Box 2: Suggested duration of secondary prophylaxis (benzathine benzylpenicillin) after an occurrence of rheumatic fever1
Category of patientDuration of prophylaxis
Patient without proven carditisFor 5 yr after the last attack, or until age 18 yr (whichever is longer)
Patient with carditis (mild mitral regurgitation or healed carditis)For 10 yr after the last attack, or at least until age 25 yr (whichever is longer)
More severe valvular diseaseLifelong
After valve surgeryLifelong
  • * These are recommendations and must be modified by individual circumstances as warranted.

  • Reproduced with permission from Rheumatic fever and rheumatic heart disease: report of a WHO expert consultation, Geneva, 29 October – 1 November 2001. no. 923 of WHO Technical Report Series. Geneva: World Health Organization; 2001, available (accessed 2013 Nov. 20).