The Rheumatic Fever Prevention Programme recommends the following antibiotics for the treatment of Group A streptococcal pharyngitis in children at high risk of rheumatic fever (Māori and Pacific children and young people living in high risk areas of the North Island):

First line treatment  
Amoxicillin orally for 10 days Children < 30 kg: 750 mg once daily
Children ≥ 30 kg: 1000 mg once daily
Benzathine benzylpenicillin, intramuscular, single dose Children < 30 kg: 450 mg (600,000 units)
Children ≥ 30 kg: 900 mg (1,200,000 units)
Alternative for definite or possible anaphylaxis to penicillin or amoxicillin  
Erythromycin ethyl succinate orally for 10 days Children and adults: 40 mg/kg/day in 2–3 divided doses

Guidance for administering an intramuscular injection of benzathine benzylpenicillin

This guidance provides a standardised protocol for administering intramuscular penicillin (benzathine benzylpenicillin), with lignocaine added for pain relief, to treat group A streptococcus (GAS) pharyngitis.

When using this guidance, registered health professionals remain responsible for ensuring their practice is up to date and informed by current evidence and individual patient assessment.

Note: 'Lignocaine' is referred to in this guidance. 'Lignocaine' is another name for 'lidocaine'.

Information sheet: Treating a sore throat with a single penicillin injection

You can give this information sheet to people who have agreed to have intramuscular penicillin, with lignocaine added for pain relief, to treat group A streptococcus (GAS) pharyngitis. It explains the injection process and what to expect after the injection is given. It also allows the health professional to record the antibiotic injection time and dose for the patient’s information.

E-learning course

A rheumatic fever e-learning course is available at LearnOnline. The course is free, and is aimed at primary care nurses, public health nurses and community health workers who work with families whose children are at risk of developing rheumatic fever.

Rheumatic Fever Co-design Initiative Resources

Resources developed to support health professionals with the prevention and management of rheumatic fever.