acute

Acute rheumatic fever without carditis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources7 sources

MSF Essential Drugs 2024 (ibuprofen oral monograph) · 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) · DailyMed Ibuprofen Tablet Package Insert (DailyMed, NLM) · Acute rheumatic fever without carditis - disease-level clinical article (acute-rheumatic-fever-without-carditis-full.txt) · Acute Rheumatic Fever - disease-level clinical article (acute-rheumatic-fever-without-carditis-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 · Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)

Verified against6 documents

MSF Essential Drugs 2024 (ibuprofen oral monograph)
DailyMed Ibuprofen Tablet Package Insert (DailyMed, NLM)
Acute Rheumatic Fever - disease-level clinical article (acute-rheumatic-fever-without-carditis-clinical.txt)
Egyptian National Drug Formulary - Antimicrobial 2023
Acute rheumatic fever without carditis - disease-level clinical article (acute-rheumatic-fever-without-carditis-full.txt)
Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

Sore throat two to four weeks before joint symptoms begin, from untreated strep infection [sore throat]
Roughly a third of patients cannot recall having had a preceding throat infection
General fever, chills, and tiredness affect most patients with the illness [chills · fatigue · fever]
Migratory joint aches, usually the earliest complaint, in 60 to 80 percent of cases [joint pain]
Sudden irregular jerking movements involving the face, hands, and feet, worse on one side
Chorea can bring agitation, anxiety, or bouts of inappropriate laughing or crying [anxiety · chorea · irritability]

Signs — what you find (6)

Affected joints look red, swollen, and are markedly tender to touch
Firm, painless lumps over joints, mainly on the extensor surfaces
A pink ring-shaped rash with raised edges and a clear center on the trunk and limbs, sparing the face [rash]
The rash fades from one spot and reappears elsewhere, described as a snake-like, fleeting pattern [rash]
Grip strength intermittently gives way when the patient squeezes the examiner's hand, the classic milkmaid finding
Facial grimacing, tics, and slurred or poorly formed speech and handwriting can accompany chorea [chorea · tics]

Tests (7)

Throat culture is the reference standard for confirming strep, though results take time
Rapid strep antigen tests run under 90 percent sensitive, so a negative needs backup culture
Antistreptolysin O or anti-DNase B antibody levels climb two to three weeks after the strep infection
A doubling of the antibody titer on repeat testing counts as a positive result
Every patient needs a cardiac work-up including chest x-ray, ECG, and echocardiogram
The ECG most often shows a prolonged PR interval, adjusted for the patient's age
Echocardiography can pick up heart involvement that the physical exam misses entirely

If not this — what else fits (8)

Lyme disease can mimic the migratory joint pain of ARF
Reactive arthritis following a strep infection is a joint-pain mimic
Septic arthritis is a joint-involvement mimic to rule out
A drug reaction or serum sickness can also cause migratory joint pain
PANDAS, a post-strep autoimmune neuropsychiatric syndrome, mimics the chorea of ARF
Tourette syndrome is on the differential for the abnormal movements seen in chorea
Kawasaki disease overlaps with ARF's rash and systemic features
Juvenile idiopathic arthritis and lupus belong on the differential for the systemic picture

SourceStatPearls "Acute Rheumatic Fever" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Secondary prophylaxis | If aspirin or an NSAID cannot be used

MAIN TREATMENT - choose one

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

200 to 400 mg three to four times daily, with or after food. Never more than 1200 mg in a day.

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).)

Dose by weight
3kg	15-30 mg/dose
4kg	20-40 mg/dose
5kg	25-50 mg/dose
6kg	30-60 mg/dose
7kg	35-70 mg/dose
8kg	40-80 mg/dose
9kg	45-90 mg/dose
10kg	50-100 mg/dose
11kg	55-110 mg/dose
12kg	60-120 mg/dose
13kg	65-130 mg/dose
14kg	70-140 mg/dose
15kg	75-150 mg/dose
16kg	80-160 mg/dose
17kg	85-170 mg/dose
18kg	90-180 mg/dose
19kg	95-190 mg/dose
20kg	100-200 mg/dose
21kg	105-210 mg/dose
22kg	110-220 mg/dose
23kg	115-230 mg/dose
24kg	120-240 mg/dose
25kg	125-250 mg/dose
26kg	130-260 mg/dose
27kg	135-270 mg/dose
28kg	140-280 mg/dose
29kg	145-290 mg/dose
30kg	150-300 mg/dose
31kg	155-310 mg/dose
32kg	160-320 mg/dose
33kg	165-330 mg/dose
34kg	170-340 mg/dose
35kg	175-350 mg/dose
36kg	180-360 mg/dose
37kg	185-370 mg/dose
38kg	190-380 mg/dose
39kg	195-390 mg/dose
40kg	200-400 mg/dose
41kg	205-400 mg/dose (upper capped)
42kg	210-400 mg/dose (upper capped)
43kg	215-400 mg/dose (upper capped)
44kg	220-400 mg/dose (upper capped)
45kg	225-400 mg/dose (upper capped)
46kg	230-400 mg/dose (upper capped)
47kg	235-400 mg/dose (upper capped)
48kg	240-400 mg/dose (upper capped)
49kg	245-400 mg/dose (upper capped)
50kg	250-400 mg/dose (upper capped)

Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Rheumatic fever polyarthritis needs sustained anti-inflammatory dosing to control joint inflammation, the same scale used for pericarditis, rather than a low symptomatic-relief dose.

Cautions

Any new murmur, chest pain, or breathlessness during the illness means carditis may be developing and referral is needed.
This is genuine anti-inflammatory dosing for migratory polyarthritis, not a symptomatic pain-relief dose - do not substitute a low PRN dose.
Gastroprotection (e.g. a PPI) should be given alongside this dose.
Any new murmur, chest pain, or breathlessness during treatment suggests carditis is developing - refer immediately; this course does not replace the secondary antibiotic prophylaxis, which must be arranged separately.
Taper rather than stop abruptly as symptoms and inflammatory markers settle.
Do not use in children under 12 years of age.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DAJUANOFEN 400 MG 20 F.C. TABS.	COPAD PHARMA	5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.	DELTA PHARMA	3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETS	SANOFI	12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.	SEDICO	6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABS	EIPICO	42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.	KAHIRA > ABBOTT LABORATORIES	78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.	EUROPEAN EGYPTIAN PHARM. IND.	31.00 EGP
ANALGIPROF 400 MG 25 SACHETS	EVA PHARMA	37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	SANOFI	2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	4.50 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Acute Rheumatic Fever - disease-level clinical article (acute-rheumatic-fever-without-carditis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Initial management of acute rheumatic fever should be as an inpatient, including cases without carditis at diagnosis, since carditis can be subclinical and detected only by echocardiography - an outpatient ibuprofen course alone is not enough.

ACETYLSALICYLIC ACID

2nd line

Formoral.solid

Adult dose and duration

60 to 100 mg/kg/day in divided doses until symptom resolution

Paediatric dose

60-100 mg/kg/day

(60 to 100 mg/kg/day in divided doses until symptom resolution)

Dose by weight
3kg	180-300 mg/day
4kg	240-400 mg/day
5kg	300-500 mg/day
6kg	360-600 mg/day
7kg	420-700 mg/day
8kg	480-800 mg/day
9kg	540-900 mg/day
10kg	600-1000 mg/day
11kg	660-1100 mg/day
12kg	720-1200 mg/day
13kg	780-1300 mg/day
14kg	840-1400 mg/day
15kg	900-1500 mg/day
16kg	960-1600 mg/day
17kg	1020-1700 mg/day
18kg	1080-1800 mg/day
19kg	1140-1900 mg/day
20kg	1200-2000 mg/day
21kg	1260-2100 mg/day
22kg	1320-2200 mg/day
23kg	1380-2300 mg/day
24kg	1440-2400 mg/day
25kg	1500-2500 mg/day
26kg	1560-2600 mg/day
27kg	1620-2700 mg/day
28kg	1680-2800 mg/day
29kg	1740-2900 mg/day
30kg	1800-3000 mg/day
31kg	1860-3100 mg/day
32kg	1920-3200 mg/day
33kg	1980-3300 mg/day
34kg	2040-3400 mg/day
35kg	2100-3500 mg/day
36kg	2160-3600 mg/day
37kg	2220-3700 mg/day
38kg	2280-3800 mg/day
39kg	2340-3900 mg/day
40kg	2400-4000 mg/day
41kg	2460-4100 mg/day
42kg	2520-4200 mg/day
43kg	2580-4300 mg/day
44kg	2640-4400 mg/day
45kg	2700-4500 mg/day
46kg	2760-4600 mg/day
47kg	2820-4700 mg/day
48kg	2880-4800 mg/day
49kg	2940-4900 mg/day
50kg	3000-5000 mg/day

Dose source

Acute rheumatic fever without carditis - disease-level clinical article (acute-rheumatic-fever-without-carditis-clinical.txt)

Why

Traditional anti-inflammatory therapy for arthritis in acute rheumatic fever.

