Penicillin for Streptococcal Pharyngitis

To the Editor.—  The article, "Penicillin Treatment of Streptococcal Pharyngitis" (222:657, 1972) is misleading in several contexts.The most serious error is the use of a mixed type of penicillin for intramuscular treatment of streptococcal pharyngitis. Mixtures of procaine and benzathine penicillin have been roundly condemned by every leading authority in the field and should never be used for streptococcal pharyngitis because (1) there is usually an inadequate quantity of benzathine penicillin, and (2) the procaine penicillin is needless. Studies by Stollerman and others have demonstrated beyond question that benzathine penicillin alone reaches a streptococcallethal level as rapidly as does any type of injected penicillin. Many pediatricians and other clinicians persist in the use of these mixed preparations, to the detriment of their patients. Two milliliters of the various mixtures of procaine penicillin and benzathine penicillin contain 600,000 units of benzathine penicillin—a quantity simply not adequate for many patients—particularly older,