Situation: A patient with acute rheumatic fever was directly put on penicillin prophylaxis.
Reaction: Oh my God! Why was the full initial course of penicillin not given?
Lesson: Make sure that patients with acute rheumatic fever are started on antibiotic therapy as delineated for eradication of streptococcal pharyngitis, whether or not pharyngitis is present at the time of diagnosis.
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