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Apart from several family outbreaks (Watson, 1961), I have encountered two widespread epidemics, each involving about 100 patients in a rural general practice in Surrey, one lasting about 9 months in 1963/64 and the second about 7 months in 1974/75 (Watson, 1967). Twenty-five unselected families in 1963/64 and 31 comparable families in 1974/75 were studied in greater detail than the rest. This paper presents a comparison between the results of treatment in these two groups. Tetracycline or Oxytetracycline 250 mg. four times a day (q.d.s.) was the usual adult treatment in the first epidemic, with proportionately less of the Oxytetracycline 125 mg. syrup for children under 10 years. In the second epidemic adults were given erythromycin stearate 250 mg. q.d.s., while children received the ethyl succinate suspension q.d.s. in age-related doses. Treatment in both epidemics was usually continued as long as signs in the chest or coughing persisted. The conclusion was that an erythromycin rather than a tetracycline is the drug of choice for a patient with an acute febrile chest infection by M. pneumoniae because (a) fever and coughing were reduced more quickly, (b) relapses were less frequent, (c) lethargy and slow convalescence were prevented or cleared in a few days, and (d) infectiousness was apparently reduced by erythromycin treatment.

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