Twice-Daily Oral Penicillin for Treatment of Streptococcal Pharyngitis: Less Is Best

Penicillin has been the drug of choice for treatment of streptococcal pharyngitis since it became available for general use in the late 1940s. Because of its efficacy, safety, narrow spectrum, and low cost, it remains standard therapy for this indication. In controlled clinical trials, penicillin is the only antibiotic that has been shown to prevent rheumatic fever when used to treat streptococcal pharyngitis.1 Penicillin is the drug to which other antibiotics approved for treatment of streptococcal pharyngitis have been compared. All strains of group A β-hemolytic streptococci remain exquisitely sensitive to penicillin and there has been no indication of emerging resistance. Over the past half century numerous studies have been reported that have helped to determine the optimal preparation, route of administration, dosage, dose interval, and duration of treatment. A major concern in using oral penicillin (the preferred treatment over the past 3 decades) has been that of compliance by the patient of taking the drug as prescribed. Most patients with streptococcal pharyngitis are well within 2 to 3 days after treatment is initiated. Without specific counseling that the drug must be taken in the proper dosage and duration to eradicate the infecting organism, avoid relapse, and prevent rheumatic fever, treatment is too often discontinued after symptoms abate.2 When this counseling is provided, treatment results may be …