Clindamycin palmitate and potassium phenoxymethyl penicillin were evaluated in 103 children with upper respiratory illnesses and pharyngeal group A streptococci, from November 1970 to July 1971. The children were assigned randomly by weight to one of the antibiotic regimens given orally for 10 days. Clindamycin palmitate and potassium phenoxymethyl penicillin dosages were 75 and 125 mg, respectively, in 5 ml tid for children weighing less than 25 kg, and 150 and 250 mg, respectively, in 10 ml bid for children weighing 25 kg or more. Recurrences of the original streptococcal group A, M, and T types within 3 weeks after the end of treatment were classified as failures. The failure rates were: clindamycin palmitate, 10% (5 of 52), and potassium phenoxymethyl penicillin, 18% (9 of 51). Possible drug-related rashes were observed in 8 of 52 clindamycin palmitate-treated patients. The geometric mean minimal inhibitory concentrations of clindamycin and penicillin against 103 isolates of group A streptococci were 0.033 and 0.007 ,g/ml, respectively. The serum concentrations about 70 min after ingesting 150 mg of clindamycin palmitate averaged 3.8 ,ug/ml and after 250 mg of potassium phenoxymethyl penicillin averaged 0.9 gg/ml. Clindamycin palmitate was as effective as potassium phenoxymethyl penicillin in eradicating group A streptococci from the pharynx in tid and bid regimens. Nevertheless, because of its rash-producing tendency in some patients and higher cost, clindamycin palmitate should not be preferred to penicillin for treatment of streptococcal sore throat in the non-penicillin-allergic patient.This investigation was initiated as a pilot study in evaluating the efficacy and side effects of two regimens of clindamycin palmitate and two of potassium phenoxymethyl penicillin (K penicillin V) against group A streptococci in upper respiratory illnesses.Clindamycin palmitate, a new semisynthetic derivative of lincomycin in the form of flavored granules, is a water-soluble ester of clindamycin [7 (S)-chloro-7-deoxylincomycin] and palmitic acid. The palmitate ester is rapidly hydrolyzed to the microbiologically active clindamycin base after ingestion of the granules in a pediatric suspension. The suspension of clindamycin palmitate was introduced in place of clindamycin hydrochloride, which is available in capsule form because of the objectionable taste of the hydrochloride. In vitro antimicrobial activity of clindamycin against group A

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