Sir.—Majeed et al1 suggest that the current approach to long-term anti-streptococcal chemoprophylaxis for children with acute rheumatic fever (ARF) should be modified. According to these authors, children with rheumatic carditis should receive such prophylaxis probably indefinitely, whereas those children with arthritis alone should receive it for only five years. However, recent data from several countries, including their own country, raise serious concern about the applicability of these recommendations.
In a recent five-year prospective follow-up of ARF in children from north India,2 we observed 24 recurrences in 22 of the 85 patients. Twenty-two of these recurrences were directly related to omission of continuous anti
streptococcal chemoprophylaxis. Of the ten recurrences among children who had carditis during the initial attack, each recurrence manifested as carditis. Equally important, recurrences produced further cardiac damage in five children, including two children in whom heart murmur had disappeared totally two to three months