Regarding secondary prophylaxis for rheumatic fever with carditis and residual valvular disease, what is the recommended duration of benzathine penicillin G prophylaxis according to Indian guidelines?

• A 5 years or until age 18 years, whichever is longer
• B 10 years or until age 25 years, whichever is longer
• C 10 years or until age 40 years, whichever is longer ✓
• D Lifelong prophylaxis in all cases of carditis

Explanation

According to the 2012 AHA and Indian (IAP/IACHR) guidelines, secondary prophylaxis duration for rheumatic fever with carditis AND residual valvular disease (persistent valve disease) is 10 years from the last attack or until age 40 years, whichever is longer — and some authorities recommend lifelong prophylaxis for severe valvular disease. For carditis without residual valve disease: 10 years or age 25. For rheumatic fever without carditis: 5 years or age 21. Benzathine penicillin G 1.2 MU IM every 3–4 weeks is the preferred regimen.

Reference: Ghai Essential Pediatrics, 10th ed.

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