Comparison of Dirithromycin and Penicillin for Treatment

In the treatment of group A b-hemolytic streptococcal pharyngitis, penicillin is the drug of choice and erythromycin is the alternative. In a double-blind, randomized study, dirithromycin, a new macrolide, was compared with penicillin for the treatment of streptococcal pharyngitis. Of 121 patients who were treated with dirithromycin, 96.7 % manifested a favorable clinical response, and of 136 patients treated with penicillin, 94.2 % manifested a favorable clinical response. Streptococci were eradicated from the pharynges of 85.3 % of 116 dirithromycin-treated patients and 82.5 % of 126 penicillin-treated patients who returned for follow-up. There were no statistically significant differences in efficacy between the two groups. The incidence of abdom-inal symptoms was higher in dirithromycin-treated patients. Being as efficacious as penicillin and having the advantages over erythromycin of once-daily dosing and the lack of drug interactions, dirithromycin is an alternative to penicillin in the treatment of streptococcal pharyngitis for patients 12 years of age and older. Penicillin is the drug of choice for the treatment of group A streptococcal pharyngitis (5). For those unable to take penicil-lin, erythromycin is the recommended alternative (5). Al-though erythromycin is safe and effective, it has disadvantages. It is given two to four times daily, a regimen that preclude