Quick Reference Guide for Health Professionals
• As outlined in the previous table, penicillin is
• All patients should have a good understanding
given in cases of ARF to ensure eradication
of the cause of ARF and the need to have sore
This quick reference guide is derived from ‘National Heart Foundation of Australia (NHFA) and
of streptococci that may persist in the upper
throats treated early. Family members should be
the Cardiac Society of Australia and New Zealand (CSANZ) Diagnosis and management of acute
respiratory tract. As this could be considered the
informed that they are at increased risk of ARF
rheumatic fever and rheumatic heart disease in Australia — an evidence-based review. 2006’ .
commencement of secondary prophylaxis, it may
be advisable to use intramuscular benzathine
• Patients and families should understand the
reason for secondary prophylaxis and the
Acute rheumatic fever (ARF) is an auto-immune
Several factors contribute to inadequate diagnosis and
• Some clinicians prefer to use oral penicillin
consequences of missing a BPG injection. They
response to bacterial infection with group A
while patients are in hospital, and to defer the
should be given clear information about where
streptococcus (GAS). People with ARF are often in
intramuscular injection until there has been
to go for secondary prophylaxis, and written
• although strategies for preventing RHD are
great pain and require hospitalisation. After the acute
improvement and patients and their families
information on appointments for follow-up with
proven, simple, cheap and cost-effective, they are
episode, rheumatic heart disease (RHD) — damage
have been properly counselled about secondary
their local medical practitioner, physician/
not adequately implemented in the populations at
to the heart valves — may remain. People who have
paediatrician and cardiologist (if needed).
had ARF previously are much more likely than the
• Patients with reliably documented penicillin allergy
• If there is cardiac valve damage, patients
• because ARF is rare in most metropolitan centres,
wider community to have subsequent episodes.
may be treated with oral erythromycin. However,
and families should also be reminded of the
the majority of clinicians will have seen very few, if
Recurrences of ARF may cause further valve damage,
most patients labelled as being allergic to
importance of antibiotic prophylaxis for dental and
penicillin are not. It is recommended that patients
other procedures to protect against endocarditis.
• there is variability in the management of these
with stated penicillin allergy be investigated
diseases, with lack of up-to-date training and
carefully, preferably with the help of an allergist,
Although ARF is relatively rare in industrialised
before being accepted as truly allergic.
• The notifying medical practitioner should make
countries, it is a significant cause of disease among
RHD occasionally resulting in inappropriate
Secondary prevention is discussed in greater detail
direct contact with community medical staff so
Aboriginal and Torres Strait Islander peoples.
in the quick reference guide Secondary Prevention of
that they are aware of the diagnosis, the need for
Incidence of RHD is also high among these
• access to health care services by population
secondary prophylaxis, and any other specific
populations, with significant rates of procedures
groups experiencing the highest rates of ARF
The full evidence-based review from which this
• Diagnostic criteria, recommended investigations
it is recommended that joint pain be treated
quick reference guide is derived provides detailed
and detailed information on differential diagnoses
with paracetamol or codeine until the diagnosis
• Diagnosis of Acute Rheumatic Fever
information on the diagnosis and management of ARF,
are given in the quick reference guide Diagnosis of
secondary prevention and RHD control programs, and
• Secondary Prevention of Acute Rheumatic Fever
• There is convincing evidence that subclinical
• Rheumatic Heart DiseaseControl Programs
• As the arthritis, arthralgia and fever of ARF
or silent rheumatic valve damage detected by
• Management of Rheumatic Heart Disease.
respond to non-steroidal anti-inflammatory
echocardiography is part of the spectrum of
drugs (NSAIDs), which may prevent the full
rheumatic carditis and should not be ignored.
These publications are available from the
clinical manifestations becoming apparent,
National Heart Foundation of Australia through:
2006 National Heart Foundation of Australia
MEDICATIONS USED IN ACUTE RHEUMATIC FEVER
• Ideally, all patients with suspected ARF (first
• Occasionally, when the diagnosis has already
episode or recurrence) should be hospitalised
been confirmed and the patient is not unwell
as soon as possible after onset of symptoms.
(eg mild recurrent chorea in a child with no
• While in hospital, the patient should be registered
other symptoms or signs), outpatient management
in centralised and local ARF/RHD registers.
