Consensus guidelines on pediatric acute rheumatic fever and rheumatic heart disease.
BACKGROUND
Acute rheumatic fever and rheumatic chronic valvular heart disease is an important preventable cause of morbidity and mortality in suburban and rural India. Its diagnosis is based on clinical criteria. These criteria need verification and revision in the Indian context. Furthermore, there are glaring differences in management protocols available in literature. These facts prompted Indian Academy of Pediatrics to review the management of rheumatic fever.


METHODS
Management of Rheumatic fever was reviewed and recommendation was formulated at national consultative meeting on 20th May 2007 at New Delhi.


OBJECTIVE
To formulate uniform guidelines on management of acute rheumatic fever and rheumatic heart disease in the Indian context. Guidelines were formulated for the management of streptococcal pharyngitis, acute rheumatic fever and its cardiac complication as well as secondary prophylaxis for recurrent episodes.


CONCLUSIONS
(1) Streptococcal eradication with appropriate antibiotics (Benzathine penicillin single dose or penicillin V oral or azithromycin). (2) Diagnosis of rheumatic fever based on Jones criteria. (3) Control inflammatory process with aspirin with or without steroids (total duration of treatment of 12 weeks). (4) Treatment of chorea according to severity (therapy to continue for 2-3 weeks after clinical improvement). (5) Protocol for managing cardiac complication like valvular heart disease, congestive heart failure and atrial fibrillation. (6) Secondary prophylaxis with benzathine penicillin and management of anaphylaxis.
Saxena
Anita
A
Kumar
R Krishna
RK
Gera
Rani Prem Kumar
RP
Radhakrishnan
S
S
Mishra
Smita
S
Ahmed
Z
Z
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D006801:Humans; D010401:Penicillin G Benzathine / Q000627:therapeutic use*; D010612:Pharyngitis / Q000188:drug therapy / Q000382:microbiology; D012213:Rheumatic Fever / Q000188:drug therapy* / Q000453:epidemiology; D012214:Rheumatic Heart Disease / Q000188:drug therapy* / Q000453:epidemiology; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D010401:Penicillin G Benzathine