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January 9, 1987

The Treatment of Streptococcal Pharyngitis

Author Affiliations

Albany (NY) Medical College

Albany (NY) Medical College

JAMA. 1987;257(2):186-187. doi:10.1001/jama.1987.03390020052014

To the Editor.—  I would like to suggest that critical review of the studies1-5 referenced by Col Bass in his article6 should lead the prudent clinician to continue to follow the American Heart Association and American Academy of Pediatrics guideline of intramuscular penicillin G benzathine or oral penicillin V given three or four times daily.In studying the optimal treatment for streptococcal pharyngitis, a randomized clinical trial in a private practice setting with a low false-positive (a) and low false-negative (β) error (high power) is ideal. Unfortunately, none of the studies referenced met these criteria. In assessing the failure rate of different treatments in streptococcal pharyngitis, it is imperative that the high and variable carrier rate for streptococci (15% to 50%) be evaluated by serological testing. The only study that evaluated the carrier rate was that by Gerber et al.5 These investigators compared traditional oral penicillin V