Scenario | Antibiotic choice(s) |
Preferred treatment in endemic areas where IM penicillin is available at low cost |
|
Alternative treatment in nonendemic areas where IM penicillin is unavailable or prohibitively expensive |
|
Confirmed penicillin allergy* |
|
Severe symptomatic RHD¶ |
|
Bleeding problems following IM injection that cannot be addressed |
|
Other barriers to using the preferred treatment that cannot be resolvedΔ |
|
Patients at low risk of recurrence◊ |
|
Breakthrough infection while on prophylaxis |
|
ARF: acute rheumatic fever; EF: ejection fraction; GAS: Group A Streptococcus; IM: intramuscular; NYHA: New York Heart Association; RHD: rheumatic heart disease.
* Penicillin allergy should be verified by history and confirmed with testing by an allergy specialist if available before choosing an alternative to penicillin G benzathine.
¶ This includes patients with severe symptomatic valvular disease, NYHA class III or IV heart failure symptoms, and/or ventricular dysfunction (ie, EF <50%). Oral therapy is preferred for these patients because they can experience vasovagal reactions with IM injections, and this may increase the risk of sudden death.
Δ Additional barriers include patient concerns (eg, extreme needle phobia) that persist despite appropriate counseling and reassurance.
◊ Patients at low risk of recurrence include those who have reached young adulthood and have remained free of ARF attacks for several years.
§ Rates of resistance to clindamycin are high and can be higher than rates of resistance to macrolides. Therefore, when beta-lactams and macrolides cannot be used, knowledge of local resistance rates should guide antibiotic selection or culture with susceptibility testing should be obtained.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