Treatment and prophylaxis of rheumatic fever in children

  • Symptoms
  • Treatment: early hospitalization, strict bed rest for 6-8 weeks. The extension of the regime gradually, depending on the child's condition and under the supervision of functional tests. Extensive use of fresh air. It is important to create a physical and mental peace. Attentive and tender attitude to the child should be combined with the proper organization of leisure in which to use various means of educational and pedagogical work (table games, drawing, modeling, a small volume of training sessions). Complete diet rich in protein and vitamins; the restriction of salt and fluid. When remitting the process activity, improving the overall conduct therapeutic gymnastics.
    Use of acetylsalicylic acid 0.15-0.2 g per day per year of life, amidopyrine 0.15 grams per day per year of life, but not more than 1.5 to 2 grams a day (daily dose is divided by the reception 3-4). Rarely prescribe sodium salicylate 0.5 g per year of life; phenylbutazone - for pre-school children of 0.05 g, children of school age 0,075-0,1 g 3 times a day.
    Drugs used during 1,5-2 weeks, then as subacute process the dose reduced to J/4, in 2 weeks - 54, later on 3/4 of the initial dose. The course of treatment is not less than 10 weeks. In chronic purulent foci of infection, accession angina, pneumonia shown antibiotics.
    The clinical manifestations of diffuse myocarditis or endomyocarditis along with salicylates shown hormones. Prednisolone appoint a rate of 0.5 - 1 mg per 1 kg of weight per day (but not more than 30 mg per day). Every 5-7 days to reduce the daily dose of 5 mg, in the last 5-7 days appoint 5 mg a day. The course duration is 6 weeks. During treatment with hormones and within two weeks after their withdrawal in turn appoint amidopyrine and acetylsalicylic acid in full doses, alternating every 2 weeks; prescribe antibiotics for 7-8 days and diet, poor salts of sodium and rich in potassium salt.
    With circulatory failure III extent slowly intravenously injected 0.05% solution strofantina 0.1-0.2-0.4 ml 20 ml of 20% glucose solution for 5 to 6 minutes, or 0.06% solution of corglycon 0.4-0.8 ml 20 ml of 20 to 40% glucose solution. The course of treatment is 10 to 14 injection. Apply the infusion of herbs of an Adonis (4 : 200) for one table. L. 3-4 times a day. The course of treatment is 10 to 14 days. Assign prednisolone based 1-1,5 mg per 1 kg of weight; highest daily dose of 40 - 60 mg for pain in the heart, sleep disorders appoint bromural 0.15-0.3 g once a day, phenobarbital 0.02-0.05 g once a day. For pain in joints use dry heat, UHF, sollux, blue light, and so on, Shows a multivitamin, fasting days, potassium diet (400-500 g baked potatoes, 300 ml of fermented milk, 200 g prunes or raisins), fruit and cottage cheese diet; recommended restriction of salt.
    After discharge from the hospital of the child referred to the local sanatorium for children suffering from rheumatism.
    Balneological health treatment in sanatoriums of Kislovodsk, Sochi, Matsesta, Odessa, and other Druskininkai

    The treatment of rheumatism in active phase should be carried out in hospital and to be integrated. Mode first 12-14 days of bed. He further expands every two weeks under the control of the functional tests. Accordingly appointed therapeutic physical training (see above).
    Diet full, rich in protein and vitamins (C, B1, B2). Calcium supplements (on indications and potassium). Acetylsalicylic acid (aspirin) 0.2-0.25 g per year of life per day or amidopyrine (pyramidonum) 0,15-0,2 g per year of life, but no more than 2-2,5 g (sodium salicylate, and phenylbutazone in children used less often). Depending on the condition of the patient dose should be gradually reduced. After discharge from the hospital for 1 month. appoint half of the initial dose.
    Corticosteroids are shown at the II and III degree of activity rheumatism; when I degree - only in cases of primary identification of significant cardiac lesions. In patients without circulatory failure and failure I and PA extent corticosteroids are assigned first to a maximum dose rate of 0,8-1 mg prednisolone per 1 kg of weight per day. Triamcinolon and dexamethasone equivalent quantities: 5 mg prednisolone = 4 mg triamcinolone = 0.75 mg dexamethasone. The maximum dose is given 8-14 days, then it decreases every 6-12 days and by the end of treatment was 5-2,5 mg of prednisone per day. The course of treatment is 35-45 days.
    With circulatory failure III extent corticosteroids are prescribed individually, usually after preparation of heart, diuretic and other means. The initial dose of the drug is small (no more than 10-15 mg of prednisone per day) with a gradual increase to full in accordance with the response of the patient for treatment. The duration of treatment for the patients is between 50 - 60 days. In some cases necessary refresher courses. Cancellation of corticosteroids should always be gradual. An indispensable condition of successful treatment of severe patients with rheumatism is the complexity and prevention of adverse effects of corticosteroids (see hormone therapy in Pediatrics).
    In severe illness with symptoms of malnutrition, as well as in the appointment of corticosteroid dose of 1 mg per 1 kg of weight shown anabolic drugs: methandrostenolone (nerobolum) in the dose of 0.2 - 0.3 mg per 1 kg of weight per day; probaly 15 - 20 mg 1 time a week; retabolil 25-50 mg 1 time in 3 weeks. The course of treatment is not more than 3-4 weeks.
    Antibiotics are prescribed in the age doses. The first 2-3 weeks penicillin (streptomycin, tetracycline), followed by indications - bicillin.
    When trochaic along with Antirheumatic therapy are applied reserpine, phenobarbital (luminal), chlorpromazine, trioxazin, physiotherapeutic procedures (see Chorea).
    Heart glycosides and diuretic medications indicated for circulatory failure (see Circulation insufficiency).
    In the subacute period of activity of rheumatism of the child referred to the local sanatorium for 2-3 months, where it gradually transferred to the typical age of the regime, where he receives anti-relapse treatment. After discharge children must be under medical supervision of rimonabant.

