Is antibiotic prophylaxis required for individuals with a history of rheumatic fever?

• A. Yes, always
• B. No, not required
• C. Only if symptomatic
• D. Only for surgical procedures

Answer: (B)

Antibiotic prophylaxis in individuals with a history of rheumatic fever is generally not required unless there is a specific indication or additional risk factors present. The main purpose of prophylaxis is to prevent recurrent rheumatic fever and subsequent rheumatic heart disease, which has been primarily associated with group A streptococcal infections.

Current guidelines recommend that antibiotic prophylaxis is only necessary for certain high-risk patients before specific procedures, particularly dental or certain surgical procedures that may expose the patient to potential streptococcal infections. For most individuals with a past episode of rheumatic fever who are not at increased risk and not undergoing high-risk procedures, routine prophylaxis is not beneficial or necessary.

Understanding this context clarifies why not having any routine prophylaxis is appropriate in the absence of acute symptoms or concurrent health considerations.