In cases of Streptococcal pharyngitis, how early should the treatment be initiated to effectively prevent Rheumatic fever?

Ans: C (9 days) Ref: Nelson Textbook of Pediatrics, 19th edition and Harrison's Principles of Internal Medicine, 18th ednExplanation:"Appropriate antibiotic therapy instituted before the 9th day of symptoms of acute GAS pharyngitis is highly effective in preventing 1st attacks of acute rheumatic fever from that episode. However, about 30% of patients with acute rheumatic fever do not recall a preceding episode of pharyngitis." Ref: NelsonCHEMOPROPHYLAXIS FOR RECURRENCES OF ACUTE RHEUMATIC FEVERDRUGDOSEROUTEPenicillin G benzathine600.000 U for children, <27 kg1 2 million U for children >27 kg. every 4 weeksintramuscularORPenicillin V250 mg twice a dayOralORSulfadiazine or sulfisoxazole0.5 g. once a day for patients <27 kgOral1.0 g. once a day for patients >27 kgFor those who are allergic to penicillin and sulfonamide drugsMacrolide or azalideVariableOralDURATION OF PROPHYLAXIS FOR PEOPLE WHO HAVE HAD ACUTE RHEUMATIC FEVER: RECOMMENDATIONS OF THE AMERICAN HEART ASSOCIATIONCATEGORYDURATIONRheumatic fever without carditis5 years or until 21 years of age. whichever is longerRheumatic fever with carditis but without residual heart disease (no valvular disease)10 years or until 2! years of age, whichever is longerRheumatic fever with carditis and residual heart disease (persistent valvular disease)10 years or until 40 years of age, whichever is longer, sometimes lifelong prophylaxis