Protocols for antibiotic use in primary and secondary prevention of rheumatic fever.

The prevention of the first attack of RF requires antibiotic treatment of suspected or proven streptococcal throat infection or tonsillitis in children between the ages of 3 and 15 years. In communities where RF is endemic, all cases of sore throat in children 3 15 years of age should be regarded as a streptococcal infection and be treated as such unless any one of the following clinical characteristics, which indicate that the sore throat should not be diagnosed as a ‘strep’ throat, is present: ulceration, hoarseness, watery nasal secretion, and/or conjunctivitis. Children not diagnosed with streptococcal pharyngitis should be treated symptomatically. If laboratory services are available, diagnosis of ‘strep’ sore throat should be confirmed microbiologically, but this confirmation should not delay the initiation of treatment. The recommended treatment of ‘strep’ throat is set out in Table I.