Management of Acute Rheumatic Fever in Children

Prevention Strategies: Primary and Secondary Prophylaxis

Acute rheumatic fever (ARF) is an inflammatory disease that occurs as a result of untreated or inadequately treated streptococcal throat infections. It primarily affects children and can lead to serious complications, including rheumatic heart disease. Effective management involves both primary and secondary prophylaxis to prevent recurrence and long-term damage.

Primary Prophylaxis

Primary prophylaxis aims to prevent the initial occurrence of ARF by treating streptococcal infections promptly.

Diagnosis and Treatment

• Early identification of Group A Streptococcus (GAS) pharyngitis through clinical evaluation and throat cultures.
• Administration of antibiotics, typically penicillin or amoxicillin, to eradicate the infection.
• Alternative antibiotics such as azithromycin for penicillin-allergic patients.

Secondary Prophylaxis

Secondary prophylaxis is crucial for preventing recurrent episodes of ARF, which can lead to progressive cardiac damage.

Long-Term Antibiotic Therapy

• Regular administration of intramuscular benzathine penicillin G every 3-4 weeks.
• Oral penicillin or sulfadiazine as alternative regimens.
• Duration of prophylaxis depends on the severity of cardiac involvement.

Monitoring and Follow-Up

• Regular echocardiographic assessments to evaluate cardiac function.
• Patient education on adherence to prophylactic regimens.
• Coordination with cardiologists for long-term management.

Conclusion

Effective management of acute rheumatic fever in children relies on timely diagnosis, appropriate antibiotic therapy, and long-term prophylaxis to prevent recurrence and complications. Public health initiatives focusing on early detection and treatment of streptococcal infections can significantly reduce the burden of this disease.