Rheumatic Fever, Acute

Description

Medicine Treatment

Referral

---

Note:
Notifiable Condition

---

I00/I01.0-2/I01.8-9

DESCRIPTION

A condition in which the body develops antibodies against its own tissues, following a streptococcal throat infection. Effective treatment and prevention of recurrent of streptococcal pharyngitis can markedly reduce the occurrence and repeat episodes of rheumatic carditis.
Commonly occurs in children, 3–15 years of age.
Recurrences are frequent.

Clinical signs and symptoms include:

• Arthralgia or arthritis that may shift from one joint to another
• Carditis including cardiac failure
• Heart murmurs
• Subcutaneous nodules
• Erythema marginatum
• Chorea (involuntary movements of limbs or face)
• Other complaints indicating a systemic illness e.g. fever

MEDICINE TREATMENT

Eradication of streptococci in throat:

Children: 18 months–11 years of age

• Phenoxymethylpenicillin, oral, 250 mg 12 hourly for 10 days

Children > 11 years of age and adults

• Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days

OR

Children

• Amoxicillin, oral, 50 mg/kg daily for 10 days

Weight kg	Dose mg	Use one of the following				Age Months/years
		Susp		Capsule
		125 mg/5mL	250 mg/5mL	250 mg	500 mg
>2-2.5 kg	100 mg	4 mL	2 mL	-	-	>34-36 weeks
>2.5-3.5 kg	150 mg	6 mL	3 mL	-	-	>36 weeks-1 month
>3.5-5 kg	200 mg	8 mL	4 mL	-	-	>1-3 months
>5-7 kg	275 mg	11 mL	5.5 mL	-	-	>3-6 months
>7-11 kg	400 mg	-	8 mL	-	-	>6-18 months
>11-17.5 kg	575 mg	-	11.5 mL	-	-	>18 months-5 years
>17.5-25 kg	750 mg	-	15 mL	3	-	>5-7 years
>25-35 kg	1000 mg	-	20 mL	4	2	>7-11 years
>35 kg	2000 mg	-	-	-	4	>11 years

LoE:IIb⁵⁵

Adults

• Benzathine benzylpenicillin, IM, single dose
  • Children < 30 kg: 600 000 IU
  • Children ≥ 30 kg and adults: 1.2 MU 
  • Dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine) or 3 mL water for injection

LoE:IIIb⁵⁶

OR

• Amoxicillin, oral, 1000 mg 12 hourly for 10 days

LoE:IIIb⁵⁷

Severe penicillin allergy:
Z88.0

Children

• Macrolide, e.g.:
• Azithromycin, oral, 10 mg/kg daily for 3 days. See dosing table

Children > 35 kg and adults

• Macrolide, e.g.:
• Azithromycin, oral, 500 mg daily for 3 days

Prophylaxis for rheumatic fever: (Z29.2)

All patients with confirmed rheumatic fever and no persistent rheumatic valvular disease

• Treat for 10 years or until the age of 21 years, whichever is longer

All patients with confirmed rheumatic fever and persistent rheumatic valvular disease

Treat lifelong

• Phenoxymethylpenicillin, oral, 12 hourly
  • Children: 125 mg
  • Adults: 250 mg

OR

• Amoxicillin, oral, daily
  • Children <30 kg: 125 mg
  • Children ≥30 kg and adults: 250 mg

LoE:IVb

OR

• Benzathine benzylpenicillin, IM, every 21–28 days (3–4 weeks)
• Children < 30 kg: 600 000 IU
• Children ≥ 30 kg and adults: 1.2 MU
• For benzathine benzylpenicillin, IM injection, dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine) or 3 mL water for injection

CAUTION Avoid IM injections if patients are on warfarin

---

Note:

For guidance on warfarin management, see Adult Hospital Level STGs and EML, Appendix II

---

Severe penicillin allergy:
Z88.0

Children < 11 years

• Macrolide, e.g.:
• Azithromycin, oral, 10mg/kg/day, 3 times weekly. See dosing table

LoE:IVb⁵⁸

Children ≥ 11 years and adults

• Macrolide, e.g.:
• Azithromycin, oral, 250 mg daily

LoE:IVb⁵⁹

REFERRAL

• All patients for diagnosis and management

Click here for the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_1 November 2024

Chapter 4: Cardiovascular Conditions_4.9 Rheumatic Fever, Acute