RHEUMATIC FEVER/RHEUMATIC HEART DISEASE CPM 3RD EDITION

Algorithm for the Management of Cases of Acute

Rheumatic Fever
1
Patient aged 5 to
15 years with joint
swelling, pain and
high temperature

Send for
consultation

3
Patient
sees a physician Y
within 48 4
hours?
N Medical
5 Examination
Make the patient
rest and treat with
benzathine penicillin
until physician can 6
see patient.
Meets the Y
Jones'
Criteria?

N 7
8
Keep patient Check whether
under the streptococcal
observation for infection was
2 weeks treated
9
10
Meets the Y Classify the
Jones' case
Criteria?

N 11 12
13
Send patient
Y to
Carditis?
Discharge hospital

14 N
If there is no 15
hospital, treat with
inflammatory drugs. Send for
Let patient rest and registry
begin secondary
prevention.
FIGURE 1

180
CPM 3RD EDITION RHEUMATIC FEVER/RHEUMATIC HEART DISEASE

Algorithm for the Secondary Prevention

of Rheumatic Fever

1
Patient with ARF in the
past and/or with RHD
seen by the physician for
secondary prevention

2 3
Treatment with
Hypersensitive Y erythromycin
to penicillin? by mouth for
10 days
4 N 5
Begin or
continue preventive Continue preventive
administration of regimen with a daily
IM penicillin dose erythromycin
every month 250 mg twice daily

6 7 8
Maintain
Y preventive Keep an eye
Has RHD? regimen for on evolution
whole life
N 11
9 10

Over 5 years Y Has reached Y Suspend the

since acute 18 years prevention
attack? of age? treatment

N N 13

12 Keep an eye on
evolution
Continue preventive
regimen until 5
years have elapsed 14 15

Y Continue
Functionally preventive
stable? regimen

16 N

Send to
specialist for
evaluation

FIGURE 2

181
RHEUMATIC FEVER/RHEUMATIC HEART DISEASE CPM 3RD EDITION

Algorithm for the Diagnosis and Treatment of Strepto-

coccal Sore Throat

1
Child 5 to 15 years
of age with an acute
infection of the upper
respiratory tract

Consultation

3
Examination by
physician, nurse or
trained auxiliary

4
Apply the clinical
and/or bacteriological
diagnosis criteria

5
Positive throat
culture
(Typical Strep
throat)
6 7
Treatment
Allergic to Y with
penicillin? erythromycin
for 10 days
N
8 9
A single dose of
benzathine penicillin Health
or 10 days of oral education
penicillin

10

Discharge

FIGURE 3

182