Dawaa Reference

Clinical reference

Acute rheumatic fever with carditis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Acute Rheumatic Fever - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459263/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD02.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Egyptian National Drug Formulary - Antimicrobial 2023

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

  • Up to a third of ARF patients have no memory of the sore throat that came before it
  • The preceding strep throat typically brings fever, throat pain, headache, and chills [chills · fever · headache · sore throat]
  • Abdominal pain, nausea, and vomiting can accompany the preceding infection, especially in young children [abdominal pain · nausea · vomiting]
  • Fever, chills, and fatigue are the most common general symptoms of ARF [chills · fatigue · fever]
  • Joint pain is usually migratory, moving between large joints such as the knee, ankle, or wrist [joint pain]
  • Joint pain or swelling is often the first thing ARF shows, seen in 60% to 80% of cases [joint pain]
  • Sydenham chorea shows up as jerky, involuntary movements affecting the face, hands, or feet [chorea · involuntary movements]
  • Chorea movements are more pronounced on one side and stop during sleep [chorea]
  • Agitation, anxiety, or inappropriate laughing or crying may accompany the chorea [anxiety · chorea · irritability]

Signs — what you find (7)

  • A fast heart rate or a new heart murmur are the most common exam findings of carditis [heart murmur · tachycardia]
  • Carditis hits the pericardium, epicardium, myocardium, and endocardium together, roughly 2 to 3 weeks after the strep infection
  • Mitral regurgitation is usually the first sign of valve involvement, producing a loud holosystolic murmur best heard at the apex, radiating to the axilla [heart murmur]
  • Aortic valve damage produces a diastolic murmur at the base of the heart, louder when the patient leans forward [heart murmur]
  • Firm, painless nodules over the extensor surfaces of joints occur in under 10% of ARF and track with severe carditis
  • Erythema marginatum is a fleeting pink ring-shaped rash on the trunk and limbs, sparing the face, in under 6% of cases [rash · redness]
  • The milkmaid's grip sign, an inability to hold a steady squeeze on the examiner's fingers, is characteristic of Sydenham chorea [chorea]

Tests (11)

  • Initial diagnosis needs 2 major criteria, or 1 major plus 2 minor criteria, under the Jones Criteria
  • A recurrent episode can also be diagnosed with 3 minor criteria alone
  • Sydenham chorea or indolent carditis appearing months after strep infection allows a presumptive diagnosis without the Jones criteria
  • NAAT testing for GAS returns a result in under an hour and is highly sensitive
  • Rapid antigen tests may be under 90% sensitive, so a backup throat culture is recommended when negative
  • ASO or anti-DNase B titers rise 2 to 3 weeks after a strep infection
  • A 2-fold or greater rise in antibody titer between paired samples counts as positive
  • All ARF patients should get a chest x-ray, ECG, and echocardiogram to assess the heart
  • Chest imaging may show an enlarged heart and pulmonary oedema
  • PR interval prolongation is the most common ECG finding and must be judged against age-based norms
  • About 10.8% of ARF patients have subclinical carditis found only on echocardiogram

If not this — what else fits (9)

  • Poststreptococcal reactive arthritis is a differential for the joint symptoms
  • Septic arthritis needs to be excluded when a joint is inflamed
  • Lyme disease is a differential for the migratory joint pain
  • Infective endocarditis is an important differential for the cardiac findings
  • Viral myocarditis can mimic the carditis of ARF
  • PANDAS is a differential for the chorea-like movements
  • Tourette syndrome and tardive dyskinesia are differentials for the movement disorder
  • Scarlet fever is a differential for the rash of ARF
  • Systemic lupus erythematosus is among the systemic-illness differentials

SourceStatPearls "Acute Rheumatic Fever" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Active rheumatic fever with carditis needs hospital-level monitoring (echocardiography, watching for heart failure); the GP recognises the picture, starts antibiotic treatment of the streptococcal trigger, and refers urgently rather than managing carditis alone. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Active rheumatic fever with carditis needs hospital-level monitoring (echocardiography, watching for heart failure); the GP recognises the picture, starts antibiotic treatment of the streptococcal trigger, and refers urgently rather than managing carditis alone.

Cautions
  • Breathlessness, tachycardia out of proportion to fever, or a new murmur indicates carditis severe enough to need same-day hospital assessment.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
2

PENICILLIN G BENZATHINE

1st line

Forminjection

Adult dose and duration

IM: 1.2 million units once every 21 to 28 days - Duration depends on risk factors and presence of valvular heart disease

Paediatric dose
Dose by age
≤27 kg:600,000 units every 3 to 4 weeks. >27 kg: 1.2 million units every 3 to 4 weeks.
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Intramuscular penicillin G benzathine provides secondary prophylaxis against recurrent Group A streptococcal infection to prevent recurrent rheumatic fever and progressive cardiac damage.

Cautions
  • Hypersensitivity to penicillin(s) or any component of the formulation
  • Do not administer IV, intra-arterially, or SubQ. inadvertent IV administration has resulted in thrombosis, severe neurovascular damage, cardiac arrest, and death.
Egyptian brands
Egyptian brandManufacturerIndicative price
HAYA BENZ-R 1.2 M.I.U. VIAL FOR I.M INJ.SEDICO > HAYA PHARM-EGYPT5.06 EGP
PENICID LA 1 200 000 UNITS VIALCID6.50 EGP
BENZACILLIN 1.2 M.I.U.FOR I.M.INJ VIAL.EL NASR7.00 EGP
RETARPEN 1.2 M.I.U. VIALSANDOZ > OCTOBER PHARMA10.50 EGP
LASTIPEN 1 200 000 IU VIALMISR12.00 EGP
BENZABIOTIC 1.2 M.I.U. I.M. VIAL.SEDICO16.00 EGP
DEPO-PEN 1.2 MIU VIAL.MUP25.00 EGP
PENCILONG (PENCITARD) 1200000 I.U./VIALNCPC NORTH BEST CO > ACDIMA INTERNATIONAL TRADING25.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.