Acute Rheumatic Fever Medication

  • Author: Robert J Meador, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Sep 8, 2011
 

Medication Summary

Treatment and prevention may involve multiple fields of discipline, including infectious diseases, cardiology, and neurology. For this reason, several different classes of medications are used. These include antibiotic, neuroleptic, and cardiac medications.

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Antibiotics

Class Summary

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

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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.

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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.

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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.

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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.

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Anti-inflammatory agents

Class Summary

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

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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).

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Glucocorticosteroids

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.

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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.

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Neuroleptic agents

Class Summary

These agents are used for chorea associated with ARF.

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Haloperidol (Haldol)

 

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

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Positive inotropic agents

Class Summary

Digoxin may be indicated for patients with congestive heart failure.

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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.

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Contributor Information and Disclosures
Author

Robert J Meador, MD  Rheumatology Fellow, Department of Rheumatology, Baylor Garland Family Practice Clinic

Robert J Meador, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

I Jon Russell, MD, PhD, MS, FACR  Director, University Clinical Research Center, Associate Professor, Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio

I Jon Russell, MD, PhD, MS, FACR is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, International Association for the Study of Pain, and International MYOPAIN Society (IMS)

Disclosure: Jazz Pharma Consulting fee Consulting; Pfizer Pharma Grant/research funds Independent contractor; Pfizer Pharma Consulting fee Speaking and teaching; Lily Pharma Grant/research funds Independent contractor; Lily Pharma Consulting fee Speaking and teaching

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: Medscape Salary Employment

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, and American College of Rheumatology

Disclosure: Abbott Honoraria Speaking and teaching; Centocor Consulting fee Consulting; Genentech Grant/research funds Other; HGS/GSK Honoraria Speaking and teaching; Omnicare Consulting fee Consulting; Pfizer Honoraria Speaking and teaching; Roche Speaking and teaching; Savient Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; 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, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

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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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