The facts of the prevention of acute rheumatic fever are disarmingly simple. For a patient with an acute sore throat, we need to know simply, "Is the culture positive for hemolytic streptococci?" If not, the trouble and expense of antibiotics can be spared. If so, several effective options are open to the practitioner. A single injection of 1.2 million units of benzathine penicillin G (or 0.6 million in young children) is optimal treatment. The alternative of ten days of oral penicillin G therapy, or, for penicillin-allergic individuals, of erythromycin therapy, is also effective, but dependent on unpredictable patient fidelity.
Unfortunately, the implementation of these principles is more complex than the simple facts of prevention suggest. The best programs for rapid and routine diagnosis of sore throats often have been mounted in communities in which rheumatic fever does not seem to be a problem at all. The streptococcal strains in such
Stollerman GH. Nurse Practitioners and the Treatment of Sore Throats. JAMA. 1974;227(11):1303. doi:10.1001/jama.1974.03230240061030
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