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Rheumatic fever and rheumatic heart disease: updates for clinical practice

Sara Noonan1,2, James Marangou1,3, Bart J Currie1

  • 1Menzies School of Health Research, Charles Darwin University, Darwin.

Australian Prescriber
|August 20, 2026
PubMed

Insights

Rheumatic heart disease (RHD) is a major childhood cardiac issue, especially impacting First Nations peoples in Australia. Prompt antibiotic treatment for Group A Streptococcus infections and regular penicillin injections are key for preventing rheumatic fever and RHD.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Rheumatic heart disease (RHD) is the leading cause of acquired childhood heart disease globally.
  • In Australia, RHD disproportionately affects First Nations communities, highlighting health inequities.
  • Group A Streptococcus infections are linked to acute rheumatic fever (ARF) and subsequent RHD.

Purpose of the Study:

  • To outline Australian guidelines for preventing, diagnosing, and managing ARF and RHD.
  • To emphasize the importance of managing skin and throat infections with antibiotics in high-risk groups.
  • To detail secondary prevention strategies for ARF, including painful but crucial penicillin injections.

Main Methods:

  • The study references the Australian Guideline for the Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease (2025).
  • Recommendations focus on antibiotic management of infections and long-acting intramuscular penicillin for secondary prevention.
  • Clinical care delivery emphasizes a cultural framework centered on the patient and family.

Main Results:

  • Guidelines recommend antibiotic management for Group A Streptococcus infections to prevent ARF and RHD.
  • Regular long-acting intramuscular penicillin is advised for secondary prevention of ARF.
  • Pain management during injections is crucial and requires skilled administration.

Conclusions:

  • Effective management of streptococcal infections and adherence to penicillin prophylaxis are vital for RHD prevention.
  • Culturally sensitive care models are essential for managing ARF and RHD in affected populations.
  • The 2025 Australian guidelines provide a comprehensive framework for clinical care, prioritizing patient and family-centered approaches.

Keywords:
Streptococcus pyogenesSydenham chorearheumatic feverrheumatic heart disease

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