Rheumatic heart disease (RHD) is the most frequent of heart disease in children worldwide. People with a history of rheumatic fever (RF) are at a higher risk of recurrent attacks and of developing RHD following a streptococcal throat infection. Giving penicillin to these people can prevent recurrent attacks of RF and subsequent RHD. Aim: to evaluate the policy of secondary prevention of RF as regards the effectiveness of LAP, Whether there are relapses of RF or not, the effectiveness of giving LAP as a 2-weekly regimen in winter and a 3-weekly regimen in summer for prevention of streptococcal colonization of the throat, the patients complains during the period of compliant LAP injections. Methods: 210 rheumatic patients, good compliant to long acting penicillin (LAP) regimes, attending regularly to Rheumatic fever outpatient clinic from May 2007 to August 2008. Demographic and clinical data were collected, documented and were undergone analytical study. Also, we had done ASOT and throat culture to them. Results: 7 cases of relapses (3 with polyarthritis, 1 with monoarthritis, 1 with carditis, 2 with chorea), but in all of them the relapses occur within the 2 years after the acute episode of RF, ASOT done in our study, after compliant LAP regimens, was high in 5.2% only, all throat cultures swabbed from the studied cases were negative. Conclusion: the effectiveness of our regimen of LAP in eradication of streptococcal colonization in the throat, but it is recommended to apply the 2 weekly LAP regimen in the first few years after the acute episode of RF especially in high risk communities .Then during the subsequent years, a 2-weekly LAP regimen in winter and a 3-weekly regimen in summer, that is appeared to be very effective.