L6: Acute Rheumatic Fever (Pt 4) Flashcards
TTT of ARF
TTT of ARF
- Eradication of streptococcus infection
TTT of ARF
- Anti-inflammatory or suppressive therapy
TTT of ARF
- Education
TTT of ARF
- Bed Rest
TTT of ARF
- TTT of Arthritis & Carditis
TTT of Arthritis & Carditis
- Arthritis or mild carditis
TTT of Arthritis & Carditis
- Severe carditis
TTT of ARF
- TTT of CHF
TTT of ARF
- TTT of Sydenham’s Chorea
TTT of Sydenham’s Chorea
- Rest
Decrease physical & emotional stress and use protective measures
TTT of Sydenham’s Chorea
- BPG
Give benzathine penicillin G 1.2 million:
- Initially for eradication of streptococcus
- Every 2 weeks for prevention of recurrence
TTT of Sydenham’s Chorea
- Anti-Inflammatory
It is not needed in patients with isolated chorea.
TTT of Sydenham’s Chorea
- For Severe Cases
Any of the following drugs may be used:
1. Phenobarbital
2. Haloperidol
3. Valproic acid, chlorpromazine, or diazepam
4. Plasma exchange
5. IV immunoglobulin therapy
Without prophylaxis, approximately 25% of patients with isolated chorea (without carditis) develop rheumatic valvular heart disease over a 20-year follow-up period.
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Prevention of ARF
Prevention of ARF
- Primary Prevention
- Prevention of the initial attack of acute rheumatic fever.
- By accurate and prompt recognition and treatment of streptococcal pharyngitis
Prevention of ARF
- Secondary Prevention
- Prevention of recurrent acute rheumatic fever.
- Through compulsive ongoing prophylaxis against streptococcal infection
Prevention of ARF
- Prevention of Bacterial endocarditis
In individuals with residual rheumatic cardiac valve disease
Primary Prevention of ARF
- When & For How Long Should Antibiotic be Used?
- 10 days course of penicillin therapy for streptococcal pharyngitis.
- Start antibiotic within 7 to 8 days of the onset of pharyngitis.
Primary Prevention of ARF
- Not Possible in
- Patients who develop subclinical pharyngitis and therefore do not seek medical treatment (30%)
- patients who develop acute rheumatic fever é out symptoms of streptococcal pharyngitis (30%)
Primary Prevention of ARF
- Regimen
Primary Prevention of ARF
- Regimen if Allergic to penicillin
Primary Prevention of ARF
- What agents are not acceptable?
- Sulfonamides
- Trimethoprim
- Tetracycline
- Chloramphenicol.
Secondary Prevention of ARF
Secondary Prevention of ARF
- Indication
is given for all patients with rheumatic fever
- including those with isolated chorea & those without RHD.
Secondary Prevention of ARF
- Duration
Secondary Prevention of ARF
- Regimen
Secondary Prevention of ARF
- Regimen (If Allergic to penicillin)
Prevention of infective endocarditis
Prevention of infective endocarditis
- For Who?
Patients with residual RHD after rheumatic fever.
Prevention of infective endocarditis
- Why?
To prevent lE during invasive procedures.
Prevention of infective endocarditis
- Invasive Procedures Requiring Prophylaxis
- Dental cleaning
- Dental extraction
- Dental implant
- Tonsillectomy
Prevention of infective endocarditis
- Penicillin?
§
Penicillin for rheumatic fever is ineffective for bacterial endocarditis due to resistant oral streptococci.
Prevention of infective endocarditis
- recommended Antibiotics
- Clindamycin
- Erythromycin
Prevention of infective endocarditis
- Dosage & Timing
A single dose, given 30-60 minutes before the procedure
