Treatment Overview

Rheumatic fever is an inflammatory condition that can develop after a strep throat or scarlet fever infection is not fully treated. For patients, particularly children, the experience can be frightening and painful. Symptoms often include swollen and tender joints, fever, fatigue, and sometimes jerky, uncontrollable body movements. Beyond the immediate physical discomfort, there is often significant anxiety regarding the potential impact on the heart.

Treatment is critical to stop the inflammation, relieve pain, and eradicate any remaining bacteria to prevent the immune system from causing further damage. The most urgent goal is to protect the heart valves from permanent scarring, known as rheumatic heart disease. Because the severity of inflammation varies, ranging from mild joint pain to severe heart involvement, treatment plans are tailored to the individual. Doctors consider the extent of cardiac symptoms and inflammation markers when selecting medications (Centers for Disease Control and Prevention, 2023).

Overview of treatment options for Rheumatic Fever

The treatment strategy for rheumatic fever operates on three fronts: eliminating the residual streptococcal bacteria, reducing acute inflammation, and preventing future recurrences. Managing the acute phase usually involves a combination of antibiotics and anti-inflammatory drugs.

Once the initial illness is resolved, the focus shifts entirely to prevention. Because a person who has had rheumatic fever is more susceptible to future attacks, long-term preventative treatment is required. This often involves years of antibiotic maintenance to ensure strep infections do not return and trigger another immune response. Medical management is the primary approach, though severe heart valve damage may eventually require surgical intervention in the long term.

Medications used for Rheumatic Fever

Antibiotics are the foundation of treatment. Penicillin is the most commonly prescribed drug to eliminate the group A streptococcal bacteria. It may be administered as a single intramuscular injection or as a course of oral medication, such as penicillin V or amoxicillin. For patients allergic to penicillin, alternatives like erythromycin or cephalosporins are used.

Crucially, after the acute infection clears, patients begin “secondary prophylaxis.” This typically involves receiving a penicillin injection once every few weeks or taking daily oral antibiotics for several years sometimes into adulthood to prevent recurrence.

To manage the significant joint pain and fever, anti-inflammatory medications are essential. Aspirin is widely used as a first-line treatment for rheumatic fever, even in children, due to its effectiveness in reducing this specific type of inflammation. Naproxen is another non-steroidal anti-inflammatory drug (NSAID) option. Clinical experience suggests that joint pain often responds dramatically to these medications within a day or two.

For cases involving severe heart inflammation (carditis), doctors may prescribe corticosteroids, such as prednisone. These are stronger anti-inflammatory drugs used to suppress the immune system’s attack on the heart tissue. If the patient experiences Sydenham chorea (involuntary movements), anticonvulsants like valproic acid or carbamazepine may be prescribed to stabilize nerve activity (Mayo Clinic, 2024).

How these medications work

Antibiotics function by destroying the cell walls of the bacteria, ensuring that the pathogen triggering the immune reaction is completely removed from the body. Prophylactic antibiotics maintain a constant level of defense in the bloodstream to prevent new strep infections from taking hold.

Anti-inflammatory drugs like aspirin and NSAIDs work by blocking the production of prostaglandins, which are chemical messengers that cause pain, fever, and swelling. By lowering these levels, the drugs reduce the intense heat and redness in the joints. Corticosteroids work more broadly by mimicking natural hormones that lower the activity of the immune system, effectively calming the aggressive immune response that risks damaging the heart valves.

Side effects and safety considerations

While antibiotics are generally safe, they can cause nausea, diarrhea, or allergic rashes. Long-term injectable penicillin commonly causes injection site pain. Corticosteroids can cause side effects including fluid retention, increased appetite, mood changes, and temporary weight gain, especially in the face.

Aspirin use in children requires strict medical supervision due to the risk of Reye’s syndrome. For rheumatic fever, however, benefits usually outweigh risks under close monitoring. Patients must seek immediate medical attention for shortness of breath, chest pain, or severe allergic reactions like facial swelling (American Heart Association, 2021).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. American Heart Association. https://www.heart.org
  2. Centers for Disease Control and Prevention. https://www.cdc.gov
  3. Mayo Clinic. https://www.mayoclinic.org
  4. MedlinePlus. https://medlineplus.gov

Medications for Rheumatic Fever

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Rheumatic Fever.

Found 8 Approved Drugs for Rheumatic Fever

Benzathine

Brand Names
Lentocilin, Extencilline, Bicillin C-R, Bicillin L-A, Bicillin

Benzathine

Brand Names
Lentocilin, Extencilline, Bicillin C-R, Bicillin L-A, Bicillin
Form: Injection, Kit
Method of administration: Intramuscular
FDA approval date: June 27, 1952
Classification: Penicillin-class Antibacterial
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Bicillin C-R and other antibacterial drugs, Bicillin C-R should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. This drug is indicated in the treatment of moderately severe infections due to penicillin-G-susceptible microorganisms that are susceptible to serum levels common to this particular dosage form. Therapy should be guided by bacteriological studies (including susceptibility testing) and by clinical response. Bicillin C-R is indicated in the treatment of the following in adults and pediatric patients: Moderately severe to severe infections of the upper-respiratory tract, scarlet fever, erysipelas, and skin and soft-tissue infections due to susceptible streptococci. NOTE: Streptococci in Groups A, C, G, H, L, and M are very sensitive to penicillin G. Other groups, including Group D (enterococci), are resistant. Penicillin G sodium or potassium is recommended for streptococcal infections with bacteremia. Moderately severe pneumonia and otitis media due to susceptible Streptococcus pneumoniae. NOTE: Severe pneumonia, empyema, bacteremia, pericarditis, meningitis, peritonitis, and arthritis of pneumococcal etiology are better treated with penicillin G sodium or potassium during the acute stage. When high, sustained serum levels are required, penicillin G sodium or potassium, either IM or IV, should be used. This drug should not be used in the treatment of venereal diseases, including syphilis, gonorrhea, yaws, bejel, and pinta.

