Patient Information

Acute Rheumatic Fever

Guidelines of diagnosis used by the American Heart Association include major and minor criteria (i.e., Jones criteria). In addition to evidence of a previous streptococcal infection, the diagnosis requires 2 major Jones criteria or 1 major plus 2 minor Jones criteria.

Major criteria

Minor criteria

Antistreptococcal prophylaxis

Antistreptococcal prophylaxis should be maintained continuously after an attack of acute RF (or chorea) to prevent recurrences. Benzathine penicillin G in a monthly IM injection of 1.2 million U is most effective, but the injections are painful and require monthly medical attention. Sulfadiazine, in a single oral dose of 1 g/day (500 mg/day in patients <= 27 kg [<= 60 lb]), is as effective as other oral regimens, including penicillin G 400,000 U divided bid or penicillin V 250 mg divided bid.

The optimum duration of antistreptococcal prophylaxis is uncertain. Some authorities believe prophylaxis should be lifelong in all RF or chorea patients, or as long as they have close contact with children, who have higher rates of carriage of group A streptococci. Others recommend prophylaxis only for the first few years after an acute attack in all patients < 18 yr, and for life only in patients with severe cardiac damage.

In patients with mild cardiac damage (i.e., murmurs but no cardiomegaly or decompensation), prophylaxis can be maintained; if it is discontinued, early treatment of streptococcal infections is required. 

Web Links:

American Heart Association -
http://www.americanheart.org/presenter.jhtml?identifier=4709 
http://www.americanheart.org/presenter.jhtml?identifier=1244

eMedicine - http://www.emedicine.com/emerg/topic509.htm