In a case of suspected rheumatic fever with persistent mitral stenosis, what is the best treatment?

In cases of suspected rheumatic fever, especially when associated with complications like persistent mitral stenosis, continuous antibiotic prophylaxis is crucial. Rheumatic fever often develops after a streptococcal throat infection and can lead to rheumatic heart disease, including damage to the heart valves.

The main goal of continuous antibiotic prophylaxis is to prevent recurrent streptococcal infections, which can trigger further episodes of rheumatic fever and exacerbate cardiac complications. The use of penicillin or other appropriate antibiotics helps to reduce the risk of reinfection and the subsequent development of more severe cardiac damage.

While other treatment options might address symptoms or complications, such as beta-blockers for heart rate control or anti-inflammatory drugs to manage inflammation, they do not directly prevent the underlying cause of recurrent rheumatic fever. Surgical valve replacement may be necessary in advanced cases to manage significant valvular dysfunction or heart failure, but this is typically considered when medical management is insufficient.

Thus, continuous antibiotic prophylaxis stands out as the best approach in managing the risk of recurrent rheumatic fever and its potential complications, making it the most appropriate choice in this context.