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To the Editor: Drs Linder and Stafford¹ found that a large number of adults are treated with antibiotics for acute pharyngitis, although the overall rate is declining. However, they also found that the number of prescriptions for inappropriate prescriptions appears to be increasing. We disagree with the authors that extended macrolides such as clarithromycin or azithromycin are necessarily inappropriate.

Penicillin should remain the first choice for streptococcal pharyngitis. However, when the patient is allergic to penicillin, the choice between erythromycin and other macrolides should be made by primary care physicians according to individual patient characteristics. Although many physicians are aware of the guidelines recommending erythromycin for group A streptococcal pharyngitis, they may choose extended macrolides because of less frequent dosing, fewer adverse effects, and less interaction with other medicines. Including extended macrolides with penicillin or erythromycin as recommended antibiotics in this analysis would increase overall use from 23% to only . . . [Full Text of this Article]

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Antibiotic Treatment of Adults With Sore Throat by Community Primary Care Physicians: A National Survey, 1989-1999
Jeffrey A. Linder and Randall S. Stafford
JAMA. 2001;286(10):1181-1186.
ABSTRACT | FULL TEXT