Treatment of Group A Streptococcal Pharyngitis: Reflections on Glue and Other Things

In this issue of The Journal, Schwartz and colleagues (p 1790) describe the results of a randomized comparative trial of seven vs ten days of orally administered penicillin therapy for group A streptococcal pharyngotonsillitis. Although recommendations for ten days of orally administered penicillin (erythromycin in penicillin-sensitive patients) have been followed for several years,1 there has been relatively little information in the literature on the merits or disadvantages of seven vs ten days of orally administered penicillin treatment in children with acute infection. The design of the present study is comprehensive for confirming the bacteriologic diagnosis in clinically ill patients, in monitoring for patient antibiotic compliance, and in surveying with throat cultures for bacterial eradication of the group A streptococci at intervals after treatment. Failure to eradicate streptococci (defined as persistence or recurrence of the same group A streptococcal serotype between one and 21 days after the end of therapy).