SECONDARY PREVENTION of RHEUMATIC FEVER (with and without carditis) Secondary prevention (i.e., the prevention of recurrences of RF) is a more practicable approach, especially in developing countries. It consists in identifying those who have had RF and giving them one intramuscular injection of benzathine benzyl penicillin (1.2 million units in adults and 600,000 units in children) at intervals of 3 weeks. This must be continued for at least 5 years or until the child reaches 18 years whichever is later. For patients with carditis (mild mitral regurgitation or healed carditis) the treatment should continue for 10 years after the last attack, or at least until 25 years of age, which ever is longer. More severe valvular disease or post-valve surgery cases need life-long Treatment. This prevents streptococcal sore throat and therefore recurrence of RF and RHD. However, the crucial problem is one of patient compliance as penicillin prophylaxis is a long-term affair. Studies have shown that secondary prevention is feasible, inexpensive and cost-effective, when implemented through primary health care systems Ref : Park 23rd edition Pgno : 381