An inflammatory condition that may follow a throat infection with group A streptococci and an important cause of acquired heart disease in the acute phase of the disease and as a result of chronic valvular complications. Acute rheumatic fever is predominantly a disease of children (not infants), adolescents and young adults.
Child & Adolescent
|Preferred antibiotic choice|
|Amoxicillin (PO)||Powder for oral liquid: 125 mg (as trihydrate)/5 mL; 250 mg (as trihydrate)/5 mL, Solid oral dosage form: 250 mg; 500 mg (as trihydrate).||50 mg/kg once daily, maximum dose 2 g||10 days|
|Alternative antibiotic choice(s)|
|Benzathine benzylpenicillin (IM)A||Powder for injection: 900 mg benzylpenicillin (=1.2 million units) in 5 mL vial; 1.44 g benzylpenicillin (=2.4 million units) in 5 mL vial||By weight:
o <27 kg: 600 000 units (375 mg) as a single dose
o 27 kg and above: 1.2 million units (750 mg) as a single dose
|In case of confirmed drug allergy or medical contraindication|
|Azithromycin (PO)B||Oral liquid: 200 mg/5 mL; Capsule: 250 mg; 500 mg (anhydrous).||10 mg/kg once daily, maximum dose 500 mg daily||3 – 5 days|
A. Painful intramuscular administration of benzathine benzylpenicillin may be reduced by dissolving benzathine benzylpenicillin 1.2 million units in 3.2 mL lidocaine 1% without adrenaline (epinephrine) and bringing the preparation to room temperature before injection
B. Significant rates of resistance of Group A Streptococcus strains to macrolides (azithromycin) and azalides (clarithromycin) have been reported in many parts of the world. Use of these antibiotics may result in treatment failure.