ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Chart 10.4 – Summary of Jones Criteria for Acute Rheumatic Fever (2015 Review), highlighting major changes from 1992 review Jones criteria revised for diagnosis of ARF 6 ARF Risk Low risk population: Incidence of ARF ≤ 2 per 100,000 school-age children or prevalence at all ages ≤ 1 per 1000 per year Moderate to high risk population: Children not included in low risk populations Major criteria: Carditis Clinical and/or subclinical* Clinical and/or subclinical* Arthritis Polyarthritis Monoartrite, poliartrite e/ou poliartralgia Korea Marked Erythema Subcutaneous nodules Korea Marked Erythema Subcutaneous nodules Minor criteria: Carditis Arthralgia Fever Inflammatory markers Extended PR Range† Polyarthralgia ≥ 38.5°C ESR peak ≥ 60 mm in 1 hr and / or CRP ≥ 3.0 mg/dL Extended PR Range† Monoarthralgia ≥ 38°C ESR peak ≥ 30 mm in 1hr and/or CRP ≥ 3.0 mg/dL Changes from the 1992 revision are highlighted in bold. * Subclinical carditis: seen only on echocardiography, without auscultatory findings. † Considering variability by age and only if carditis is NOT counted as a major criterion. ARF: acute rheumatic fever; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate. Table 10.8 – Primary and secondary prophylaxis regimens for acute rheumatic fever and rheumatic heart disease Recommendation Recommendation level Level of evidence Reference Primary prophylaxis Penicillins: Amoxicillin 50 mg/kg (maximum 1 g) VO 1x/day for 10 days Penicillin G Benzatin Patients up to 27 kg: 600,000 IU IM in single dose; patients > 27kg: 1,200,000 IU IM in single dose Penicillin V Potassium Patients up to 27 kg: 250 mg OR 2 or 3x/day for 10 days; patients > 27 kg: 500 mg OR 2 or 3x/ day for 10 days I B 549,550 Allergic to Penicillin: Low Spectrum Cephalosporins (Cephalexin, Cefadroxil) Variable Azithromycin 12 mg/kg (maximum 500 mg) OR 1x/day for 10 days Clarithromycin 15 mg/kg OR per day, divided into 2 doses (maximum 250 mg 2x/day) for 10 days Clindamycin 20 mg/kg OR/day (maximum 1.8 g per day) divided into 3 doses for 10 days IB IIa IIa IIa B B B B 549,550 Secondary Prophylaxis: Penicillin G Benzatin Patients up to 27 kg: 600,000 IU IM every 3 to 4 weeks †; patients > 27 kg: 1,200,000 IU IM every 3 to 4 weeks † Penicillin V Potassium 250 mg OR 2x/day Sulfadiazine Patients up to 27 kg: 0.5 g OR 1x/day; patients > 27 kg: 1 g OR 1x/day Macrolide or azalide (for penicillin and sulfadiazine allergic patients) ‡ Variable 1 1 1 1 A B B C 549,550 † Administration every 3 weeks is recommended in certain high risk situations. ‡ Macrolide antibiotics should not be prescribed to patients using other cytochrome P450 3A inhibiting drugs such as azole antifungals, human immunodeficiency virus protease inhibitors, and some selective serotonin reuptake inhibitors. IM: intramuscular; IU: international units; OR: orally. 852