True regarding secondary prophylaxis of a 6 year old child with carditis is: March 2005
**Core Concept**
The question is testing knowledge on secondary prophylaxis in rheumatic fever, specifically in a pediatric patient with carditis. Secondary prophylaxis aims to prevent recurrent attacks of rheumatic fever and subsequent valvular damage in patients who have already developed the disease.
**Why the Correct Answer is Right**
The American Heart Association recommends long-term antibiotic prophylaxis for patients with a history of rheumatic carditis to prevent recurrence and progression of valvular disease. This is particularly important in children, as they are at higher risk of developing complications from rheumatic fever. The prophylactic regimen typically involves a daily dose of an oral antibiotic, such as penicillin, to maintain a serum concentration above the minimum inhibitory concentration (MIC) of the causative organism, Group A beta-hemolytic streptococcus (GABHS).
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not specify the duration or frequency of antibiotic prophylaxis, which is a critical aspect of secondary prophylaxis in rheumatic fever.
**Option B:** This option is incorrect because it does not address the specific need for long-term prophylaxis in patients with carditis, who are at higher risk of recurrence and valvular damage.
**Option C:** This option is incorrect because it does not mention the use of oral antibiotics, which is the preferred method of secondary prophylaxis in children with rheumatic carditis.
**Clinical Pearl / High-Yield Fact**
Remember that secondary prophylaxis in rheumatic fever should be continued indefinitely in patients with a history of carditis, as the risk of recurrence and valvular damage persists even after apparent clinical recovery.
**Correct Answer:** A. Daily oral penicillin prophylaxis is recommended for children with a history of rheumatic carditis to prevent recurrence and progression of valvular disease.