Prophylaxis in rheumatic and nonrheumatic mitral insufficiency

Clinical, epidemologic, and experimental findings suggest that acquired mitral insufficiency should not invariably the attributed to rheumatic fever. In this series of childhood cases, more than 50 per cent of the instances of "pure" mitral insufficiency did not have an acceptable past history of rheumatic fever in terms of the Jones Criteria for the diagnosis of rheumatic fever. The authors therefore recommend that daily antibacterial prophylaxis should be limited to those children with valvular heart disease who have had at least one of the major manifestations of the Jones Criteria. But all cases or acquired valvular heart disease should remain under continued clinical observation, and be given antibacterial therapy to prevent bacterial endocarditis of the damaged valves whenever indicated.