Antistreptococcal Prophylaxis

Alvan R. Feinstein, MD; Mario Spagnuolo, MD; Saran Jonas, MD; Muriel Levitt; Esther Tursky, RN
JAMA. 1967;199(2):137. doi:10.1001/jama.1967.03120020131042.
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To the Editor:—  Dr. Feldman has confused the treatment of disease with prevention. We were investigating the prophylaxis of recurrent rheumatic fever, not the treatment of streptococcal infections or the "exhibition of a therapeutic agent." The oral penicillin regimen (200,000 units once daily) that we tested is one of several programs recommended by the Committee on Prevention of Rheumatic Fever... of the American Heart Association (Circulation21:151, 1960). In previous clinical trials with other oral regimens (JAMA188:489, 1964), a double daily dose of penicillin had been found no more effective for preventing streptococcal infections than a single dose or than oral sulfadiazine. We thank Dr. Feldman for complimenting our research techniques, and we suggest he direct his quarrel to the committee that recommends these prophylactic agents.The reference to control of the "carrier state" in "streptococcal outbreaks" is irrelevant. We were studying the prevention of rheumatic fever


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