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.
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