Prophylaxis of rheumatic fever

 American Heart Association Recommendations for Duration of Secondary Prophylaxisa 

 Rheumatic fever without carditis 

DURATION OF PROPHYLAXIS 

For 5 years after the last attack or 21 years of age (whichever is longer) 

Rheumatic fever with carditis but no residual valvular disease 

For 10 years after the last attack, or 21 years of age (whichever is longer) 

Rheumatic fever with persistent valvular disease, evident clinically or on echocardiography 

For 10 years after the last attack, or 40 years of age (whichever is longer); sometimes lifelong prophylaxis