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PEDIATRICS Vol. 109 No. 6 June 2002, pp. 1189
Penicillin Failures?!
To the Editor.—Kaplan and Johnson, in their article in the November 2001 issue of Pediatrics, claim that oral penicillin V and intramuscular benzathine penicillin G (BPG) have an unacceptably high rate of "microbiologic treatment failures." My problem with their article is that I feel the endpoint, that of "microbiologic treatment failures," is poorly chosen. The correct endpoint should be "clinical treatment failures," and the primary measuring standard should be whether or not the patient gets acute rheumatic fever.
Penicillin’s primary purpose, in the treatment of streptococcal pharyngitis, is to prevent rheumatic fever. Penicillin may also help to shorten the duration of streptococcal pharyngitis by as much as 1 day, but this advantage is of much less importance than the prevention of rheumatic fever. The eradication of group A streptococci from the pharynx is an issue of no importance, which is one reason repeat throat cultures are not recommended after the treatment of a strep throat. It simply doesn’t matter whether penicillin treatment leads to a "microbiologic treatment failure" or not. What matters is whether the patient gets well, or in this particular case in point, whether a serious illness is prevented.
In an age of increasing antimicrobial resistance by most microorganisms, the publication of this article has the potential to undermine the goal of using the most narrow spectrum antibiotic for the shortest duration possible. If inexperienced physicians, influenced by an article like this, begin using unnecessarily broad-spectrum antibiotics for a condition quite adequately treated by a very narrow spectrum antibiotic—not to mention a cheap and safe one—then our patients will have been done a disservice. We should not abandon penicillin until it is proven that its effectiveness in the prevention of rheumatic fever has been compromised.
Bryan L. Burke, Jr, MD, FAAP
Department of General Pediatrics
DeVos Children’s Hospital
Grand Rapids, MI 49506
REFERENCE
1. Kaplan EL, Johnson DR. Unexplained microbiological efficacy of intramuscular benzathine penicillin G and of oral penicillin V in eradication of group A streptococci from children with acute pharyngitis. Pediatrics.2001; 108 :1180 –1186[Abstract/Full Text]
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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