What is the most appropriate choice for secondary prophylaxis of rheumatic fever in a patient with mitral valve disease?

For a patient with mitral valve disease due to a history of rheumatic fever, long-term secondary prophylaxis is essential to prevent recurrent rheumatic fever and further damage to the heart valves. The standard recommendation for secondary prophylaxis in such patients is the administration of intramuscular penicillin G benzathine every 21 to 28 days.

In this specific case, the most appropriate duration of secondary prophylaxis is typically until the individual reaches age 40, particularly if they have evidence of ongoing valve damage or significant heart disease. This approach balances the need for preventive treatment with the understanding that the risk of rheumatic fever decreases as patients age if they remain free of additional throat infections with Group A Streptococcus.

The rationale for using intramuscular penicillin G benzathine every 21-28 days is due to the long-acting nature of the formulation, which provides sustained levels of penicillin in the bloodstream, offering consistent protection against streptococcal infections that could trigger another episode of rheumatic fever.

Other options listed may not provide appropriate coverage or comply with the recommended guidelines for duration and form of prophylaxis. For instance, oral penicillin or azithromycin are less effective at maintaining therapeutic levels over time compared to the