Medication Summary
Medical therapy for acute rheumatic fever (ARF) involves the following areas:
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Eradication of group A streptococcal infection
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Management of arthritis pain and inflammation with NSAIDs or salicylate
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Treatment of carditis with glucocorticoids
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Control of chorea
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Prophylaxis against group A beta-hemolytic Streptococcus infections in patients who have developed ARF
Antimicrobials
Class Summary
Because of the direct link between ARF and group A beta-streptococcal infection, the first step in treatment is the eradication of the organism.
Antibiotic regimens used for prevention of recurrence are mentioned briefly under Further Outpatient Care.
Penicillins, Natural
Penicillin G benzathine (Bicillin LA, Bicillin C-R)
Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Because of its prolonged blood level, monthly injection is widely accepted as the treatment of choice for prophylaxis.
Penicillin G procaine (Crysticillin, Wycillin)
Long-acting parenteral penicillin (IM only) indicated in the treatment of moderately severe infections caused by penicillin G–sensitive microorganisms.
Administer by deep IM injection only into the upper outer quadrant of the buttock. In infants and small children, the midlateral aspect of the thigh may be the best site for administration.
Penicillin VK (Beepen-VK, Betapen-VK, Robicillin VK, Veetids)
Penicillin VK is the oral formulation of penicillin and an alternative treatment of rheumatic fever.
Penicillins, Amino
Amoxicillin
Inhibits the biosynthesis of the cell-wall mucopeptide and is effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.
Antibiotics, Lincosamide
Clindamycin (Clindamax, Cleocin, Cleocin Pediatric)
Antibiotic treatment alternative for patients allergic to penicillin.
Binds 23S RNA of 50S ribosome subunit to inhibit bacterial protein synthesis.
Macrolides
Erythromycin (EES, E-Mycin, Ery-Tab, Erythrocin)
Antibiotic treatment alternative for patients allergic to penicillin.
Inhibits RNA-dependent protein synthesis, possibly by stimulating the dissociation of peptidyl tRNA from ribosomes, which inhibits bacterial growth.
In children, age, weight, and severity of infection determine the proper dosage. When bid dosing is desired, one-half the daily dose may be administered q12h. For more severe infections, the dose may be doubled.
Azithromycin (Zithromax)
Antibiotic treatment alternative for patients allergic to penicillin.
Acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.
Concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues.
Treats mild-to-moderate microbial infections.
Plasma concentrations are very low, but tissue concentrations are much higher, giving it value in treating intracellular organisms. Has a long tissue half-life.
Biaxin (DSC), Clarithromycin
Antibiotic treatment alternative for patients allergic to penicillin.
Reversibly binds 50S ribosomal subunit and inhibits RNA-dependent protein synthesis in susceptible organisms.
Cephalosporins, 1st Generation
Cephalexin (Keflex, Panixine Disperdose)
Antibiotic treatment alternative for patients allergic to penicillin.
Binds penicillin binding proteins in actively dividing bacteral cells; inhibits bacterial cell-wall synthesis.
Glucocorticoids
Class Summary
These agents possess anti-inflammatory (ie, glucocorticoid) and salt-retaining (ie, mineralocorticoid) properties. These agents modify the body's immune response to diverse stimuli. Indicated in carditis and severe Sydenham chorea.
Prednisone (Deltasone, Sterapred)
Decrease inflammation contributing to carditis. Also useful in severe Sydenham chorea.
Anti-inflammatory agents
Class Summary
Reduce the pain and inflammation of arthritis.
Aspirin (Ascriptin, Bayer Buffered Aspirin, Ecotrin)
Treats mild to moderate pain. Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.
Naproxen (Anaprox, Naprelan, Naprosyn)
For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis.
Anticonvulsants, Other
Class Summary
Help manage Sydenham chorea.
Carbamazepine (Carbamazepine CR, Carbamazepine Chewtabs, Carbatrol)
Stabilizes inactivated state of sodium channels, making neurons less excitable.
Valproic acid (Depacon (DSC), Depakene (DSC), Stavzor (DSC))
May increase GABA concentration in the central nervous system.
Diuretics
Class Summary
Used to manage heart failure symptoms in ARF.
Diuretics, Loop
Furosemide (Lasix, Furoscix)
Inhibits reabsorption of Na+ and Cl- at proximal and distal tubules and Loop of Henle.
Diuretics, Potassium-Sparing
Spironolactone (Aldactone, CaroSpir)
Increases Na+, Cl-, and water excretion, but conserves K+, H+.
Nitrates
Class Summary
Used to manage heart failure symptoms in ARF.
Nitrates, Angina
Nitroglycerin IV (Glyceryl trinitrate IV, IV Nitroglycerin, NitroBid IV)
Enters vascular smooth muscle and is converted to nitric oxide, which induces cGMP synthesis and vasodilation; decreases preload.
Nitroglycerin PO (Glyceryl trinitrate PO)
Enters vascular smooth muscle and is converted to nitric oxide, which induces cGMP synthesis and vasodilation; decreases preload.
Immunosuppressants
Hydroxychloroquine sulfate (Plaquenil)
Mechanism unclear. May provide some benefit in carditis based on in vitro studies and a small case report, but must be used with caution due to risk of QTc prolongation.
Antipsychotics, 2nd Generation
Class Summary
May provide some relief of neuropsychiatric symptoms from Sydenham chorea
Olanzapine (Zyprexa, Zyprexa Relprevv, Zyprexa Zydis)
Atypical antipsychotic. Dopamine and serotonin receptor antagonist.
Risperidone (Risperdal, Perseris, Risperdal Consta)
Atypical antipsychotic. Dopamine and serotonin receptor antagonist.
SV2A Ligands
Class Summary
May provide some relief of neuropsychiatric symptoms from Sydenham chorea
Levetiracetam (Keppra, Elepsia, Keppra XR)
Modulates neurotransmitter release by binding to the synaptic vesicle protein SV2A.
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Medication Summary
- Antimicrobials
- Penicillins, Natural
- Penicillins, Amino
- Antibiotics, Lincosamide
- Macrolides
- Cephalosporins, 1st Generation
- Glucocorticoids
- Anti-inflammatory agents
- Anticonvulsants, Other
- Diuretics
- Diuretics, Loop
- Diuretics, Potassium-Sparing
- Nitrates
- Nitrates, Angina
- Immunosuppressants
- Antipsychotics, 2nd Generation
- SV2A Ligands
- Show All
- References
