Management protocols for Rheumatic Fever in Uganda

Jones Criteria

Evidence of recent streptococcal infection (ASO titre/throat swab) PLUS 2 major manifestations OR 1 major + 2 minor. Major: Polyarthritis, Carditis, Erythema marginatum, Subcutaneous nodules, Sydenham’s chorea. Minor: Polyarthralgia, Fever, Increased ESR/CRP, prolonged PR on ECG.

Eradicate Streptococci

Phenoxymethylpenicillin (Pen V) 250 mg every 6 hours for 10 days (Child: 125 mg/dose). OR Benzathine benzylpenicillin 1.2 MU IM stat (Child <30 kg: 0.6 MU).

Treat Inflammation

Acetylsalicylic acid 4-8 g/day until signs subside (Child: 80-100 mg/kg/day in 3 doses) PLUS magnesium trisilicate. If allergic to aspirin: Low dose steroid.

Chorea

Valproate 10-20 mg/kg/day.

Prophylaxis

Pen V 500 mg 12 hourly (Child: 125-250 mg 12 hourly) OR Benzathine benzylpenicillin 1.2 MU IM every 4 weeks. Duration: without carditis (5 yrs or until 21yo); with carditis but no residual heart disease (10 yrs or until 25yo); with residual heart disease (until 40yo or for life).