Oral Penicillin Prophylaxis of Streptococcal Infections

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Abstract
Studies employing oral penicillin for the control of epidemic streptococcal infections in Navy recruits between 1951 and 1954 are summarized. Daily doses as small as 50,000 U were effective in suppressing development of epidemics although not completely preventing all infections when conditions of high risk prevailed. 100,000 or 125,000 U daily were not significantly better, being inadequate to effectively terminate epidemics once started, or to eradicate group A streptococci from the pharynx of carriers. A daily dosage of 500,000 U of oral penicillin dramatically ended epidemics of streptococcal infection and, when continued for 10 days or more, eradicated streptococci from nearly all carriers. Suppression of epidemics with small doses reduced the incidence of rheumatic fever. Termination of epidemics with the 500,000 U dose also terminated cases of rheumatic fever. Despite marked reduction of carriers by use of the dose for 10 days or more, epidemics gradually recurred in large recruit populations. There was promise of more prolonged effect in small isolated groups. Hypersensitivity reactions were infrequent, occurring in 0.34% of 39, 615 men given oral penicillin. No evidence was found of increasing resistance of streptococci to penicillin or of sensitization of men to the antibiotic.