Acute GAS pharyngitis should be treated promptly by penicillin or other antibiotics. Indian Council of Medical Research (ICMR) recommends that all cases of pharyngitis must receive penicillin. One need not wait to isolate GAS organisms. A single dose of 1.2 mega units of Benzathine penicillin given IM or a ten day course of oral penicillin V is given. In case of allergy to penicillin, one uses macrolides or cephalosporins.
Table Prophylaxis of Rheumatic Fever
Primary Prophylaxis
Intramuscular Benzathine penicillin G 12,00,000 U once(6,00,000 U, if weight less than 27 kgs)
Oral Penicillin V 500 mg bid daily for 10 days
Erythromycin 250 mg bid daily for 10 days
Other (Clindamycin, Dose varies
Nafcillin, Ampicillin,
Amoxicillin,
Cephalexin)
Secondary Prophylaxis
Intramuscular Benzathine penicillin G 12,00,000 U every 3-4 weeks
Oral Penicillin V 250 mg bid daily
Sulfadiazine 1 gm od (0.5 gm od in children)
Erythromycin 250 mg bid daily
stearate