New guidelines recommend antibiotic treatment for sore throats in high-risk children and adolescents without diagnostic confirmation of strep A to prevent acute rheumatic fever.

Released last month, the new guidelines on rheumatic heart disease and acute rheumatic fever (ARF) differ from the 2024 WHO guideline, which recommends antibiotic treatment only when strep A pharyngitis is confirmed.

The revised guidelines, from the Menzies School of Health Research and the Heart Foundation of Australia, also explicitly recognise skin infections as a trigger for ARF, recommending antibiotic treatment of strep A impetigo in high-risk populations.

In contrast, the WHO guideline does not recommend treating skin infections to prevent rheumatic heart disease.