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RHD – 21-day penicillin — RACP Paediatrics MCQ

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HardCardiologyRHD – 21-day penicillinRACP Paediatrics

A 12-year-old Aboriginal girl with rheumatic heart disease has had a confirmed breakthrough episode of acute rheumatic fever despite documented complete adherence to 28-day benzathine benzylpenicillin. She has no penicillin allergy. Which secondary-prophylaxis change is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Shorten intramuscular benzathine benzylpenicillin dosing to every 21 days

Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E

B is correct. RHDAustralia reserves 21-day benzathine benzylpenicillin for selected patients with breakthrough ARF despite complete 28-day adherence or very high recurrence consequences. A oral prophylaxis is less reliable. C recurrence strengthens, not removes, the indication. D ceftriaxone is not the recommended secondary regimen. E ignores the specific breakthrough criterion for shortening the interval.

Reference: RHDAustralia, 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease: https://www.rhdaustralia.org.au/system/files/fileuploads/arf_rhd_guidelines_3.2_edition_march_2022.pdf