Available recommendations for secondary prophylaxis for rheumatic heart disease (RHD)
| Guidelines | Preferred antibiotic | Intramuscular benzathine benzylpenicillin doses | Interval of benzathine injections | Oral alternative treatments and doses | Duration | Year |
|---|---|---|---|---|---|---|
| WHO56 | Benzathine penicillin G | <30 kg 600000 U ≥30 kg: 1200000 U | 21 days if high risk 28 days if low risk | Phenoxymethylpenicillin 250 mg twice daily | No evidence of carditis: 5 years since last attack or 18 years* Resolved carditis: 10 years since last attack or 25 years old* Moderate –severe or surgery: Lifelong. | 2001 |
| Australia and New Zealand57 | Benzathine penicillin G | <20 kg 600 000 U ≥20 kg 1 200 000 U | 4 weeks (3 weeks for selected groups) | Phenoxymethylpenicillin 250 mg twice daily | No evidence of carditis: 10 years since last attack or 21 years* No RHD or mild: 10 years since last attack or 21 years old* Moderate: until 35 years Severe: 40 years or longer | 2012 |
| India58 | Benzathine penicillin G | <27 kg 600 000 U ≥27 kg: 1 200 000 U | <27 kg:15 days >27 kg: 21 days | Phenoxymethylpenicillin Children: 250 mg twice daily Adults: 500 mg twice daily | No evidence of carditis: 5 years since last attack or 18 years* Mild to moderate: 10 years since last attack or 25 years old* Severe RHD or post-intervention: Lifelong or until 40 years of age | 2008 |
| South Africa55 | Benzathine penicillin G | <30 kg 600 000–900 000 U ≥ 30kg: 1 200 000 U | 3 weekly | Phenoxymethylpenicillin ≥30 kg :250 mg twice daily <30 kg :125 mg twice daily | No evidence of carditis: 5years since last attack or 18 years* Established: 10 years since last attack or 25 years old Severe/post valve replacement: Lifelong. | 1997 |
*Whichever is longer.