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July 1959

The Prophylaxis of Streptococcal Infections in Patients with Rheumatic Fever: A Comparison Between Sulfadiazine and Erythromycin

AMA Am J Dis Child. 1959;98(1):66-71. doi:10.1001/archpedi.1959.02070020068008

The relationship between group A streptococcal infections and the subsequent occurrence of rheumatic fever has been well established. It has also been shown that initial and recurrent attacks of rheumatic fever can be prevented if streptococcal infections are prevented or effectively treated.1 Several antibacterial agents have been employed for the prophylaxis of streptococcal infections in patients with rheumatic fever or rheumatic heart disease.2 Sulfadiazine and penicillin are the two agents most widely used. Sulfadiazine prophylaxis has greatly reduced the incidence of streptococcal infections and recurrence of rheumatic fever, but protection is not complete and 5% to 10% of patients develop reactions to the drug.2 Penicillin prophylaxis has proved to be more effective than sulfadiazine prophylaxis, but reactions also develop in 2% to 5% of persons receiving penicillin.3 Because of the shortcomings of sulfadiazine and penicillin, it seemed desirable to investigate other antimicrobial drugs as prophylactic agents