50 Years Ago in The Journal of Pediatrics:

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Alvarez-Pagan M, Rees DC, Conway GF. J Pediatr 1957;50:39-43

In the 1940s, researchers had developed phenoxymethyl penicillin (penicillin V), an acid-stable form of penicillin that could resist inactivation by stomach acids. In view of the obvious advantages of oral administration of penicillin in children, the authors studied the use of penicillin V in a series of 84 patients between the ages of 5 months and 12 years. Subjects were included if they were diagnosed with an infection and were ill enough that they would usually be treated with a course of parenteral procaine penicillin G. None of the bacterial isolates were analyzed for antibiotic sensitivities. The patients were diagnosed with acute tonsillitis or pharyngitis (n = 53), otitis media (n = 20), or laryngotracheobronchitis or bronchopneumonia (n = 11). Depending on clinical features such as fever pattern, patient response was classified into 4 categories: excellent, good, satisfactory, and unsatisfactory. Sixty-five patients showed excellent or good response, 12 satisfactory, and 7 unsatisfactory (therapeutic failure). The authors included descriptions of 2 case reports thought to be typical of the study population: a 19-month-old boy with pneumonia and a 6-year-old boy with acute pharyngitis. Both appeared to respond to the course of penicillin V. The results were stated to be favorable when compared with results expected from treatment with courses of twice-daily intramuscular penicillin G. The authors concluded that the oral suspension of penicillin V was proven to be effective in the treatment of respiratory tract infections, as well as being well tolerated by children.

Much has changed in the past 50 years. Current studies with similar objectives would usually require more subjects (including suitable control subjects) and appropriate statistical analyses to convince pediatricians of the virtues of the antibiotic in question. More importantly, although penicillin resistance was reported shortly after it became widely available for clinical use in the 1940s, it has become increasingly apparent only over the past 2 decades that antibiotic resistance poses a major threat to our ability to combat bacterial infections. In contrast to what would currently be expected, none of the subjects from whom Staphylococcus aureus was isolated showed unsatisfactory response. The convenience of treating most types of infections with the same antibiotic has long gone. Judicious use of antibiotics, sensitivity testing of suspected pathogens, rationalization of therapeutic regimes, and stringent infection control measures are now important ways to help prevent infection of individuals, as well as reduce the spread of resistant organisms.