310 Where There Is No Doctor 2011
Sore throat and the danger of rheumatic fever:
For the sore throat that often comes with the common cold or flu, antibiotics
should usually not be used and will do no good. Treat with gargles and
acetaminophen.
However, one kind of sore throat—called strep throat—should be treated with
penicillin. It is most common in children and young adults. It usually begins suddenly
with severe sore throat and high fever, often without signs of a cold or cough. The
back of the mouth and tonsils become very red, and the lymph nodes under the jaw or
in the neck may become swollen and tender.
Give penicillin (p. 350) for 10 days. If penicillin is given early and continued for
10 days, there is less danger of getting rheumatic fever. A child with strep throat
should eat and sleep far apart from others, to prevent their getting it also.
Rheumatic Fever
This is a disease of children and young adults. It usually begins 1 to 3 weeks after
the person has had a strep throat (see above).
Principal signs (usually only some of these signs are present):
• fever
• joint pain, especially in the
wrists and ankles, later the
knees and elbows. Joints
become swollen, and often
hot and red.
• curved red lines or lumps
under the skin
• uncontrolled movements
• in more serious cases,
weakness, shortness of breath,
and perhaps chest pain
Treatment:
♦ If you suspect rheumatic fever, see a health worker. There is a risk that the heart
may become damaged.
♦ Give penicillin (see p. 350).
♦ Take aspirin in large doses (p. 378). A 12-year-old can take up to 2 tablets of
300 mg. 4 times a day. Take them together with milk or food to avoid stomach
pain. If the ears begin to ring, take less.
Prevention:
♦ To prevent rheumatic fever, treat ‘strep throat’ early with penicillin—for 10 days.
♦ To prevent return of rheumatic fever, and added heart damage, a child who has
once had rheumatic fever should take penicillin for 10 days at the first sign of a
sore throat. If he already shows signs of heart damage, he should take penicillin
on a regular basis or have monthly injections of benzathine penicillin (p. 351)
perhaps for the rest of his life. Follow the advice of an experienced health
worker or doctor.