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คุณหมอ Arlim คะ ดิฉันคัดลอกมาจาก Up to date เกี่ยวกับ prophylaxis of acute rheumatic fever คำตอบสั้นๆ คือ ถ้าให้เป็นยากิน เด็กไม่แพ้ penicillin ก็ควรให้ Pen V (250 mg) 1x2 หรือถ้าไม่มี pen V ก็ให้ amoxicillin (250) 1x2 ถ้าแพ้ penicillin ก็ให้ oral erythromycin (250 mg) 1x2 (ไม่ใช่ 2x2 ค่ะ) สำหรับขนาดของ roxithromycin ต้องไปขอหาดูค่ะ ANTIBIOTIC PROPHYLAXIS The goal of prophylaxis against group A streptococcal infection is to prevent recurrence of acute rheumatic fever (ARF). Recurrence is most common within two years of the original attack but can happen at any time. Recurrence rates decrease with increasing age. Antibiotic prophylaxis should be started immediately after resolution of the acute episode. Either oral or parenteral therapy can be given. -Penicillin V potassium 400,000 units (250 mg) twice per day, or -Sulfadiazine 500 mg per day for children ≤27 kg and 1000 mg per day for children >27 kg and adults. The classic parenteral regimen is benzathine penicillin G 1.2 million units intramuscularly every four weeks. However, injections every three weeks may be more effective in preventing recurrences of acute rheumatic feve. Individuals who are allergic to penicillin and sulfadiazine can be treated with oral erythromycin 250 mg twice daily. Duration of prophylaxis The duration of prophylaxis is not well defined, and depends upon the number of previous attacks, the time lapsed since the last attack, the risk of exposure to streptococcal infections, the age of the patient, and the presence or absence of cardiac involvement. WHO guidelines The World Health Organization (WHO) published guidelines for secondary prevention of ARF in 2001. The WHO recommendations for the duration of secondary prophylaxis are: Patients without proven carditis At least five years of antibiotic prophylaxis following diagnosis of ARF or until age 18. Patients with mild mitral regurgitation At least ten years of prophylaxis or until age 25. Patients with severe valve disease and/or after valve surgery Life-long prophylaxis. In our opinion, individuals with documented evidence of rheumatic heart disease should be on continuous prophylaxis indefinitely because rheumatic fever can recur as late as the fifth or sixth decade of life. Regardless of whether or not prophylaxis is continued, there should always be a low threshold to test and treat acute episodes of group A streptococcal pharyngitis. A possible future alternative to long-term prophylaxis in an individual with rheumatic fever may be streptococcal vaccines designed not only to prevent recurrent infections in rheumatic-susceptible individuals, but also to prevent streptococcal disease in general. Posted by : chpantip , E-mail : (chpantip@medicine.psu.ac.th) , Date : 2008-08-08 , Time : 13:20:09 , From IP : 172.29.3.68 |
