Is seven days of treatment as effective as 10 days?

EDITOR—Zwart et al recommend seven days of treatment for streptococcal infections as opposed to three days.1 For several decades we were educated to continue penicillin for such cases for no fewer than 10 days.2 The rationale was that streptococci must be eradicated to prevent rheumatic fever and that this was achievable only after 10 days of treatment. This was based on bacteriological, epidemiological, and clinical observations. The cost of oral penicillin is almost negligible, and I think we need more assurance to be persuaded to cut treatment to only seven days. Is there any study that will prove that treatment for seven days is as effective as treatment for 10 days for preventing rheumatic fever?

Antibiotics should not be used for self limiting illnesses

EDITOR—I have two concerns about Zwart et al's article 1: firstly, the methodology, and, secondly and more importantly, that it was conceived at all, in view of the issue of antibiotic use.

The study had an unusually high number of exclusions (36.7%), and 26.6% of the patients were not randomised. The secret code of treatment was broken at the request of the doctor or the patient. There was a faster resolution in the patients in the seven day treatment arm at two days than in the three day treatment arm at two days, despite identical treatment, and I am not convinced by the authors' explanation. A possibility concerning all the above points is that the randomisation was not successful, and therefore the results of the trial may not be secure.

However, these doubts are minor compared with the real issue, which is how we use the precious resource of antibiotics. Resistance to commonly used antibiotics is rising fast.2 The increasing use of antibiotics encourages resistant organisms in patients and in the community.3 In most cases antibiotics do not prevent complications. …