What is the first-line antimicrobial therapy for eradication of streptococcal infection in rheumatic fever?

• A. Erythromycin
• B. Penicillin IM
• C. Azithromycin
• D. Clindamycin

Answer: (B)

Long-acting intramuscular benzathine penicillin G is the best option to eradicate streptococcal infection in rheumatic fever. Its single, sustained dose delivers effective penicillin levels for about a week or more, ensuring reliable elimination of Streptococcus pyogenes even if the patient has trouble completing a course of oral therapy. This reliable eradication is crucial in rheumatic fever management to prevent recurrent attacks and further cardiac involvement.

Penicillin has excellent activity against the streptococcus that triggers rheumatic fever, and its safety, low cost, and proven track record make it the first-line choice. If a patient cannot receive penicillin due to allergy, alternatives such as erythromycin or azithromycin can be used, though they are not preferred as the initial regimen. Clindamycin may be an option in some penicillin-allergic scenarios but is not the preferred first-line agent for eradication.