Studies have shown that eradication of GAS from patients with ARF does not alter the course of their disease, nor does it change the outcome of rheumatic valvular lesions. Despite this evidence, the recommendation is to treat patients with ARF with antibiotics in an effort to eradicate the bacteria from the pharynx and to prevent repeated exposure to the streptococcal antigens.28 In the case of primary prevention, antibiotics have proven be to quite successful. A systematic review found that antibiotic treatment of GAS effectively reduces the attack rate of ARF by 70%. However, this systematic review only studied patients who had only GAS infection and no signs of ARF.38
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