|Secondary prophylaxis with benzathine penicillin G (BPG) is the only rheumatic heart disease control strategy shown to be clinically effective and cost-effective at both community and population levels. Randomised controlled trials have shown that regular administration is required to prevent recurrent acute rheumatic fever.
Secondary prevention refers to the early detection of disease and implementation of measures to prevent recurrent and worsening disease.
All people with acute rheumatic fever or rheumatic heart disease should continue secondary prophylaxis for a minimum of 10 years after the last episode of acute rheumatic fever or until the age of 21 years (whichever is longer). Those with moderate or severe rheumatic heart disease should continue secondary prophylaxis up to the age of 35–40 years.
Adherence to secondary prophylaxis
Secondary prevention of further episodes of acute rheumatic fever is a priority. It should include strategies aimed at improving the delivery of secondary prophylaxis and patient care, the provision of education, coordinating available health services and advocacy for necessary and appropriate resources.
Rheumatic heart disease control programs
A coordinated control program, including specialist review and echocardiography, is the most effective approach to improving BPG adherence and clinical follow-up of people with rheumatic heart disease. Control programs should aim to support clinical and public health practice indirectly by increasing expertise among health service providers and supporting them to provide services to patients.