Benzathine penicillin given every three weeks as IM injection (1.2 mega units) has given the best results. Oral agents (penicillin V) are given in patients with lower risk of rheumatic recurrence. In patients with penicillin allergy, sulphadiazine or erythromycin is used. According to ICMR recommendation, secondary prophylaxis should be carried out till 35 years of age. As per American Heart Association (AHA, 1995), the recommendations vary for secondary rheumatic prophylaxis. In general it is recommended that patients with established rheumatic heart disease, should receive prophylaxis till 10 years after the last episode or 40 years of age, which ever is longer. Some patients who develop post streptococcal reactive arthritis without carditis are given Benzathine penicillin 1.2 mega units ever three weeks for 1 year.