Prophylaxis against recurrent rheumatic fever to prevent carditis progression is BEST managed by which regimen in an 8-year-old with established rheumatic heart disease?
- A Oral penicillin V 250 mg twice daily until age 18 years
- B Benzathine penicillin G 1.2 million units IM every 3–4 weeks until age 21 years or for 10 years after last episode, whichever is longer ✓
- C Oral amoxicillin 500 mg once daily for 5 years
- D Prophylaxis is not necessary if the child has completed full treatment of acute attack
Correct answer: B. Benzathine penicillin G 1.2 million units IM every 3–4 weeks until age 21 years or for 10 years after last episode, whichever is longer
Explanation
Secondary prophylaxis with benzathine penicillin G IM every 3–4 weeks is superior to oral regimens (better compliance, higher penicillin levels). In patients with rheumatic heart disease (valvular involvement), prophylaxis should continue until at least age 21 years or for 10 years after the last episode, whichever is longer. Patients without carditis may discontinue at 21 or 5 years after last episode. Oral penicillin is an alternative for those who refuse injections but has lower compliance.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.