Splendid! An intramuscular injection of benzathine penicillin (600,000 units under 25kg; 1.2 million units over 25kg) right away will eliminate any S. pyogenes currently carried by Sally. Then every 4 weeks Sally will need to get another shot to prevent future strept. throat infections. If Sally's heart damage is not permanent then the prophylactic penicillin injections can end at the end of childhood. If permanent heart damage exists then the injections should continue for the life of the patient.
Sally did recover quite quickly. The prenisone lowered the inflammation in her joints so that the pain was gone by the end of the week. Her heart murmur was gone in 4 weeks and a radiograph of her heart revealed normal heart size at the end of 6 weeks. She was slowly weaned off the steroid and aspirin was given for during this weaning process and for two weeks after removal of the prenisone. Sally was set up with a monthly visit to the office for her penicillin shot.
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WONDERFUL job. You have now completed this case. If you want another challenging case of this nature go to the Baylor Pediatrics Cases.
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