MethylPREDNISolone

Brand Names
Solu-Medrol MethylPREDNISolone, Solu-Medrol, Medrol

MethylPREDNISolone

Brand Names
Solu-Medrol MethylPREDNISolone, Solu-Medrol, Medrol
Form: Injection, Tablet
Method of administration: Oral, Intravenous, Intramuscular
FDA approval date: October 24, 1957
Classification: Corticosteroid
When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use of Methylprednisolone Sodium Succinate for Injection, USP, is indicated as follows: Allergic states Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic diseases Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hematologic disorders Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond-Blackfan anemia), idiopathic thrombocytopenic purpura in adults (intravenous administration only; intramuscular administration is contraindicated), pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic diseases For the palliative management of leukemias and lymphomas. Nervous System Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor, or craniotomy. Ophthalmic diseases Sympathetic ophthalmia, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, temporal arteritis, polymyositis, and systemic lupus erythematosus.

Kenalog

Brand Names
Lidolog, Mlk F3, Mlk F1, Pro-C-Dure 6, Bupivilog

Kenalog

Brand Names
Lidolog, Mlk F3, Mlk F1, Pro-C-Dure 6, Bupivilog
Form: Kit
Method of administration: Intra-articular, Epidural, Topical, Intramuscular, Infiltration
FDA approval date: January 16, 2014
Intramuscular Where oral therapy is not feasible, injectable corticosteroid therapy, including triamcinolone acetonide injectable suspension is indicated for intramuscular use as follows: Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders: Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Gastrointestinal diseases: To tide the patient over a critical period of the disease in regional enteritis and ulcerative colitis. Hematologic disorders: Acquired (autoimmune) hemolytic anemia, Diamond-Blackfan anemia, pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used with appropriate antituberculous chemotherapy. Neoplastic diseases: For the palliative management of leukemias and lymphomas. Nervous system: Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy. Ophthalmic diseases: Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis and systemic lupus erythematosus. Intra-Articular The intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

CeFAZolin

Generic Name
CeFAZolin

CeFAZolin

Generic Name
CeFAZolin
Form: Injection, Powder, Solution
Method of administration: Intravenous, Parenteral, Intramuscular
FDA approval date: December 09, 1988
Classification: Cephalosporin Antibacterial
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cefazolin for Injection, USP and other antibacterial drugs, Cefazolin for Injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Cefazolin for Injection, USP is indicated for the treatment of the following serious infections due to susceptible organisms. Cefazolin for Injection, USP is a cephalosporin antibacterial indicated in the treatment of the following infections caused by susceptible isolates of the designated microorganisms: Respiratory tract infections.

MethylPREDNISolone Acetate

Brand Names
Medroloan, Medroloan SUIK, Depo-Medrol, Dyural

MethylPREDNISolone Acetate

Brand Names
Medroloan, Medroloan SUIK, Depo-Medrol, Dyural
Form: Injection, Kit
Method of administration: Intra-articular, Intramuscular, Intrasynovial, Intralesional, Soft Tissue, Infiltration, Topical, Intrameningeal, Intra-arterial
FDA approval date: May 28, 1959
Classification: Corticosteroid
A. FOR INTRAMUSCULAR ADMINISTRATION When oral therapy is not feasible and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intramuscular use of Methylprednisolone Acetate Injectable Suspension is indicated as follows: A llergic States : Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions. De rmatologic Diseases : Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). E ndocrine Disorders : Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. G astrointestinal Diseases : To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hem atologic Disorders : Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond Blackfan anemia), pure red cell aplasia, select cases of secondary thrombocytopenia. M iscellaneous : Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic Diseases : For palliative management of leukemias and lymphomas. Nervous System : Cerebral edema associated with primary or metastatic brain tumor or craniotomy. O phthalmic Diseases : Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Re nal Diseases : To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome, or that due to lupus erythematosus. Re spiratory Diseases : Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. R heumatic Disorders : As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus. B. FOR INTRA-ARTICULAR OR SOFT TISSUE ADMINISTRATION (See WARNINGS) Methylprednisolone Acetate Injectable Suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. C. FOR INTRALESIONAL ADMINISTRATION Methylprednisolone Acetate Injectable Suspension is indicated for intralesional use in alopecia areata, discoid lupus erythematosus, keloids, localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques, necrobiosis lipoidica diabeticorum. Methylprednisolone Acetate Injectable Suspension also may be useful in cystic tumors of an aponeurosis or tendon (ganglia).
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