Table 3.

Recommended antibiotics regimens for secondary prophylaxis of rheumatic fever and rheumatic heart disease [18], [19], [20], [21].

Antibiotic	Child ≤27 Kg	Adult or > 27 kg	Route of administration
Agent of Choice
Benzathine benzylpenicillin Ga	600,000 unitsb	1,200,000 units	Single intramuscular injection every 4 weeks ce
Penicillin V		250 mg q12 h	Oral
For individuals allergic to Penicillin
Sulfonamide: “sulfadiazine”	500 mg q24 h	1000 mg q24 h	Oral
For individuals allergic to Sulfonamide or Penicillin
Erythromycine		250 mg q12 hd	Oral
Azithromycine	6 mg/kg q24 h (up to 250 mg)	250 mg q24 h	Oral

^aIntramuscular injection should be avoided in all individuals receiving oral anticoagulant (i.e. warfarin).

^bFor small children and infants Benzathine benzylpenicillin dose is 25,000 units per kg.

^cIn high-risk population, administration every 3 weeks is justified and recommended in populations in which the incidence of rheumatic fever is particularly high and those who have recurrent acute rheumatic fever despite adherence to an every-4-week regimen.

^dDosing for children: 20 mg/kg/day divided twice daily (maximum 500 mg per day; erythromycin is an acceptable alternative to azithromycin, although the latter has fewer adverse effects and permits once daily dosing).

^eContraindications to macrolides: a. Hypersensitivity to macrolide antibiotics or any component of the formulation. b. History of cholestatic jaundice/hepatic dysfunction associated with prior azithromycin use. c. Altered cardiac conduction: Macrolides (especially erythromycin) have been associated with rare QTc prolongation and ventricular arrhythmias, consider avoiding use in patients with prolonged QT interval or concurrent use of Class IA (eg, quinidine, procainamide) or Class III (eg, amiodarone, dofetilide, sotalol) antiarrhythmic agents or other drugs known to prolong the QT interval.