A 10-year-old child is diagnosed with acute rheumatic fever. He has carditis (mitral regurgitation on echo), polyarthritis, and elevated ESR/CRP. He has no penicillin allergy. According to current guidelines, the treatment plan includes secondary prophylaxis. The duration of benzathine penicillin G prophylaxis for this patient with carditis but no residual valve disease after 10 years should be:

• A 5 years from the last attack or until age 21, whichever is longer
• B 10 years from the last attack or until age 25, whichever is longer
• C Lifelong prophylaxis regardless of valve disease
• D 10 years from the last attack or until age 21, whichever is longer ✓

Explanation

Per WHO/AHA guidelines on rheumatic fever secondary prophylaxis: patients with carditis but no residual valve disease need prophylaxis for 10 years after the last attack or until age 21, whichever is longer. Those with persistent valvular disease require 10 years or until age 25 (whichever is longer). Lifelong prophylaxis is for those with severe residual disease, especially if valve surgery is contemplated. The correct category here (carditis without residual disease) requires 10 years or age 21.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.