Massell B F
JAMA. 1979 Apr 13;241(15):1589-94. doi: 10.1001/jama.241.15.1589.
Orally administered clindamycin and penicillin were compared for effectiveness in preventing streptococcal infections in 202 randomly assigned patients with previous rheumatic fever (RF). Among 143 patients aged 21 years or younger observed for 537 patient-years, the number of streptococcal infections (and number per patient-year) was 23 (0.084) in the penicillin group and 12 (0.045) in the clindamycin group. Excluding uncooperative patients, the rate of streptococcal infection remained less, though not statistically significant, in the clindamycin group than in the penicillin group. Two RF recurrences occurred in the penicillin group, and no recurrence occurred in the clindamycin group. Clindamycin was well tolerated except for possible mild gastrointestinal symptoms in six patients. Clindamycin can be substituted for penicillin for RF prophylaxis when there is allergy to penicillin or concern about the development of penicillin-resistant mouth organisms.
对202例随机分配的既往有风湿热（RF）病史的患者口服克林霉素和青霉素预防链球菌感染的有效性进行了比较。在143例21岁及以下的患者中观察了537患者年，青霉素组的链球菌感染数（及每患者年感染数）为23例（0.084），克林霉素组为12例（0.045）。排除不合作的患者后，克林霉素组的链球菌感染率仍低于青霉素组，尽管差异无统计学意义。青霉素组发生2例RF复发，克林霉素组未发生复发。除6例患者可能出现轻微胃肠道症状外，克林霉素耐受性良好。当对青霉素过敏或担心出现耐青霉素口腔微生物时，克林霉素可替代青霉素用于RF预防。
