风湿热.docx

1、风湿热AHA Scientific StatementPrevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal PharyngitisA Scientific Statement From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the I

2、nterdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics* Michael A. Gerber, MD, Chair; Robert S. Baltimore, MD; Charles B. Eaton, MD, MS; Michael Gewitz, MD,

3、FAHA; Anne H. Rowley, MD; Stanford T. Shulman, MD; Kathryn A. Taubert, PhD, FAHA Abstract TopAbstractIntroductionPrevention of Initial Attacks.Prevention of Recurrent Attacks.ReferencesPrimary prevention of acute rheumatic fever is accomplished by proper identification and adequate antibiotic treatm

4、ent of group A -hemolytic streptococcal (GAS) tonsillopharyngitis. Diagnosis of GAS pharyngitis is best accomplished by combining clinical judgment with diagnostic test results, the criterion standard of which is the throat culture. Penicillin (either oral penicillin V or injectable benzathine penic

5、illin) is the treatment of choice, because it is cost-effective, has a narrow spectrum of activity, and has long-standing proven efficacy, and GAS resistant to penicillin have not been documented. For penicillin-allergic individuals, acceptable alternatives include a narrow-spectrum oral cephalospor

6、in, oral clindamycin, or various oral macrolides or azalides. The individual who has had an attack of rheumatic fever is at very high risk of developing recurrences after subsequent GAS pharyngitis and needs continuous antimicrobial prophylaxis to prevent such recurrences (secondary prevention). The

7、 recommended duration of prophylaxis depends on the number of previous attacks, the time elapsed since the last attack, the risk of exposure to GAS infections, the age of the patient, and the presence or absence of cardiac involvement. Penicillin is again the agent of choice for secondary prophylaxi

8、s, but sulfadiazine or a macrolide or azalide are acceptable alternatives in penicillin-allergic individuals. This report updates the 1995 statement by the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. It includes new recommendations for the diagnosis and

9、treatment of GAS pharyngitis, as well as for the secondary prevention of rheumatic fever, and classifies the strength of the recommendations and level of evidence supporting them. Key Words: AHA Scientific Statements pediatrics infectious diseases prevention rheumatic heart disease rheumatic fever s

10、treptococcal pharyngitis Introduction TopAbstractIntroductionPrevention of Initial Attacks.Prevention of Recurrent Attacks.ReferencesThis scientific statement is an update of a 1995 statement on prevention of rheumatic fever by this committee.1 Prevention of both initial and recurrent attacks of rhe

11、umatic fever depends on control of group A -hemolytic streptococcal (GAS) tonsillopharyngitis (strep throat). Prevention of first attacks (primary prevention) is accomplished by proper identification and adequate antibiotic treatment of streptococcal infections. The individual who has had an attack

12、of rheumatic fever is at high risk of developing recurrences after subsequent GAS pharyngitis and needs continuous antimicrobial prophylaxis for years to prevent such recurrences (secondary prevention).26 In developing areas of the world, acute rheumatic fever and rheumatic heart disease are estimat

13、ed to affect nearly 20 million people and are the leading causes of cardiovascular death during the first 5 decades of life.7 In contrast, the incidence of acute rheumatic fever has decreased dramatically in most developed countries.8 In certain areas of the United States, a few localized outbreaks

14、in civilian and military populations were reported in the 1980s.8,9 This reappearance of acute rheumatic fever serves as a reminder of the importance of continued attention to prevention of rheumatic fever in this and other developed countries; however, currently, the overall incidence of acute rheu

15、matic fever remains very low in most areas of the United States.10,11 The recommendations in the present statement are primarily based on this assumption. Physicians practicing in areas outside the United States with a higher incidence of acute rheumatic fever or in areas of the United States experi

16、encing an outbreak of acute rheumatic fever need to take this into consideration. The writing group was charged with the task of performing an assessment of the evidence and assigning a classification of recommendations and a level of evidence (LOE) to each recommendation. The American College of Cardiology/American Heart Association (AHA) classification sy