CLINDAMYCIN IN PERSISTING STREPTOCOCCAL PHARYNGOTONSILLITIS AFTER PENICILLIN TREATMENT

239 patients with streptococcal pharyngotonsillitis completed treatmen t with phenoxymethyl penicillin 12.5 mg per kg body weight b.i.d. for 10 days. At examination after completing therapy, throat specimens fro m 53 patients (22%) yielded growth of group A streptococci of the same T-type as the initial culture (bacterial treatment failure). 20 of th ese 53 (38%) had symptoms and signs of tonsillitis (clinical and bacte rial treatment failure). 48 of the patients with bacterial failure wer e randomly allocated to phenoxymethyl penicillin or clindamycin in an open design; 22 of them received a second course of phenoxymethyl peni cillin for 10 days and 26 were given clindamycin, 6.5 mg per kg body w eight b.i.d. (children) or 300 mg t.i.d. (adults) for 10 days. After c ompleting their treatment, 14 of 22 patients (64%) given phenoxymethyl penicillin harboured the same T-type as in the previous two cultures, while group A streptococci were not recovered from any of the 26 pati ents receiving clindamycin. In patients with clinical failure after ph enoxymethyl penicillin treatment, a new course with this drug is not m otivated. In that situation clindamycin seems to be an efficient choic e.