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Plain language summary
Prophylactic penicillin probably reduces rheumatic fever recurrences and streptococcal throat infections among children and adolescents with rheumatic fever or rheumatic heart disease (moderate certainty of evidence).
The effect of prophylactic penicillin on mortality and adverse events among children and adolescents with rheumatic fever or rheumatic heart disease is uncertain (very low certainty of evidence).
No studies reported the effects on rheumatic heart disease progression and disability among children and adolescents with rheumatic fever or rheumatic heart disease.
Acute rheumatic fever is an autoimmune disease that may occur following group A streptococcal throat infection. It can affect multiple systems, including the joints, heart, brain, and skin. Only the effects on the heart can lead to permanent illness; chronic changes to the heart valves are referred to as chronic rheumatic heart disease. No treatment has been shown to alter the progression of acute rheumatic fever to chronic rheumatic heart disease. Secondary prophylaxis can improve the prognosis of established rheumatic valvular disease. The recommended choice of treatment is long-term penicillin secondary prophylaxis (BMJ Best Practice (accessed Nov 20 2020)).