• Aspirin : 100 - 120 mg/kg/day.
  
  
• Prednisolone: 2 - 3 mg/kg/day
  ( maximum 60mg/day. )
  
  
• Congestive heart failure In patients who present with heart failure, digitalis and diuretics are considered. Digitalis i.e. digoxin was previously contraindicated since some patients are extremely sensitive to the glycoside. It can be used if one remains on low dosage schedule.
  
  
• Chorea - Isolated chorea is treated symptomatically since neither aspirin nor steroids have any effect on the course. The combination of phenobarbitone and chlorpromazine works well, if not haloperidol can be used.
  
  

The story of rheumatic fever does not end with the completion of anti-inflammatory treatment and normalization of acute phase reactants. Every patient of acute rheumatic fever is a candidate for continuous prophylaxis as risk of recurrent attack of acute rheumatic fever continue.

The method of choice is monthly intramuscular injection of 1.2 mega units of benzathine penicillin and at times every three weeks. In case of genuine penicillin allergy, sulfonamides (0.5gm/daily <25 kg and one gm daily above>25kg) or erythromycin can be used.

The point of confusion is when to stop prophylaxis. If a patient presents with severe carditis or with recurrent episodes of Acute Rheumatic Fever, prophylaxis is considered for life. For moderate carditis, prophylaxis till 16 years and for mild or no carditis for 3 years from last episode should be given.

Last created on 18-09-2001
Last updated on 01-07-2006