Failure of Secondary Prophylaxis with Erythromycin in Rheumatic Heart Disease.

Background: Erythromycin is recommended for secondary prophylaxis in children with rheumatic heart disease, who are allergic to penicillin. Case Characteristics: A 9-year-old girl, with rheumatic heart disease, on secondary prophylaxis with erythromycin 250 mg BD, presented with acute rheumatic fever. Outcome: Responded to steroids and started on a higher dose (250 mg TDS) of erythromycin for secondary prophylaxis. Message: There is need to document the resistance of group A streptococci to erythromycin.