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Acute Rheumatic Fever Medication

  • Author: Robert J Meador, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
Updated: Jul 19, 2016

Medication Summary

Treatment and prevention of acute rheumatic fever (ARF) may involve multiple specialties, including infectious diseases, cardiology, and neurology. For this reason, several different classes of medications are used. These include antibiotic, cardiac, and neuroleptic medications.



Class Summary

Antibiotics are the initial pharmacotherapy for prevention and treatment of rheumatic fever.

Penicillin G procaine (Crysticillin)


Long-acting parenteral penicillin indicated in the treatment of moderately severe infections caused by microorganisms sensitive to penicillin G. IM administration only.

Adults: Deep IM injection into the upper outer quadrant of the buttock only.

Infants and small children: IM injection into midlateral aspect of the thigh is suggested.

Some authors prefer 10 d of therapy.

Penicillin G benzathine (Bicillin L-A)


Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity. Long-acting depot form of penicillin G. Because of its prolonged blood level, several authors believe this to be the DOC. Others prefer daily injections with short-acting penicillin.

Penicillin VK (Beepen-VK, Betapen-VK, Robicillin VK, Veetids)


Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects. PO alternative.

Erythromycin (EES, E-Mycin, Ery-Tab, Erythrocin)


Alternative for patients allergic to penicillin (although not the DOC).

Drug may inhibit RNA-dependent protein synthesis by stimulating the dissociation of peptidyl t-RNA from ribosomes. Inhibits bacterial growth.

In children, age, weight, and the severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken every 12 h. For more severe infections, dose may be doubled.


Anti-inflammatory agents

Class Summary

These agents inhibit inflammation to prevent destruction in the joints and heart.

Aspirin (Ascriptin, Bayer Buffered Aspirin, Ecotrin)


For treatment of mild to moderate pain and headache. Considered the first DOC for the treatment of arthritis due to acute rheumatic fever (ARF).



Class Summary

These agents demonstrate anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties. Glucocorticoids produce profound and varied metabolic effects. These agents also modify the body's immune response to diverse stimuli.

Prednisone (Deltasone, Liquid-Pred, Meticorten, Orasone, Sterapred)


Patients with carditis require prednisone. The goal is to decrease myocardial inflammation. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. After 2-3 wk, dosage may be tapered, reduced 25% each week.


Neuroleptic agents

Class Summary

These agents are used for chorea associated with ARF.

Haloperidol (Haldol)


Dopamine receptor blocker used for irregular spasmodic movements of the limbs or facial muscles.


Positive inotropic agents

Class Summary

Digoxin may be indicated for patients with congestive heart failure.

Digoxin (Lanoxin)


Acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

Contributor Information and Disclosures

Robert J Meador, Jr, MD Rheumatologist, Dallas Diagnostic Association

Robert J Meador, Jr, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, Texas Medical Association, Dallas County Medical Society, Lupus Foundation of America, Lone Star Chapter, Sjögren’s Syndrome Foundation

Disclosure: Nothing to disclose.


Irwin Jon Russell, MD, PhD, MS, FACR, ACR-Master Medical Director for Fibromyalgia Research and Consulting, (Retired) Faculty, Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio

Irwin Jon Russell, MD, PhD, MS, FACR, ACR-Master is a member of the following medical societies: Alpha Omega Alpha, International Myopain Society, American College of Physicians, American College of Rheumatology, International Association for the Study of Pain

Disclosure: Received consulting fee from Daiichii Sankyo for review panel membership; Received grant/research funds from Pfizer Pharma for independent contractor; Received grant/research funds from Lilly Pharma for independent contractor.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, American College of Rheumatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Janssen<br/>Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Genentech; Pfizer; Questcor.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

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Clinical manifestations and time course of acute rheumatic fever.
Chest radiograph showing cardiomegaly due to carditis of acute rheumatic fever.
Erythema marginatum, the characteristic rash of acute rheumatic fever.
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