactam allergies and the high rate of macrolide resistance in GAS isolates for some regions.
