Treatment

Treatment involves:

• bed rest but not immobilisation, undertaken until the CRP is normal - 2 weeks to 3 months
• penicillin to eradicate the streptococcus; benzylpenicillin 600mg iv stat and then penicillin V 250mg/6h PO
• large doses of aspirin, or aspirin and steroids, improve the clinical picture but do not affect the vasculitis:
  • aspirin at doses of 90mg/kg/day PO (in 4 hourly divided doses; up to maximum of 10g) for two days. After initial aspirin treatment then 70mg/kg/day for 8 weeks. Note that such high doses of aspirin may lead to side effects such as ototoxicity, hyperventilation, GI upset and metabolic acidosis. Thus blood levels of aspirin metabolites should be monitored.
  • corticosteroids are indicated in severe carditis. Prednisolone is given in an initial dose of 2mg/kg/d in four divided doses. This regime is maintained for 2 weeks and then tapered off over 4-8 weeks.
• analgesia for carditis
• if severe arthritis then immobilization of joints
• haloperidol if there is St Vitus dance