Management Management of the acute episode includes eradication of tonsillar and pharyngeal GAS, and symptomatic treatment of the presenting manifestations and management of carditis and/or heart failure Antiinflammatory agents can be symptomatically beneficial, but have no curative properties Considering that the available treatment is supportive, the most effective therapeutic approach is directed toward prophylaxis.183 Apart from mild cases who are not unwell, all patients with suspected acute RF should ideally be hospitalized Hospitalization helps in investigations to establish the diagnosis This opportunity should also be used for emphasizing the importance of secondary prophylaxis Eradication of Group a Streptococcal Infection It is important to eradicate the infecting agent even in the presence of a negative throat culture Although antimicrobial therapy does not influence the course or severity of the disease, it is necessary to avoid the continuous exposure to streptococcal antigens.184,185 As soon as the diagnosis is established, patients with any manifestations of the acute rheumatic process, including the late ones such as chorea, should undergo antibiotic therapy to eradicate Streptococcus The efficacy of eradication is dependent on the choice of the drug and the length of time in which effective levels are maintained in the blood The most reliable drug is intramuscular benzathine penicillin as a single dose or a full 10-day course of oral penicillin or amoxicillin In all patients, eradication should be followed by long-term secondary prophylaxis to prevent recurrences Eradication is similar to treatment recommended for acute streptococcal pharyngotonsillitis (Table 54.3).186 Table 54.3 Primary Prevention of Rheumatic Fever: Treatment for Group A Streptococcal Pharyngotonsillitis and Eradication of Streptococci Agent Benzathine penicillin Dose 600,000 U for patients