Rheumatic fever is due to an autoimmune reaction to group streptococci and involves many organs, primarily the heart, the joints and the central nervous system.

Salient features:-

  • Major criteria are pancarditis, polyarthritis, chorea, erythema marginatum and subcutaneous nodule.
  • Minor criteria are arthralgia, fever, raised PR interval

Non pharmacological treatment

  • Bed rest for two weeks followed by gradual ambulation

Pharmacological treatment

  • penicillin V 500 mg BD for 10 days or Inj. benzathine penicillin G- 1.2 million units in single does or Tab. erythromycin 250 mg QID for 10 days – if patient is allergic to penicillin.

For secondary prophylaxis for rheumatic fever, give Inj. benzathine penicillin 1.2 million units every 3 weeks or Tab. penicillin V 250 mg BD daily or Tab. erythromycin 250 mg twice daily.

Rheumatic fever without carditis:

  • For 5 years after the last attack or 21 years of age (whichever is longer).

Rheumatic fever with carditis but no residual valvular disease:-

  • For 10 years after the last attack, or 21 years of age (whichever is longer).

Rheumatic fever with persistent valvular disease, evident clinically or on echocardiography:-

  • For 10 years after the last attack, or 40 years of age (whichever is longer). Sometimes lifelong prophylaxis may be required.


  1. Arthritis: Tab. aspirin 2 g QID in adults and 80-100 mg/kg/day in children till symptoms persist or Tab. naproxen: 10-20 mg/kg/day can also be used.
  2. Carditis: Tab. prednisolone 1-2 mg/kg/day can be used for short periods or up to a maximum of 3 weeks
  3. Chorea: It occurs as a long term sequelae (3-6 months). Carbamazepine or sodium valproate is preferred to haloperidol (0.05 mg/kg/day) to reduce the abnormal movements but response may take up to 2 weeks. Treatment should continue up to 1-2 weeks after symptoms subside

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By Gnurse