Acute Rheumatic Fever Medication

Updated: Dec 10, 2020
  • Author: Robert J Meador, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
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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.