Repeated attacks of acute rheumatic fever can be prevented in children, who have previously suffered one or more attacks, by giving benzathine penicillin (Bicillin LA) 1.2 million units intramuscularly every 4 weeks (600 000 units if the child weighs less than 30 kg). This must be continued until adulthood when it should be reviewed. As the injections are painful, the child and family must understand that it is most important to prevent ongoing heart damage. The mother should keep a card which records the monthly injections. Careful follow up is essential.