Secondary prophylaxis for rheumatic fever: simple concepts, difficult delivery.

Registers of those with rheumatic heart disease or a history of acute rheumatic fever (RF) are key to prevent RF recurrences and improve disease control. Randomized controlled trials show intramuscular long-acting benzathine penicillin G is more effective than oral penicillin to prevent recurrences. Although some guidelines recommend three-weekly benzathine penicillin, four weekly is effective if compliance rates are high. Four-weekly penicillin delivery is also preferable to three-weekly regimens for health resource and logistical reasons and for patient acceptability and compliance.