Intended for healthcare professionals

Rapid response to:

General Practice

Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults

BMJ 2000; 320 doi: (Published 15 January 2000) Cite this as: BMJ 2000;320:150

Rapid Response:

On the seventh day ye shall NOT rest

The outcome measures in this study related to symptomatic relief of
sore throat. However, the prevention of rheumatic fever is still the most
important aim of Penicillin treatment in Streptococcal throat infections,
and to that end a 10-day course of Penicillin remains the gold standard of
treatment. While rheumatic fever is certainly not a major problem in the
Western world, when it occurs it is often very subtle in its presentation,
causes very serious morbidity, and is still by no means rare.

I am concerned that reducing the duration of treatment to less than
10 days is flirting with fate, and may be courting disaster.
It may have been appropriate for the Creator to desist from His labours on
the seventh day, but I will certainly continue treating my patients for a
full ten days.

Ref: Pichichero ME. Group A beta-hemolytic streptococcal infections.
Pediatr Rev 1998 Sep; 19(9): 291-302

Competing interests: No competing interests

20 January 2000
Gary Zentner
Clalit Health Services, Beth Hakerem, Jerusalem, Israel