Table 5.

Recommended Durations of Secondary Prophylaxis According to Major International Guidelines

Guideline	Secondary Prophylaxis Duration Recommended
Australian (2012) [10]	• In all patients for at least 10 y after previous ARF • Severe RHD until age 40 y or indefinitely, per physician discretion • Moderate RHD or RHD without prior documented ARF date until age 35 y • Mild RHD or ARF without RHD diagnosis until age 21 y or for 10 y after last ARF (whichever is longer)
New Zealand (2014) [16]	• After definite/probable ARF, continue prophylaxis for at least 10 y, consider 5 y of prophylaxis after ARF in patients with mild or no carditis over 21 y or in patients with ARF classified as “possible” • Severe RHD generally until age 40 y, with review at age 30 ya • Moderate RHD until age 30 ya • Mild RHD or ARF without RHD diagnosis, until age 21 y or for 10 y after last ARF (whichever is longer)
American (AHA 2009) [17]	• ARF with carditis and residual heart disease until age 40 y or for 10 y after last ARF (whichever is longer); lifetime prophylaxis may be needed • ARF with carditis but no residual heart disease until age 21 y or for 10 y after last ARF (whichever is longer) • ARF without carditis until age 21 y or for 5 y after last ARF (whichever is longer)
Indian (2008) [18]	• Lifelong in severe disease or postintervention patients; may opt for secondary prophylaxis until age 40 y • ARF with healed, mild, or moderate carditis until age 25 y or for 10 y after last ARF (whichever is longer) • ARF without carditis until age 18 y or for 5 y after last ARF (whichever is longer)
WHO Expert Consultation Geneva (2001) [15]	• Lifelong if severe valvular disease or after valve surgery • For 10 y after last ARF or until age 25 y in patients with previous diagnosis of carditis • For 5 y after last ARF or until age 18 y in patients without proven carditis

Abbreviations: ARF, acute rheumatic fever; RHD, rheumatic heart disease.

^aFor severe RHD at age 40 years or moderate RHD at age 30 years, cessation of prophylaxis is still at the physician’s discretion based on the individual patient risk.