Table 4.
Duration of antibiotics as secondary prophylaxis for rheumatic fever and rheumatic heart disease [17], [18], [19], [20].
| Category of patient | Duration of prophylaxis |
|---|---|
| Rheumatic fever with carditis and residual heart disease (persistent valvular disease) | >10 years since last episode and at least until age 40 years, sometimes lifelong prophylaxisa |
| Rheumatic fever with carditis but no residual heart disease (no valvular disease) | For 10 years after the last attack, or at least until 21 years of age (whichever is longer) |
| Rheumatic fever without carditis | 5 years or until 21 years, whichever is longer |
| More severe valvular diseaseb | Lifelong |
| After valve surgery | Lifelong |
a
Patients who are at high risk and likely to come in contact with populations with high prevalence of streptococcal infection, i.e., teachers, day-care workers, clinical or Echocardiographic evidence.
b
Valve severity is diagnosed according to the following ECHO criteria: a. Valve area (cm2) < 1 in aortic, mitral and tricuspid valve. b. Mean gradient (mmHg): aortic >40, mitral >10, pulmonic >64, tricuspid >5.