Prophylaxis For Rheumatic Fever: Treatment, Procedure, Cost and Side Effects

Rheumatic fever, caused by Streptococcus pyogenes, is a rare but serious condition which develops as a consequence of throat infection. It is one of the primary causes of rheumatic heart disease. This disease can result in carditis, irreversible valve damage and heart failure in children and young people. Streptococcus pyogenes can cause a deleterious effect on children who are susceptible. Rheumatic fever is basically an inflammatory disorder that can cause throat infection or scarlet fever in some people. The bacteria cause our body to attack its own tissues and this causes widespread inflammation. This inflammation is the basis for all the symptoms of rheumatic fever.

Rheumatic fever can be most effectively prevented by treating the Streptococcus pyogenes infection with appropriate antibiotics. This reduces the risk of developing rheumatic heart disease significantly. Antibiotics help to control and prevent rheumatic fever by lowering the risk of further infection from the Streptococcus bacteria and thus prevent damage to the heart valves. Thus, by using secondary prophylaxis antibiotics, heart valve surgery to replace/epair damaged heart valves can be delayed or prevented.

The precipitating cause of rheumatic fever are the Group A Streptococcus (GAS) infections of the pharynx. The primary treatment of rheumatic fever requires therapy for GAS pharyngitis. Intramuscular penicillin G benzathine, oral penicillin V potassium and oral amoxicillin are the anti-microbial agents that are generally used. However, people with recurrent rheumatic fever and corresponding rheumatic heart disease should go for prophylaxis.

People with well-documented histories of rheumatic fever and those who have/are developing symptoms of rheumatic heart disease will benefit from continuous prophylaxis. It is necessary to start the prophylaxis as soon as acute rheumatic fever or rheumatic heart disease is diagnosed in a person. Doctors determine how to treat and also how to undertake the administration of drugs on the basis of a patient’s clinical condition and adherence to therapy. There are a number of factors on which the duration of the secondary prophylaxis depends. They are patients’ age, date of last attack and the presence and severity of rheumatic heart disease.

The most effective treatment is the intramuscular injection of repository penicillin. Recent data has suggested that if 1,200,000 units of benzyl-benzathine penicillin are administered every 3 weeks, the risk of recurring rheumatic fever is substantially reduced. It is essential for the health workers administering the drug into a patient’s body should be trained in the technique of giving injections. The drug should be administered deep into the muscle. Otherwise superficial injections allow the drug to be in the subcutaneous tissue and this results in decreased absorption and lower serum levels.

Oral phenoxymethyl penicillin can be given as an alternative to those people who are not given the regular and repeated injections benzathine benzylpenicillin.

Mostly children are affected by the A streptococcus bacteria. There are a number of symptoms which can help to understand whether a child is eligible for treatment or not. Some of them are sore throat with tender and swollen lymph nodes, a red rash, difficulty in swallowing, thick and bloody discharge from nose and a body temperature of 101 degrees Fahrenheit or above. The other symptoms that help to understand whether a person needs prophylaxis for rheumatic fever are red and swollen tonsils, small, red spots on the roof of the mouth, nausea, headache and vomiting.

People who have not been affected by the A Streptococcus bacteria and do not show the symptoms of rheumatic fever are not eligible for the prophylaxis. And patients who are allergic to penicillin are given some alternative treatments. Whether a person is eligible for this treatment or not depends on patient adherence to the prescribed regimen.

Common side-effects of using repository penicillin to treat prophylaxis of rheumatic fever are pain at the injection site, nausea and vomiting. The drug may also interact with other antibiotics that a person may take. This may lead to further complications. The repository penicillin drug should be consumed by pregnant women only after consulting with a doctor. This is because the drug passes on to breast milk and thus can be detrimental for a newborn child.

Rheumatic fever is caused by a bacteria and it mainly affects children. The post-treatment guidelines require a person to maintain proper hygiene methods so that the bacteria does not infect again. A person should cover his/her mouth while coughing or sneezing, wash his/her hands properly, avoid contact with sick people and also to avoid sharing personal items with people who are sick. Even when the acute illness has subsided, people should continue to take penicillin or an equivalent antibiotic for many years to avoid recurrences. It is better to avoid alcohol, carbonated and caffeinated drinks and spicy foods.

Rheumatic fever can last from 6 weeks to about months. The duration primarily depends on how the heart has been affected by disease. Proper diagnosis and timely administration of relevant drugs can help to protect the heart. But in case of acute rheumatic fever, the heart muscles get affected and the heart’s ability to pump blood is jeopardized. Thus it takes time to recover if someone has rheumatic heart disorder as the heart valves get affected.

The cost of the penicillin injection that is to be administered to a patient is not high. The total cost to treat rheumatic fever depends on how long the fever persists. Nevertheless, the cost of the repository penicillin to treat rheumatic fever costs something around Rs 90000 for 10 syringes. The cost to replace damaged heart valves can range from Rs 150000 – Rs 350000. However, the treatment depends on how severe is the condition of the patient and on whether he is suitable to receive such treatment or not.

An attack of rheumatic fever usually subsides within a few weeks or a few months. However, if a child has rheumatic heart disease, there may never be a full recovery. The heart damage may last for a lifetime. A child can also have rheumatic fever more than once. Hence, it is advisable for him/her to be on antibiotics for a prolonged period of time to prevent recurrence.

There are a number of herbal remedies to treat rheumatic fever. Herbal tea prepared from dandelion leaf helps to treat rheumatic fever. Drinking Echinacea tea helps to strengthen the immune system and thus helps to prevent rheumatic fever. A mix of asparagus, fenugreek and black cumin and carom seeds helps to reduce the swelling and speeds up the healing process. In addition, ginger has anti-inflammatory properties and so helps to cure rheumatic fever from roots. The anti-fungal properties of garlic also help to fight rheumatic fever.