DEMONSTRATION of the unique role of group A streptococcal respiratory infection in the precipitation of rheumatic fever led to the development of methods of preventing rheumatic fever by penicillin treatment of streptococcal infection. Instances in which penicillin treatment fails to prevent subsequent rheumatic fever usually can be related to the reappearance of the infecting strain in the throat or nose.1-3 Therefore, if any method of therapy of streptococcal infection is to be effective in the prevention of rheumatic fever, it should eradicate the group A Streptococcus from the tissues.
Early studies with sulfonamides indicated that treatment of group A streptococcal infections with these drugs did not prevent rheumatic fever.4,5 Subsequently, these results seemed to be explained by the fact that sulfanilamide, sulfadiazine, and other sulfonamides, in contrast to penicillin, are bacteriostatic rather than bactericidal for group A streptococci. Thus, although streptococci in tissues of the upper respiratory tract