Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease

Jessica L. de Dassel, Diana Lennon, Scott Dougherty, Anna P. Ralph

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


The chief focus of secondary prevention is antibiotic prophylaxis. This comprises long-term antibiotic therapy for individuals with acute rheumatic fever (ARF) or rheumatic heart disease (RHD), to prevent ARF recurrences triggered by recurrent group A streptococcal infections, and thereby prevent development or worsening of RHD. Standard recommendations include use of intramuscular benzathine penicillin G at least every 28days for a minimum 5-10-years period after diagnosis of ARF. Challenges include the following: programmatic delivery of this regimen, which requires effective recall systems and use of pain-minimizing techniques for injection delivery; the need for culturally and age-appropriate adherence support tailored for young people; penicillin intolerance (which is uncommon); and securing the penicillin supply, especially in low-income settings.

Original languageEnglish
Title of host publicationAcute Rheumatic Fever and Rheumatic Heart Disease
EditorsScott Dougherty, Jonathan Carapetis, Liesl Zuhlke, Nigel Wilson
Place of PublicationMissouri
PublisherElsevier Science Ltd.
Number of pages28
ISBN (Electronic)9780323639828
ISBN (Print)9780323754606
Publication statusPublished - 2021


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