60mg/kg/day (max 4g) given in 4–6 doses/day;
Single-dose intramuscular benzathine penicillin G (preferable) or 10 days oral penicillin V (intravenous not needed, oral erythromycin
(mild) until diagnosis may increase to 90mg/kg/day if needed, under
0.5–1.0mg/kg/dose (adults 15–60mg/dose) 4–6 hrly
Aspirin (first line) or naproxen once diagnosis confirmed, if arthritis or severe arthralgia present. Paracetamol (first line) or codeine
Mild arthralgia and fever may respond to paracetamol alone
80–100mg/kg/day (4–8g/day in adults) given in
Influenza vaccine for children receiving aspirin during the influenza season (autumn/winter)
Reduce to 60–70mg/kg/day when symptoms improve
Consider ceasing in the presence of acute viral illness,
and consider influenza vaccine if administered during
Carbamazepine or valproic acid if treatment necessary
1–2mg/kg/day (max 80mg). If used >1 week,
• diuretics/fluid restriction for mild or moderate failure
• ACE inhibitors for more severe failure, particularly if aortic regurgitation present
Children: 1–2mg/kg stat, then 0.5–1mg/kg/dose
• glucocorticoids optional for severe carditis (consider treating for possible opportunistic infections)
• digoxin if atrial fibrillation present
Adults: 20–40mg/dose 12–24 hrly, up to
Valve surgery for life-threatening acute carditis (rare)
1–3mg/kg/day (max 100–200mg/day) in 1–3 doses
Round dose to multiple of 6.25mg (quarter of a tab)
Temperature, pulse, respiratory rate, blood pressure 4 times daily
Children: 0.1mg/kg/day in 1–2 doses, increased
gradually over 2 weeks to max of 1mg/kg/day
Children: 0.1–0.2mg/kg once daily, up to 1mg/kg/dose
Adults: 2.5–20mg once daily (max 40mg/day)
Early dietary advice if overweight and in failure, to avoid further weight gain
Children: 15mcg/kg stat and then 5mcg/kg after
6 hrs, then 3–5 mcg/kg/dose (max 125mcg)
Strict bed rest not necessary for most patients
Gradual ambulation for patients with heart failure or severe acute valve disease
7–20mg/kg/day (7–10mg/kg/day usually sufficient)
Usually 15–20mg/kg/day (can increase to 30mg/kg/day)
IF CLINICAL CARDITIS PRESENT (HEART MURMUR, HEART FAILURE, PERICARDIAL EFFUSION, VALVULAR DAMAGE)
Document cardiac symptoms and signsDaily weight and fluid balance chartDiuretics, ACE inhibitors, digoxin if indicated. Consider glucocorticoidsAnticoagulation if atrial fibrillation presentCardiology opinion
MEDICATIONS USED IN ACUTE RHEUMATIC FEVER
• Ideally, all patients with suspected ARF (first
• Occasionally, when the diagnosis has already
episode or recurrence) should be hospitalised
been confirmed and the patient is not unwell
as soon as possible after onset of symptoms.
(eg mild recurrent chorea in a child with no
• While in hospital, the patient should be registered
other symptoms or signs), outpatient management
in centralised and local ARF/RHD registers.
60mg/kg/day (max 4g) given in 4–6 doses/day;
Single-dose intramuscular benzathine penicillin G (preferable) or 10 days oral penicillin V (intravenous not needed, oral erythromycin
(mild) until diagnosis may increase to 90mg/kg/day if needed, under
0.5–1.0mg/kg/dose (adults 15–60mg/dose) 4–6 hrly
Aspirin (first line) or naproxen once diagnosis confirmed, if arthritis or severe arthralgia present. Paracetamol (first line) or codeine
Mild arthralgia and fever may respond to paracetamol alone
80–100mg/kg/day (4–8g/day in adults) given in
Influenza vaccine for children receiving aspirin during the influenza season (autumn/winter)
Reduce to 60–70mg/kg/day when symptoms improve
Consider ceasing in the presence of acute viral illness,
and consider influenza vaccine if administered during
Carbamazepine or valproic acid if treatment necessary
1–2mg/kg/day (max 80mg). If used >1 week,
• diuretics/fluid restriction for mild or moderate failure
• ACE inhibitors for more severe failure, particularly if aortic regurgitation present
Children: 1–2mg/kg stat, then 0.5–1mg/kg/dose
• glucocorticoids optional for severe carditis (consider treating for possible opportunistic infections)
• digoxin if atrial fibrillation present
Adults: 20–40mg/dose 12–24 hrly, up to
Valve surgery for life-threatening acute carditis (rare)
1–3mg/kg/day (max 100–200mg/day) in 1–3 doses
Round dose to multiple of 6.25mg (quarter of a tab)
Temperature, pulse, respiratory rate, blood pressure 4 times daily
Children: 0.1mg/kg/day in 1–2 doses, increased
gradually over 2 weeks to max of 1mg/kg/day
Children: 0.1–0.2mg/kg once daily, up to 1mg/kg/dose
Adults: 2.5–20mg once daily (max 40mg/day)
Early dietary advice if overweight and in failure, to avoid further weight gain
Children: 15mcg/kg stat and then 5mcg/kg after
6 hrs, then 3–5 mcg/kg/dose (max 125mcg)
Strict bed rest not necessary for most patients
Gradual ambulation for patients with heart failure or severe acute valve disease
