Dr Ravenel and I both agree that the available evidence suggests that penicillin treatment produces only a modest acceleration in the resolution of symptoms. For reasons I will describe, I wonder if the available evidence is applicable to current practice. If it is not, we may never have the relevant evidence, since a controlled trial of penicillin therapy at this point in history would raise ethical questions.
The study by Denny et al1 and another report from the Warren Air Force Base by Brink et al2 are pertinent. Both report controlled trials of penicillin therapy in young adult men with exudative pharyngitis, most of whom had streptococcal infection. In both studies history and physical examination data were collected meticulously. At the same time, certain limitations of these studies should be noted. Both are almost 30 years old and were performed at a time when the severity