To the Editor: I believe the article by Dr. Alban on the treatment of group A streptococcal infections with sulfamethoxazole (Amer J Dis Child109: 304-307 [April] 1965) should be challenged on several grounds. Otherwise, I fear that physicians will accept the evidence presented as indicating that this drug is an adequate substitute for ten days of therapy with penicillin in streptococcal infections. In my opinion the data presented do not warrant such a conclusion.
The major point concerns the timing of the follow-up cultures. Dr. Alban states that these cultures were obtained "at the end of therapy." It is well known that sulfadiazine, for example, will frequently suppress streptococci in the pharynx so that they are not recovered on culture (Bull Hopkins Hosp77:143, 1945). When the drug is withdrawn, the organism reappears, but it may take several days. Penicillin administered in short courses similarily produces transient suppression.