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Primary Prevention of Rheumatic Fever: Is there a role for general practice? marike Ora © New Zealand has ‘oncentrat rheumatic fev Pacific children in a few localities There is no evidence that the treatment of au 3 3s ® = 2 3 g > a = 5 @ < S = @ 8 = 5 S s 3 = streptococcal infections in general practice has any effect on the incidence of acute rheumatic fever ventions to reduce the level of streptococcal ted schools or isolated on infections in sel communities may be of value © The Ministry of Health recommends caution in implementing immediate changes to current clinical practice Evidence-based health care cy Library iii MANATU HAUORA Published with the permission of the Director-General of Heth ISBN 04720824 June 197 Report written by: DrJohn Durham and De Marjan Kiakovie Senior Lecture in Genera Practice General Practice Department Welington School of Medicine PO. ox 7318 Welington South Acknowledgements “The wowsexprosed inthis report are those ofthe author, Dr John Dam ad De Mars Koi. ‘Valuable asses inthe preparton ofthe report was povided by members ofthe Skesing Group who 6: Assoiate Profesor Bruce Aroll Genel Practice Department Auckland School of Medicine. Defi elo, General Practitioner, 785 Mt Eden Road, Auckland restr Anthony Dow General Practice Departren,lington Scho of Medicine race Departmen, Walington School of Medicine _e Lyn Moin, General Practice Department, Wallington Schoo of Medicine Br Sue Pllon, Genera ‘This reports base on a systematic erature review funded bythe Miniteyof Heath Enuitics lense dre any policy enguises about he prevention of dei fever ‘The Manager, Prevention Poicy Ministry of Heat POBox 5015 Welingon Pease diet any enquiries about the systematic review ofthe future development of guidelines fr general Practice to theatre: ‘General Practice Department Walington School of Medicine 0. Box 7313 Wetington South Evidence-based Health Care Primary Prevention of Rheumatic Fever Is there a role for general practice? Key Points © Acute rheumatic fever is a serious problem, both as an acute illness and because of the long-term morbidity from chronic rheumatic heart disease. © New Zealand has a high incidence of acute rheumatic fever, concentrated in Mori and Pacific children in a few localities. streptococcal infection has been said to be an important means of primary | prevention. | © New Zealand general practitioners show a wide variation in how they diagnose and treat patients with sore throat. ‘© For many patients, their first attack of rheumatic fever is not preceded by a sore throat or symptoms that warrant seeing their general practitioner. | (© Throat swabs and antibiotic prescriptions in the management of sore throats are a significant cost to the public health system. © There is no evidence that the treatment of streptococcal infections in general practice has any effect on the incidence of acute rheumatic fever, ©The general practice treatment of the preceding group A betachaemolytic € Interventions to reduce the levelofstreptococea infections in selected schools | or isolated communities may be of value and should be tested with a | randomised control trial. © The Ministry of Health recommends caution in implementing immediate changes to current clinical practice. There may be reasons other than the prevention of rheumatic fever why streptococcal sore throats should continue tobe treated. feed HEALTH Information Centre Ministry of Health Wellington