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Antimicrobial Prophylaxis Against Acute Rheumatic Fever and Spontaneous Bacterial Endocarditis

Secondary Prophylaxis

Indicated for patients with previous acute (ARF) and/or rheumatic heart disease (RHD)

continuous because subclinical Group A beta-hemolytic streptococcal pharyngitis can trigger recurrent ARF

Risk of recurrence is greatest in first 5 years after ARF and in those with RHD; the risk is 50% per episode of streptococcal pharyngitis


Persistent RHD: is provided for at least 10 years and at least until age 40; lifelong should be considered

RF with carditis 10 years, or well into adulthood

RF without carditis: 5 years, or until age 21 (whichever is longer)


IM Benzathine Pen G 1.2 M, units IM Q3-4 wk

P.O. Penicillin V 250 mg BID

P.O. Sulfadiazine 0.5-1.0 gm QD

P.O. Erythromycin 250 mg BID

Infective Endocarditis

Goal is to prevent infective endocarditis in susceptible patients (with underlying structural cardiac disease) when undergoing procedures that are likely to induce transient bacteremia

Coverage is provided for the procedure

No controlled data support efficacy; recommendations are based on in vitro susceptibility data

Conditions Requiring

Cardiac Conditions

Highest-Risk Patients (Recommended)

Prosthetic heart valves

Previous IE

Complex cyanotic congenital lesions

Surgical systemic-pulmonary shunts or conduits