7–20mg/kg/day (7–10mg/kg/day usually sufficient)
Usually 15–20mg/kg/day (can increase to 30mg/kg/day)
IF CLINICAL CARDITIS PRESENT (HEART MURMUR, HEART FAILURE, PERICARDIAL EFFUSION, VALVULAR DAMAGE)
Document cardiac symptoms and signsDaily weight and fluid balance chartDiuretics, ACE inhibitors, digoxin if indicated. Consider glucocorticoidsAnticoagulation if atrial fibrillation presentCardiology opinion
Quick Reference Guide for Health Professionals
• As outlined in the previous table, penicillin is
• All patients should have a good understanding
given in cases of ARF to ensure eradication
of the cause of ARF and the need to have sore
This quick reference guide is derived from ‘National Heart Foundation of Australia (NHFA) and
of streptococci that may persist in the upper
throats treated early. Family members should be
the Cardiac Society of Australia and New Zealand (CSANZ) Diagnosis and management of acute
respiratory tract. As this could be considered the
informed that they are at increased risk of ARF
rheumatic fever and rheumatic heart disease in Australia — an evidence-based review. 2006’ .
commencement of secondary prophylaxis, it may
be advisable to use intramuscular benzathine
• Patients and families should understand the
reason for secondary prophylaxis and the
Acute rheumatic fever (ARF) is an auto-immune
Several factors contribute to inadequate diagnosis and
• Some clinicians prefer to use oral penicillin
consequences of missing a BPG injection. They
response to bacterial infection with group A
while patients are in hospital, and to defer the
should be given clear information about where
streptococcus (GAS). People with ARF are often in
intramuscular injection until there has been
to go for secondary prophylaxis, and written
• although strategies for preventing RHD are
great pain and require hospitalisation. After the acute
improvement and patients and their families
information on appointments for follow-up with
proven, simple, cheap and cost-effective, they are
episode, rheumatic heart disease (RHD) — damage
have been properly counselled about secondary
their local medical practitioner, physician/
not adequately implemented in the populations at
to the heart valves — may remain. People who have
paediatrician and cardiologist (if needed).
had ARF previously are much more likely than the
• Patients with reliably documented penicillin allergy
• If there is cardiac valve damage, patients
• because ARF is rare in most metropolitan centres,
wider community to have subsequent episodes.
may be treated with oral erythromycin. However,
and families should also be reminded of the
the majority of clinicians will have seen very few, if
Recurrences of ARF may cause further valve damage,
most patients labelled as being allergic to
importance of antibiotic prophylaxis for dental and
penicillin are not. It is recommended that patients
other procedures to protect against endocarditis.
• there is variability in the management of these
with stated penicillin allergy be investigated
diseases, with lack of up-to-date training and
carefully, preferably with the help of an allergist,
Although ARF is relatively rare in industrialised
before being accepted as truly allergic.
• The notifying medical practitioner should make
countries, it is a significant cause of disease among
RHD occasionally resulting in inappropriate
Secondary prevention is discussed in greater detail
direct contact with community medical staff so
Aboriginal and Torres Strait Islander peoples.
in the quick reference guide Secondary Prevention of
that they are aware of the diagnosis, the need for
Incidence of RHD is also high among these
• access to health care services by population
secondary prophylaxis, and any other specific
populations, with significant rates of procedures
groups experiencing the highest rates of ARF
The full evidence-based review from which this
• Diagnostic criteria, recommended investigations
it is recommended that joint pain be treated
quick reference guide is derived provides detailed
and detailed information on differential diagnoses
with paracetamol or codeine until the diagnosis
• Diagnosis of Acute Rheumatic Fever
information on the diagnosis and management of ARF,
are given in the quick reference guide Diagnosis of
secondary prevention and RHD control programs, and
• Secondary Prevention of Acute Rheumatic Fever
• There is convincing evidence that subclinical
• Rheumatic Heart DiseaseControl Programs
• As the arthritis, arthralgia and fever of ARF
or silent rheumatic valve damage detected by
• Management of Rheumatic Heart Disease.
respond to non-steroidal anti-inflammatory
echocardiography is part of the spectrum of
drugs (NSAIDs), which may prevent the full
rheumatic carditis and should not be ignored.
