Rheumatic fever (RF) remains a major problem in New Zealand. The New Zealand Heart Foundation Guideline gives detailed advice on diagnosis, management, and secondary prophylaxis.
There is also a CDHB Rheumatic Fever Prophylaxis Register of patients requiring secondary prophylaxis within the CDHB area - see below. Please contact Paediatrics for patients aged 15 or under. See HealthPathways for RF management in primary care.
Secondary Prophylaxis
There is reasonable evidence that regular administration of benzathine benzylpenicillin prevents group A streptococcal pharyngitis and recurrent acute rheumatic fever. Note that this is intramuscular benzathine benzylpenicillin, not benzylpenicillin sodium (penicillin G).
Duration of secondary prophylaxis:
Persons with a history of acute rheumatic fever with no or mild carditis: minimum of 10 years after most recent episode or until 21 years of age, whichever is longer.
All persons with history of acute rheumatic fever with moderate carditis: minimum of 10 years after most recent episode or until age 30, whichever is longer.
All persons with history of acute rheumatic fever with severe carditis: minimum of 10 years after most recent episode until age 30, with specialist review for consideration of longer prophylaxis.
Dosage:
In New Zealand it is recommended that 900 mg (1.2 mega units) of benzathine benzylpenicillin IM should be used for secondary prophylaxis for all persons weighing 20 kg or more. Dosing is by intramuscular injection every 28 days.
For patients who are penicillin allergic or if intramuscular is declined, please see the New Zealand Guideline for rheumatic fever.
CDHB Rheumatic Fever Prophylaxis Register: All patients in Canterbury, West Coast, and South Canterbury who qualify for rheumatic fever prophylaxis should be notified to Community and Public Health, phone 03 364 1777 or fax 03 379 6484. Prophylaxis is usually administered in a primary care setting. Community and Public Health will liaise with the general practice.