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The Pediatric Forum
January 2000

Variables Influencing Penicillin Treatment Outcome

Arch Pediatr Adolesc Med. 2000;154(1):91. doi:

In reply

Certainly the article by Dr Bergman1 published in 1963 remains a seminal work on poor adherence to penicillin dosaging in the treatment of group A β-hemolytic streptococcal pharyngitis. We agree that compliance may be better in private suburban pediatric practices than in hospital clinics. If all of the many papers from the Elmwood Pediatric Group clinical trials2 on group A β-hemolytic streptococcal pharyngitis comparing various antibiotics and antibiotic regimens were to be reviewed, the overall compliance with the full duration of prescribed therapy would be in the range of 90% to 95%. In our recent article,3 compliance ranged from 87% to 99% as measured on day 5 of treatment based on an assay of antibiotic presence in urine. Virtually identical percentages were confirmed with medication diaries and measurement of remaining medication at the end of the 10-day prescribed treatment courses, so we have evidence to support the notion that nearly all of the penicillin made it to the children's stomachs. Nevertheless, we agree that a full 10-day regimen of penicillin or any antibiotic is an adherence barrier.