Question

A 16-year-old Aboriginal girl from a remote community has a history of rheumatic fever and moderate rheumatic mitral regurgitation. She has been receiving secondary prophylaxis with intramuscular benzathine benzylpenicillin G every 4 weeks but has missed her last two injections. She remains in the community with limited access to specialist care. What is the most appropriate strategy to reduce her risk of recurrent rheumatic fever?

Accepted Answer

Continue benzathine benzylpenicillin every 4 weeks until at least age 21 years or 10 years after last attack

Answer

Cease benzathine benzylpenicillin now that she is older than 15 years

Answer

Switch to oral penicillin twice daily as adherence is easier

Answer

Extend the dosing interval to every 8 weeks to improve tolerance

Answer

Change to azithromycin weekly to reduce injection pain

Practice question