Cautions

Risk of Reye syndrome in children and adolescents; requires monitoring of salicylate levels and GI tolerance.
Gastroprotection recommended during high-dose therapy.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ASPOCID 300 MG 200 TABS.	CID	80.00 EGP (0.40/unit)
AGGREX 75MG 60 TABS.	RAMEDA	33.00 EGP (0.55/unit)
ASPOCID 75MG 20 TAB.	CID	22.00 EGP (1.10/unit)
ECOPRIN 325MG 10 ENTERIC COATED TAB.	SIGMA	5.00 EGP
RIVO 75 MG 30 CHEW. TABS.	ARAB DRUG COMPANY (ADCO)	21.00 EGP
ASPRICARLO 81MG 30 CHEWABLE TABS.	EUROPEAN EGYPTIAN PHARM. IND.	45.00 EGP
ASPIRIN PROTECT 100 MG 30 GASTRO-RESISTANT TABS.	MEMPHIS > BAYER BITTERFELD GMBH-GERMANY	78.00 EGP
JUSPRIN 81 MG 60 E.C.TABS.	FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > JULPHAR	81.00 EGP

SECONDARY PROPHYLAXIS

PENICILLIN G BENZATHINE

Secondary prophylaxis

1st line

Forminjection

Adult dose and duration

IM: 1.2 million units once every 21 to 28 days x 5 years or until age 21

Paediatric dose

Dose by age
≤27 kg:	600,000 units every 3 to 4 weeks. >27 kg: 1.2 million units every 3 to 4 weeks.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Intramuscular penicillin G benzathine secondary prophylaxis prevents recurrent Group A streptococcal infection and recurrent attacks of rheumatic fever.

Cautions

Hypersensitivity to penicillin(s) or any component of the formulation
Do not administer IV, intra-arterially, or SubQ. inadvertent IV administration has resulted in thrombosis, severe neurovascular damage, cardiac arrest, and death.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HAYA BENZ-R 1.2 M.I.U. VIAL FOR I.M INJ.	SEDICO > HAYA PHARM-EGYPT	5.06 EGP
PENICID LA 1 200 000 UNITS VIAL	CID	6.50 EGP
BENZACILLIN 1.2 M.I.U.FOR I.M.INJ VIAL.	EL NASR	7.00 EGP
RETARPEN 1.2 M.I.U. VIAL	SANDOZ > OCTOBER PHARMA	10.50 EGP
LASTIPEN 1 200 000 IU VIAL	MISR	12.00 EGP
BENZABIOTIC 1.2 M.I.U. I.M. VIAL.	SEDICO	16.00 EGP
DEPO-PEN 1.2 MIU VIAL.	MUP	25.00 EGP
PENCILONG (PENCITARD) 1200000 I.U./VIAL	NCPC NORTH BEST CO > ACDIMA INTERNATIONAL TRADING	25.00 EGP

IF ASPIRIN OR AN NSAID CANNOT BE USED

PREDNISOLONE

If aspirin or an NSAID cannot be used

2nd line

Strength5 mg

Formoral.solid

Adult dose and duration

5 to 60 mg/day as a single daily dose or in 2 to 4 divided doses, tapered

Paediatric dose

The ENDF prednisolone monograph gives no paediatric figure for this indication, so none is stated here. Acute rheumatic fever is largely a childhood disease - refer.

Dose source

Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)

Why

The disease article gives a glucocorticoid as the option when the patient cannot take aspirin or an NSAID; the card previously offered only those two.

Cautions

Abrupt withdrawal is not recommended, particularly with doses of 40 mg or more or 3 weeks of treatment or more.
The dose should be gradually decreased to the lowest dose that maintains an adequate clinical response.
No paediatric dose is stated in the ENDF for this use, and this is a predominantly paediatric condition - refer rather than extrapolate.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HOSTACORTIN H 5MG 30 TAB.	SANOFI	12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.	ARAB DRUG COMPANY (ADCO)	24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)	KAHIRA	250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.	EIPICO	69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.	EVA PHARMA	79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.	ANDALOUS PHARMA	84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.	SANOFI WINTHROP > SANOFI	84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solid	RAMEDA	7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	9.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.