Length of penicillin treatment of streptococcal infections

doi:10.1136/bmj.320.7250.1665

BMJ 2000;320:1665 ( 17 June )

Letters

Length of penicillin treatment of streptococcal infections

Is seven days of treatment as effective as 10 days?

Antibiotics should not be used for self limiting illnesses

The data do not support the conclusions

Life tables should be used with caution

Care must be taken when extrapolating data

Authors' reply

Is seven days of treatment as effective as 10 days?

The first 150 words of the full text of this article appear below.

EDITOR $---$ Zwart et al recommend seven days of treatment for streptococcal infections as opposed to three days.¹ For severaldecades we were educated to continue penicillin for such casesfor no fewer than 10 days.² The rationale was that streptococcimust be eradicated to prevent rheumatic fever and that this wasachievable only after 10 days of treatment. This was based onbacteriological, epidemiological, and clinical observations. Thecost of oral penicillin is almost negligible, and I think we needmore assurance to be persuaded to cut treatment to only sevendays. Is there any study that will prove that treatment for sevendays is as effective as treatment for 10 days for preventing rheumaticfever?

Dan Michaeli, chairman, board of directors.
Clalit Health Services, Tel Aviv 62098, Israel michaeli@netvision.net.il

1.	Zwart S, Sachs APE, Ruijs GJHM, Gubbels JW, Hoes AW, de Melker RA. Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults. BMJ 2000; 320: 150-154[Abstract/Free Full Text]. (15 January.)
2.	Christie AB. Streptococcal infections $---$ scarlet fever. In: Christie AB, ed. Infectious diseases: epidemiology and clinical practice. Edinburgh: Livingstone, 1969:983.

Antibiotics should not be used for self limiting illnesses

EDITOR $---$ I have two concerns about Zwart et al's article¹: firstly, the methodology, and, secondly and more importantly,that it was conceived at all, in view of the issue of antibioticuse.

The study . . . [Full text of this article]

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