Rheumatic fever, treatment

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

Treatment of inflammatory conditions, such as rheumatoid arthritis, osteoarthritis, and rheumatic fever ... 

Prevention of recurrent attacks of rheumatic fever- Prevention of recurrent attacks of rheumatic fever (not for initial treatment of streptococcal infections) Patients greater than 30 kg (greater than 66 lbs) -1 g/day less than 30 kg (less than 66 lbs) - 0.5 g/day. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

E. The patient has exudative pharyngitis, presumably secondary to group A streptococcus. Antibiotic treatment is indicated to reduce the duration and severity of symptoms and to prevent acute rheumatic fever. The antibiotic of first choice is penicillin V. Other reasonable alternatives are benzathine penicillin G, erythromycin, cephalosporin, clindamycin, azithromycin, and clarithromycin. Amikacin, lome-fioxacin, metronidazole, and netilmicin are not active against group A streptococcus. 

Respiratory, skin, and soft-tissue infections UTIs pelvic inflammatory disease (PID) brucellosis trachoma Rocky Mountain spotted fever typhus Q fever lickettsia severe acne (Adoxa) smallpox psittacosis ornithosis granuloma inguinale lymphogranuloma venereum intestinal amebiasis (adjunctive treatment) prevention of rheumatic fever ... 

As antirheumatic Salicylates are the drug of choice in the treatment of rheumatoid arthritis. In larger dose they suppress the swelling, immobility and redness of the joints involved. They are also useful in the acute rheumatic fever. They produce relief in pain, swell-... 

The introduction of the sulfa drugs was followed by the development of the penicillin antibiotics. Fleming s chance observation of the anti-bacterial action of the penicillin mold in 1928 and the subsequent isolation and identification of its active constituent by Florey and Chain in 1940 marked the beginning of the antibiotics era that still continues today. At roughly the same time, the steroid hormones found their way into medical practice. Cortisone was introduced by the pharmaceutical industry in 1944 as a drug for the treatment of arthritis and rheumatic fever. This was followed by the development of steroid hormones as the active constituents of the contraceptive pill. 

The effect of Salix alba L. (white willow) is largely owed to a glycoside, salicin. Salicin is antipyretic and analgesic and has been used in the treatment of rheumatic fever (salicilin tablets British Pharmaceutical Codex, 1949). In 1893, Felix Hofmann, a chemist working for the Bayer chemical company in Germany, first synthesized acetyl-salicylic acid, the acetylated form of salicin. Aspirin is one of the most commonly used pharmaceuticals containing salicin. Today, the main commercial sources of salicin are Salix fragilis and Salix purpurea (Salicaceae), which are native to Eurasia. 

Aspirin is employed for mild to moderate pain of varied origin but is not effective for severe visceral pain. Aspirin and other NSAIDs have been combined with opioid analgesics for treatment of cancer pain, where their anti-inflammatory effects act synergistically with the opioids to enhance analgesia. High-dose salicylates are effective for treatment of rheumatic fever, rheumatoid arthritis, and other inflammatory joint conditions. 

Mitral stenosis is seen typically as a consequence of chronic rheumatic fever. Isolated congenital mitral stenosis is very rare and not suitable for balloon valvuloplasty. Clinical symptoms depend on the degree of obstruction. Dyspnea, atrial fibrillation, embolic events, pulmonary edema, and right heart decompensation may occur and are all indications for treatment. Surgery and catheter intervention provide similar results. Balloon valvuloplasty produces best results in patients with little or no calcification of the mitral leaflets (20—23). 

Generally in West Africa, the fruit is widely used in traditional remedies for the treatment of disease conditions including convulsion, gastric ulcer, rheumatism, fevers, whitlow, skin rashes, smallpox, malaria and dysentery (2, 39, 40, 104). It is also used to manage diabetes and cardiovascular diseases like hypertension and stroke in some parts of Ghana (Amoako-Atta, CBUD Director, KNUST, personal communication). The fruits are used to flavor foods and alcoholic beverages 2, 40). 

The evidence that treatment of group A streptococcal pharyngitis prevents rheumatic fever comes solely from studies using depot intramuscular penicillin. Penicillin administered by other routes has been assumed to be equally efficacious. The ability of other antibiotics to eradicate group A Streptococcus has led to extrapolation that these agents also will prevent rheumatic fever. 

The goals of treatment of pharyngitis are to improve clinical signs and symptoms, minimize adverse drug reactions, prevent transmission to close contacts, and prevent acute rheumatic fever and suppurative complications, such as peritonsillar abscess, cervical lymphadenitis, and mastoiditis. ... 

Antimicrobial treatment should be limited to those who have clinical and epidemiologic features of group A streptococcal pharyngitis with a positive laboratory test. Penicillin is the drug of choice in the treatment of group A streptococcal pharyngitis (Table 107-8). It has the narrowest spectrum of activity, and it is effective, safe, and inexpensive. The only controlled studies that have demonstrated that antimicrobial therapy prevents rheumatic fever were done with procaine penicillin, which was later replaced with benzathine penicillin. " ... 

Dajani A, Taubert K, Eerrieri P, et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever A statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Pediatrics 1995 96 758-764. 

Chamovitz R, Catanzaro El, Stetson CA, et al. Prevention of rheumatic fever by treatment of previous streptococcal infections. N Engl J Med 1954 251 466-471. 

Rheumatic heart disease, which is relatively rare in Western countries today, is characterized by damaged (scarred and deformed) heart valves. It is always a result of rheumatic fever, which is an infection caused by group A p-hemolytic streptococci. Children aged 5 to 15 are the usual victims. This is a preventable condition, if the initial attack of rheumatic fever is correctly diagnosed and treated. Treatment and prevention of a relapse is carried out by long-term (years) administration of penicillin G, V, or erythromycin (if allergic) and occasionally sulfonamides. 

In this preantimicrobial era large city hospital patients as recently as 1930 consisted primarily of those with bacteremia, endocarditis, syphilis, rheumatic fever, and tuberculosis, diseases for which no meaningful treatment existed. Tragically, large segments of these patients were children and adolescents—most of whom would die. Today the great preponderance of patients in the hospitals of the industrial countries suffer from cancer, heart diseases, and diabetes-related hypertension and its consequences. 

Oral/IV use for treatment of infections of the respiratory tract, skin and skin structure, and STDs caused by susceptible organisms treatment of pertussis, diphtheria, erythrasima, intestinal amebiasis, conjunctivitis of the newborn, Legionnaires disease, listeriosis, nongonococcal urethritis, pneumonia of infancy, urogenital infections during pregnancy treatment of acute pelvic inflammatory disease, syphilis, uncomplicated urethral, endocervical, or rectal infections in adults prevention of attacks of rheumatic fever prevention of bacterial endocarditis. 

Penicillin, a naturally occurring antibiotic, is indicated in the treatment of group A streptococcal upper respiratory infections, prophylaxis of poststreptococcal rheumatic fever, syphihs of less than one year s duration, moderate to severe systemic infections, uncomphcated gonorrhea, pneumococcal pneumonia, and endocarditis prophylaxis for dental surgery (see Table 23). 

Sodium thiosalicylate, a nonnarcotic analgesic, antipyretic, and antiinflammatory agent, is indicated for mild pain, in the treatment of rheumatic fever, or acute gouty arthritis (see also Table 3). 

---