Guidelines on rheumatic fever, rheumatic heart disease & GAS sore throat

Download clinical guidelines, tools and other information related to group A streptococcal (GAS) sore throat, rheumatic fever, and rheumatic heart disease.

The Heart Foundation has supported the development of three evidence-based, best practice New Zealand guidelines to maximise diagnosis and management of rheumatic fever, rheumatic heart disease and group A streptococcal sore throat.

Diagnosis, Management and Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease: (2014 Update second edition)

This guideline for the diagnosis, management and secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) was published in 2014. As a result of the 2019 update to the Group A Streptococcal Sore Throat Management Guideline, the following medication regimes have changed, but have not been updated in this document.

Page referenceMedication2014 ARF and RHD GuidelineMedication regime change in 2019 GAS Guideline Update
13PhenoxymethylpenicillinTwice daily2-3 times daily
13, 29AmoxicillinOnce daily1-2 times daily
26, 29, 36, 70Erythromycin max daily dose1000mg1600mg
Acute rheumatic fever & rheumatic heart disease guideline. 2014 Update

Group A Streptococcal (GAS) Sore Throat Management Guideline 2019 Update.

The Group A Streptococcal Sore Throat Management guideline was substantially reviewed and updated in 2019. Key changes from the 2014 edition include:

  • a redefinition of ‘high risk for rheumatic fever’
  • revisions of Clinical Question 7 on the management of treatment failure and GAS recurrence, including the removal of cephalexin from antibiotic prescribing
  • erythromycin regime change
  • revision of household contact management.
Group A Streptococcal (GAS) Sore Throat Management Guideline 2019 Update

Download the Summary of key changes for 2019 GAS guideline update 2019 (PDF).

Download Clinical Question 7 – Management of Treatment Failure and GAS Recurrence. 2019 Update (PDF).

Download Guide for Sore Throat Management - Algorithm (PDF).

Download Guide for Household Sore Throat Management - Algorithm (PDF).

Download Management of Recurrent Treated GAS Positive Sore Throats - Algorithm (PDF).

Proposed Rheumatic Fever Primary Prevention Programme 2009 – also known as the Primary Prevention of Rheumatic Fever guideline

The following Proposed Rheumatic Fever Primary Prevention Programme was published in 2009. As a result of the 2019 update to the Group A Streptococcal Sore Throat Management Guideline, the definition of high risk for rheumatic fever has been updated but is not updated in this document.

Guidelines for rheumatic fever: Proposed rheumatic fever primary prevention plan (2009)

Group A Streptococcal Sore Throat Management Guideline: Update 2019

Populations at high risk of rheumatic fever:

  • Māori and Pacific peoples&
  • youth, especially those aged five to 14 years
  • those living in lower socioeconomic circumstance within the North Island, especially within parts of the Northland, Auckland, Waikato, Bay of Plenty, Rotorua, Gisborne, Hawke’s Bay and the Wellington area.
The population at High Risk for Rheumatic Fever is defined as those individuals who have a personal, family or household history of rheumatic fever, or who have two or more of the following criteria:
  • Māori or Pacific ethnicity, age 3-35 years, with emphasis on children and young people (4-19 years old),
  • those living in crowded circumstances
  • in lower socioeconomic areas of the North Island.
Rheumatic fever primary prevention programme

Related clinical resources

The Heart Foundation has a number of other RF-related clinical tools which can be downloaded below.

Guide for use of echocardiography in ARF (PDF)

Prevention of Infective Endocarditis (2008) (PDF)

Infective endocarditis wallet card

Antibacterial prophylaxis for dental procedures (PDF)

Secondary prophylaxis rheumatic fever algorithm (PDF)

Resources for patient

The Heart Foundation has produced a booklet for families affected by rheumatic fever. It explains what rheumatic heart disease is and what to expect from the journey ahead.

Our Journeys programme offers people the opportunity to hear from others living with heart disease or to share their own story.

Hear from people living with RHD