These publications are available from the
clinical manifestations becoming apparent,
National Heart Foundation of Australia through:
2006 National Heart Foundation of Australia
Terça-feira, 20 de Julho de 1999 Número 167/99 I A Esta 1.a série do Diário da República é constituída pelas partes A e B DIÁRIO DA REPÚBLICA Sumario167A Sup 0 S U M Á R I O Supremo Tribunal de Justiça Comissão Nacional de Eleições DIÁRIO DA REPÚBLICA — I SÉRIE-A SUPREMO TRIBUNAL DE JUSTIÇA Procurando regulamentar melhor esta questão — a
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Quick Reference Guide for Health Professionals
• As outlined in the previous table, penicillin is
• All patients should have a good understanding
given in cases of ARF to ensure eradication
of the cause of ARF and the need to have sore
This quick reference guide is derived from ‘National Heart Foundation of Australia (NHFA) and
of streptococci that may persist in the upper
throats treated early. Family members should be
the Cardiac Society of Australia and New Zealand (CSANZ) Diagnosis and management of acute
respiratory tract. As this could be considered the
informed that they are at increased risk of ARF
rheumatic fever and rheumatic heart disease in Australia — an evidence-based review. 2006’ .
commencement of secondary prophylaxis, it may
be advisable to use intramuscular benzathine
• Patients and families should understand the
reason for secondary prophylaxis and the
Acute rheumatic fever (ARF) is an auto-immune
Several factors contribute to inadequate diagnosis and
• Some clinicians prefer to use oral penicillin
consequences of missing a BPG injection. They
response to bacterial infection with group A
while patients are in hospital, and to defer the
should be given clear information about where
streptococcus (GAS). People with ARF are often in
intramuscular injection until there has been
to go for secondary prophylaxis, and written
• although strategies for preventing RHD are
great pain and require hospitalisation. After the acute
improvement and patients and their families
information on appointments for follow-up with
proven, simple, cheap and cost-effective, they are
episode, rheumatic heart disease (RHD) — damage
have been properly counselled about secondary
their local medical practitioner, physician/
not adequately implemented in the populations at
to the heart valves — may remain. People who have
paediatrician and cardiologist (if needed).
had ARF previously are much more likely than the
• Patients with reliably documented penicillin allergy
• If there is cardiac valve damage, patients
• because ARF is rare in most metropolitan centres,
wider community to have subsequent episodes.
may be treated with oral erythromycin. However,
and families should also be reminded of the
the majority of clinicians will have seen very few, if
Recurrences of ARF may cause further valve damage,
most patients labelled as being allergic to
importance of antibiotic prophylaxis for dental and
penicillin are not. It is recommended that patients
other procedures to protect against endocarditis.
Quick Reference Guide for Health Professionals
• As outlined in the previous table, penicillin is
• All patients should have a good understanding
given in cases of ARF to ensure eradication
of the cause of ARF and the need to have sore
This quick reference guide is derived from ‘National Heart Foundation of Australia (NHFA) and
of streptococci that may persist in the upper
throats treated early. Family members should be
the Cardiac Society of Australia and New Zealand (CSANZ) Diagnosis and management of acute
respiratory tract. As this could be considered the
informed that they are at increased risk of ARF
rheumatic fever and rheumatic heart disease in Australia — an evidence-based review. 2006’ .
commencement of secondary prophylaxis, it may
be advisable to use intramuscular benzathine
• Patients and families should understand the
reason for secondary prophylaxis and the
Acute rheumatic fever (ARF) is an auto-immune
Several factors contribute to inadequate diagnosis and
• Some clinicians prefer to use oral penicillin
consequences of missing a BPG injection. They
response to bacterial infection with group A
while patients are in hospital, and to defer the
should be given clear information about where
streptococcus (GAS). People with ARF are often in
intramuscular injection until there has been
to go for secondary prophylaxis, and written
• although strategies for preventing RHD are
great pain and require hospitalisation. After the acute
improvement and patients and their families
information on appointments for follow-up with
proven, simple, cheap and cost-effective, they are
episode, rheumatic heart disease (RHD) — damage
have been properly counselled about secondary
their local medical practitioner, physician/
not adequately implemented in the populations at
to the heart valves — may remain. People who have
paediatrician and cardiologist (if needed).
had ARF previously are much more likely than the
• Patients with reliably documented penicillin allergy
• If there is cardiac valve damage, patients
• because ARF is rare in most metropolitan centres,
wider community to have subsequent episodes.
may be treated with oral erythromycin. However,
and families should also be reminded of the
the majority of clinicians will have seen very few, if
Recurrences of ARF may cause further valve damage,
most patients labelled as being allergic to
importance of antibiotic prophylaxis for dental and
penicillin are not. It is recommended that patients
other procedures to protect against endocarditis.