Understanding Prophylaxis of Rheumatic Fever
Rheumatic fever is an inflammatory condition that can result from inadequate treatment of a throat infection caused by a specific type of bacteria, group A Streptococcus—the same bacteria responsible for strep throat. It is associated with several potentially severe health outcomes, including joint involvement and inflammation of the heart (carditis). Proper diagnosis and treatment of strep throat is necessary to prevent rheumatic fever, especially in those with a high risk of the condition.
The goal of prophylaxis for the prevention of rheumatic fever is to eliminate recurrent streptococcal throat infections. This is typically achieved by using long-term antibiotic therapy in high-risk individuals. The use of antibiotics should also be considered in those with a history of frequent throat infections, though in these cases, prophylaxis may not be necessary.
Types of Prophylaxis
Prophylaxis for rheumatic fever can be divided into primary and secondary prevention. Primary prophylaxis is aimed at preventing initial episodes of rheumatic fever by treating or preventing throat infections. Secondary prophylaxis is aimed at preventing recurrent episodes of rheumatic fever by treating throat or skin infections that may be associated with the condition.
Primary Prophylaxis of Rheumatic Fever
Primary prevention of rheumatic fever typically involves the use of antibiotics, such as penicillin, to treat initial streptococcal throat infections. Penicillin V is typically the choice of antibiotic as it is affordable and well-tolerated. The regimen usually involves a single dose or course of regular doses of penicillin.
However, some individuals may require more aggressive treatment, such as longer courses of antibiotics or antibiotics with longer durations of action, such as amoxicillin or azithromycin.
In individuals who are allergic to penicillin, other antibiotics such as erythromycin may be used. However, people with severe penicillin allergies may need to be desensitized.
Secondary Prophylaxis of Rheumatic Fever
Secondary prophylaxis is recommended for those who have had at least one attack of rheumatic fever and are at risk of recurrent attacks. It involves the use of antibiotics to prevent recurrent streptococcal throat infections. Penicillin V is the preferred antibiotic, though other antibiotics such as erythromycin may be used.
The standard regimen for secondary prevention of rheumatic fever involves either daily 19-24 million units of penicillin V or 2.4 million units of penicillin V every other day for up to five years. The erythromycin regimen involves either 250 mg of erythromycin Kinder twice daily or 500 mg of erythromycin Kinder once daily for up to five years.
Benefits of Prophylaxis of Rheumatic Fever
Prophylaxis is an effective way to reduce the risk of rheumatic fever and its potentially serious complications. It has been shown to reduce the recurrence of rheumatic fever by up to 85% and can help to achieve long-term remission. In addition, it is a safe and cost-effective approach to help prevent this potentially debilitating condition.
By preventing throat infections, prophylaxis can also reduce the risk of other throat-related conditions, such as tonsillitis and sinusitis.
Complications of Prophylaxis of Rheumatic Fever
While prophylaxis can be beneficial in preventing rheumatic fever and its complications, there are also potential risks and side effects associated with its use, such as allergic or infectious reactions. In addition, overuse of antibiotics can lead to antibiotic resistance.
It is important to note that prophylaxis for rheumatic fever is not a substitute for proper treatment of strep throat infections. Those at risk should be monitored closely for signs and symptoms of rheumatic fever and receive prompt treatment if it develops.