1.4 Rheumatic fever

Type of Infection	First Line (with Dosage and Duration)	Alternative First Line (with dosage and Duration)	Comments
Uncomplicated	Penicillin G benzathine 0.6 million {weight < 27 Kgs}, 1.2 million {>27Kgs} units IM as a single dose Penicillin V, 500 mg q8h for 10 days Or Amoxicillin 500 mg q8h for 10 days	Confirmed penicillin allergy – Azithromycin 500 mg per oral / q24h for 5 days	Secondary prophylaxis: An injection of 0.6-1.2 million units of Benzathine penicillin G intramuscularly every 3 weeks is the recommended regimen Or Penicillin V, 250 mg BD Or Oral erythromycin 20 mg/Kg/dose Maximum dose of 500 mg BD.

For common etiological agents of Rheumatic fever, see Annexure B.1.4

Aspirin, steroids, or nonsteroidal anti-inflammatory drugs (NSAIDs) may be given to reduce inflammation.