154 chapter 17
Treatment
• If you think a child might have rheumatic fever, get medical advice quickly. Early treatment
may help prevent heart damage. (After fever and joint pain have begun, treatment does
not seem to shorten the length of the illness.)
• Give penicillin V by mouth for 10 days; or give a single injection of benzathine
benzylpenicillin into the buttock muscles (one-half in each buttock); or inject procaine
penicillin daily for 10 days. For children allergic to penicillin, use erythromycin. See box for
doses. (For cautions in the use of penicillin, see Where There Is No Doctor, p. 351.)
• Give aspirin or ibuprofen in high dosage. See INFORMATION SHEET on page 134.
Continue giving the medicines until a few days after all signs are gone.
• Apply heat or cold packs to painful joints to help reduce pain and swelling (see p. 132).
• Do full range-of-motion exercises of painful joints gently every day (see Chapter 42).
• Do ‘exercises without motion’ to maintain strength (see p. 140).
• The child should stay in bed or rest quietly most of the time until all signs are
gone (about 6 weeks). Then he can begin activities little by little.
AntibiotiC Treatment of Rheumatic Fever
Name of medicine
Penicillin V
(by mouth)
Benzathine
benzylpenicillin
(by injection)
Age or weight
up to 1 year
1 to 5 years
6 to12 years
over 12 years
OR
up to 30 kg.
over 30 kg.
OR
Procaine penicillin G
all children
(by injection)
OR for persons allergic to penicillin:
Erythromycin
tablets
(by mouth)
up to 2 years
2 to 8 years
over 8 years
Dose
62.5 mg.
125 mg.
250 mg.
500 mg.
450 to 675 mg.
(600,000 to
900,000 units)
900 mg.
(1,200,000 units)
50 mg./kg./day or
50,000 units/kg./day
up to a maximum of
1,200,000 units
125 mg.
250 mg.
250 to 500 mg.
How to take
4 times a day for
10 days, by mouth
single deep injection
into the muscle, once
every 3 to 4 weeks
(give one-half into
each buttock)
daily, for 10 days, by
deep injection into the
muscle (give one-half
into each buttock)
4 times a day for
10 days, by mouth
Note: It is safer to give children medicines by mouth rather than by injection whenever possible.
For precautions in giving medicines to children, see p. 236.
PREVENTION of repeat attacks
Persons who have once had rheumatic fever have a risk of getting it again. For these
persons, take care to treat any sore throat quickly with penicillin. If the person shows
signs of heart damage (murmur) with the first attack, there is a high risk of further
damage with repeat attacks. These persons would be wise to take a preventive dose
of penicillin regularly for at least one attack-free year or until they are 17 years old (after
which the risk of strep throat is lower). Long-term prevention is especially important in
persons who already have serious rheumatic heart damage.
PREVENTIVE DOSAGES:
• or 1 injection of 1.2 million units of benzathine penicillin G, once a month,
• or 1 tablet of 500 mg. of sulfadiazine 2 times a day,
• or 1 tablet of 250 mg. of penicillin V, 2 times a day with an empty stomach.
• For children allergic to penicillin, give 1 tablet of 250 mg. of erythromycin, 2
times a day.
Before using these medicines, read the precautions. See the GREEN PAGES of Where There Is No Doctor.
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