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Acute GAS pharyngitis should be treated promptly by penicillin or other antibiotics. Indian Council of Medical Research (ICMR) recommends that all cases of pharyngitis must receive penicillin. One need not wait to isolate GAS organisms. A single dose of 1.2 mega units of Benzathine penicillin given IM or a ten day course of oral penicillin V is given. In case of allergy to penicillin, one uses macrolides or cephalosporins.
Table Prophylaxis of Rheumatic Fever
Primary Prophylaxis Intramuscular Benzathine penicillin G 12,00,000 U once(6,00,000 U, if weight less than 27 kgs) Oral Penicillin V 500 mg bid daily for 10 days Erythromycin 250 mg bid daily for 10 days Other (Clindamycin, Dose varies Nafcillin, Ampicillin, Amoxicillin, Cephalexin)
Secondary Prophylaxis
Intramuscular Benzathine penicillin G 12,00,000 U every 3-4 weeks Oral Penicillin V 250 mg bid daily Sulfadiazine 1 gm od (0.5 gm od in children) Erythromycin 250 mg bid daily stearate
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Benzathine penicillin given every three weeks as IM injection (1.2 mega units) has given the best results. Oral agents (penicillin V) are given in patients with lower risk of rheum
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