Acute GAS pharyngitis should be treated promptly by penicillin or other antibiotics. Indian Council of Medical Research (ICMR) recommends that all cases of pharyngitis must receive penicillin. One need not wait to isolate GAS organisms. A single dose of 1.2 mega units of Benzathine penicillin given IM or a ten day course of oral penicillin V is given. In case of allergy to penicillin, one uses macrolides or cephalosporins.

                                                                         Table Prophylaxis of Rheumatic Fever

                        Primary Prophylaxis
                         Intramuscular                                      Benzathine penicillin G  12,00,000 U once(6,00,000 U, if weight less than 27 kgs)
                         Oral                                                     Penicillin V                      500 mg bid daily for 10 days
                                                                                    Erythromycin                   250 mg bid daily for 10 days
                                                                                    Other (Clindamycin,  Dose varies    
                         Nafcillin, Ampicillin,        
                         Amoxicillin,        
                         Cephalexin)

                    Secondary Prophylaxis

                     Intramuscular                                         Benzathine penicillin G  12,00,000 U every 3-4 weeks
                      Oral                                                        Penicillin V                     250 mg bid daily
                                                                                     Sulfadiazine                  1 gm od (0.5 gm od in children)
                                                                                     Erythromycin                 250 mg bid daily  
                     stearate