Paediatrics - Queensland Health - Queensland Government

presence of RHD
Place person on Recall Register and monitor closely
Immune complications
Recommended duration of secondary prophylaxis.
-- the most effective regime for continuous prophylaxis is a 4 weekly injection
of benzathine penicillin - may be increased to 3 weekly, see current edition
of NHFA guideline www.heartfoundation.org.au
-- consult MO for antibiotic prophylaxis for procedures expected to produce
bacteraemia
Provide education and support to patient and family. Resources available include;
Strong Heart, Strong Body books, DVD and reminder cards (from Tropical Public
Health)
Contact the ARF / RHD Control Program (arfregister@health.qld.gov.au) in your
district or Public Health Unit for help, even if ARF only suspected
Antenatal patients with RHD may deteriorate because of the increased cardiac
workload during pregnancy. Pregnant women known to have RHD need to be
assessed early in pregnancy and monitored closely with 2 weekly follow up.
The woman will also need antibiotic cover if prolonged labour and / or ruptured
membranes [1]
Primary prevention:
-- have a low threshold for treating throat infections with penicillin in Aboriginal
and Torres Strait Islander and Pacific Islander children. See URTI - child /
URTI - adult
-- reduce the prevalence of scabies and impetigo
Give influenza and pneumococcal vaccines according to the current edition of the
NHMRC Australian Immunisation Handbook. See Immunisation program
6. Referral / consultation
Consult MO on all occasions of suspected ARF
Consult MO for anticoagulation therapy / INR range
Refer to Paediatrician within 3 months of diagnosis
References
1. National Heart Foundation, RF/RHD Guideline Development Working Group, and Cardiac Society of
Australia and New Zealand, Diagnosis and management of acute rheumatic fever and rheumatic heart
disease in Australia: An evidence based review. 2006, National Heart Foundation Australia.
2. Therapeutic Guidelines. Rheumatic fever in children. 2010 [cited 2011 January].
Primary Clinical Care Manual 2011 Controlled copy V 1.0 579