Pediatrics provides specialized medical care for infants, children, and adolescents. Learn about routine screenings, vaccinations, and treatments.
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The first step in treating rheumatic fever is to completely remove the group A Streptococcus bacteria from the throat. Even if the sore throat is gone, the bacteria can still be present and keep the immune system active. Doctors give a full course of antibiotics, usually as a single injection of benzathine penicillin G, which lasts for several weeks. If injections are not possible, a 10-day course of oral penicillin V or amoxicillin can be used, but it is harder to make sure all doses are taken. For people allergic to penicillin, other antibiotics like erythromycin, clarithromycin, or azithromycin are used. Getting rid of the bacteria helps stop the immune reaction and also prevents spreading the infection to others.
After treating the infection, the next goal is to reduce the inflammation that causes symptoms. The type of anti-inflammatory medicine depends on how severe the disease is and which organs are affected. For patients with arthritis and mild or no heart problems, high-dose aspirin is the main treatment. Aspirin works very well in rheumatic fever, often easing joint pain and fever within a day or two. Although aspirin is usually avoided in children because of the risk of Reye syndrome, it is used here because the benefits are greater than the risks, as long as the child is watched closely for side effects and does not have a viral illness. Treatment lasts for several weeks and is slowly reduced as the patient improves.
Patients with severe heart inflammation, such as an enlarged heart, heart failure, or serious heart rhythm problems, need stronger anti-inflammatory treatment. In these cases, doctors use steroids like prednisone or methylprednisolone, which work faster and more powerfully than aspirin. Treatment usually lasts 2 to 3 weeks at a high dose, then is slowly reduced. As steroids are lowered, aspirin is often added back to prevent inflammation from returning. Other treatments for heart failure, like diuretics to remove extra fluid and medicines to lower the heart’s workload, may also be used. Patients must rest in bed during the worst phase, and activity is increased slowly as they get better.
Sydenham chorea is usually managed with supportive care, since it often goes away on its own. The involuntary movements and mood changes can be upsetting, so a calm and quiet environment helps reduce stress and symptoms. For mild cases, rest and reassurance are enough. If the movements are severe and affect daily life, doctors may prescribe medicines like valproic acid or carbamazepine, which control the movements and have fewer side effects than older drugs. In very severe cases, treatments like steroids or IVIG may be used to help symptoms go away faster. It is important for parents and teachers to know that these behavior changes are part of the illness and to be patient and supportive.
The most important part of long-term care is secondary prevention, which means giving regular antibiotics to stop new strep infections. People who have had rheumatic fever are much more likely to get it again if they catch strep throat. Each new attack can cause more heart damage. So, after the first treatment, patients start regular antibiotic shots, usually benzathine penicillin G every 3 to 4 weeks. This method works better than taking pills. If shots are not possible, oral penicillin or sulfadiazine can be used, but it is very important not to miss any doses. How long this prevention lasts depends on the patient’s risk: 5 years or until age 21 for those without heart problems, 10 years or until age 21 for those with heart inflammation but no lasting damage, and 10 years or until age 40 (or sometimes for life) for those with permanent heart valve problems.
Good care for rheumatic fever is about more than just medicine. During the illness, patients need bed rest, good nutrition, and pain relief for arthritis. In the hospital, doctors closely watch vital signs, fluid levels, and heart health. After the worst phase, patients come back for regular checkups to monitor inflammation, heart function, and make sure they are keeping up with their antibiotics. Education is very important. At Liv Hospital, we help patients and families understand the disease, why long-term antibiotics matter, and when to see a doctor for a sore throat. Working together with families helps prevent future problems and supports full recovery.
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Despite general precautions, aspirin is the most effective medication for controlling the severe joint pain and inflammation of rheumatic fever and is used under strict medical supervision.
Bed rest duration varies by severity. Patients with active heart inflammation may need bed rest for weeks to months to reduce heart strain and allow healing.
Missing a dose leaves the patient unprotected against strep bacteria. A new infection can trigger a recurrence of rheumatic fever, causing further permanent heart damage.
No, medications for chorea are used only to control symptoms during the active phase. Once the movements resolve, usually within a few months, the drug is stopped.
Medication reduces inflammation and manages heart failure symptoms, but it cannot fix scar tissue on valves. Severe valve damage may eventually require surgical repair or replacement.
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