HI Prevention of initial attack of rheumatic fever (primary prevention) is accomplished by prompt diagnosis and antibiotic treatment of group A streptococcal tonsillopharyngitis. Prevention of recurrent rheumatic fever (secondary prevention) requires prevention of recurrent GAS pharyngitis. We recommend continuous antimicrobial prophylaxis, rather than recognition and treatment of acute GAS pharyngitis episodes. In general, prophylaxis for in the setting of carditis should continue until the patient is a young adult (18 years of age), which is usually 10 years from an acute attack with no recurrence . At the end of a planned course for secondary prophylaxis, the risk for GAS exposure and severity of valvular disease should be reviewed. We suggest long acting benzathine penicillin G for secondary prevention of recurrent rheumatic fever. Switching from intramuscular to oral prophylaxis once patients have reached young adulthood and have remained free of rheumatic attacks is appropriate. We suggest administering secondary prophylaxis in the setting of suspected poststreptococcal reactive arthritis for up to one year after the onset of symptoms . Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued. TAKE CARE