Primary prevention of acute rheumatic fever (ARF) interrupts the link between group A streptococcal (Strep A) infections and the autoimmune response to the infection.1 If given early in the infection, antibiotics interrupt the autoimmune response and ARF does not occur.2^,3 This requires identifying and treating Strep A infections of the throat and skin in people at high risk of ARF.

Some Australian population group are at high risk of ARF following Strep A infection, including:4

• Aboriginal and Torres Strait Islander peoples, particularly those living in rural or remote settings across central and northern Australia, are known to be at very high risk.
• Aboriginal and Torres Strait Islander peoples, and Māori and Pacific Islander groups living in urban settings, particularly where there is household crowding, are also at high risk.
• people with a history of ARF or rheumatic heart disease are at high risk of developing recurrent ARF.

Treatment for Strep A throat infections is either one intramuscular benzathine benzylpenicillin injection or a course of antibiotic tablets/syrup. Treatment for Strep A associated skin infection is either antibiotic tablets/syrup or one intramuscular benzathine benzylpenicillin injection.5

Antibiotics for Strep A throat infections in people at high risk of ARF can reduce development of ARF by up to two-thirds.6 However, Strep A is present in only between 10% and 40% of children presenting with a sore throat.7

Identifying the cause of the throat or skin infection is important to make sure the correct treatment is given. Waiting for test results for people (particularly children) at high risk for ARF may result in ARF developing before treatment is started. It is therefore recommended in Australia that all children in high-risk groups receive primary prevention with antibiotic therapy for sore throats and skin sores immediately after a swab has been taken. People who are not at high risk of ARF should generally not have primary prevention treatment started until a Strep A infection has been confirmed.8

For more information, see Chapter 5 in the RHDAustralia 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition).

• 1. Hurst JR, Kasper KJ, Sule AN, McCormick JK. Streptococcal pharyngitis and rheumatic heart disease: the superantigen hypothesis revisited. Infection, Genetics and Evolution. 2018;61:160-175. View Source
• 2. Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. 2009;119:1541-1551. View Source
• 3. Zühlke LJ, Karthikeyan G. Primary Prevention for Rheumatic Fever: Progress, Obstacles, and Opportunities. Global Heart. 2013;8(3)221-226. View Source
• 4. RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020. View Source
• 5. RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020.
• 6. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database of Systematic Reviews. 2013;11:CD000023: View Source
• 7. Oliver J, Malliya Wadu E, Pierse N, et al. Group A Streptococcus pharyngitis and pharyngeal carriage: A meta-analysis. PLOS Neglected Tropical Diseases. 2018;12(3):e0006335 View Source
• 8. RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020.