Oral Prophylaxis of Recurrent Rheumatic Fever. Sulfadiazine vs a Double Daily Dose of Penicillin.

Oral penicillin, 200,000 units twice daily, has been tested against oral sulfadiazine, 1.0 gm daily, for prophylaxis of streptoco[ill][ill]al infections and recurrences of rheumatic fever. A group of young patients who had had previous rheumatic episodes were randomly allocated to the two regimens under comparison, and were followed for three calendar years. The attack rates per patient-year in the sulfadiazine and double-dose penicillin groups were, respectively: for streptococcal infections, 22% and 20%; for rheumatic recurrences, 3% and 4%. The results indicate that oral penicillin does not achieve its bactericidal superiority over sulfadiazine when given in the relatively low dosage of 200,000 units, once or twice daily. For oral prophylaxis in patients who have had rheumatic fever, sulfadiazine seems equally effective or better than this type of penicillin regimen.