ACUTE RHEUMATIC FEVER

TREATMENT

ANTI-STREPTOCOCCAL THERAPY - duration 10/7

 IV C-penicillin 50,000 IU/kg 6H, or;
Oral penicillin V 250mg 6H (<30kg), 500mg 6H (>30kg)
Oral EES (if allergic to penicillin)

ANTI-INFLAMMATORY THERAPY

Mild / no carditis
Oral aspirin 80-100mg/kg in 4 divided dose for 2-4/52, tapering over 4 weeks

Pancarditis, moderate-severe carditis
Aspirin (as above) +
Oral prednisolone 2mg/kg/dose in 2 divided dose for 2-4/52

SECONDARY PROPHYLAXIS 
Oral penicillin V 250mg BD
Oral EES 250mg BD (if allergic to penicillin)
IM Benzathine Penicillin 0.6 mega unit (<30kg), 1.2mega unit (>30kg) every 3-4/52

DURATION OF PROPHYLAXIS
Until 21 years old or 5years from last attack (whichever longer)
Lifelong if carditis or vulvular involvement


REF: Paediatric Protocol for Malaysia Hospital, 3rd Edition