    Prevention of rheumatic fever includes a range of activities. Children, who are frequently ill with tonsillitis, chronic tonsillitis, catarrh of the upper respiratory tract, as well as undergoing scarlet fever, must be registered with a doctor rheumatologist. You should make a reasonable hardening of healthy children; children with chronic infections should be treated; for the prevention of recurrence of children who have had rheumatic attack after discharge from hospital within 3-6 months. 1 time per week in the spring and autumn intramuscularly bicillin: pre-school age children by 300 000 UNITS, the children of school age 600 000 UNITS.
    In the inactive phase rheumatism bicillin appoint 2 times a year: in spring and autumn in the same dose of 1 times a week for 6 weeks. At the same time appoint acetylsalicylic acid 0.1 g per year of life per day: 1 / 3 doses in the morning and 2/3 - in the evening for 6 weeks, and ascorbic acid.
    At occurrence of angina, chronic tonsillitis , and other sites of infection from the first day of the disease designate penicillin intramuscularly daily for 200 000 IU at the age of 3-6 years, 300 000 UNITS at the age of 7-10 years and 400 000 IU children of older age, combined with Antirheumatic means (amidopirina, acetylsalicylic acid, analgin) at the rate of 0.2 g per year of life (daily dose) in the first 3-5 days, and 0.1 g per year of life in the next days. The course of treatment is 10 days.

    Prevention of rheumatic fever primary consists in increase of a common resistibility of the child's body, which contribute to hardening, dosed physical culture and sport, correct mode of the day, rational nutrition, organized since the first years of life. It is necessary warning and timely rehabilitation centers of infection.
    Medication (secondary prevention of rheumatic fever subject: children with congenital heart disease - within 5 years after the last attack (later - according to individual indications); children without heart disease - within 3 years after the attack; children with sluggish over rheumatism, depending on the state, but not less than 3 years; children, "threatened" by disease rheumatism. Drug prevention is to assign spring and autumn at 6 weeks bicillin and acetylsalicylic acid (aspirin). Bicillin-1 and bicillin 3 intramuscularly 1 week 300000-600000 ED. Course - 6 injections. Bicillin 5 impose on 1000000-1 500000 UNITS of 1 times in 3 weeks (2 injections). At the same time appoint acetylsalicylic acid inside the rate of 0.1 g per year of life per day. In the case of untreated penicillin bicillin prevention is carried out only acetylsalicylic
    The most important preventive measures at exacerbation of chronic tonsillitis, pharyngitis, repeated catarrh of the respiratory tract. From the first day of illness, you must assign penicillin for 7-10 days and Antirheumatic drugs (acetylsalicylic acid, amidopirina) on 12-14 days. Children with severe, often relapsing course of rheumatism bicillin you want to assign to the whole autumn-winter-spring period, leaving, if his condition allows, only the summer months. According to individual indications such children appoint reskin (chloroquine, delagil) inside 0,125 - 0,25 g 1-2 times a day for 3-6 months.
    Children with heart defects and especially with circulatory shows re-planned hospitalization for preventive treatment (I. A. Cashiers). Persistent therapy in the active phase of rheumatoid arthritis and preventive measures can reduce the number of relapses and improve disease outcome.