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To the Editor: Dr Gonzales¹ discussed the reasons that physicians prescribe antibiotics for ARIs with cough, despite the fact that nearly all are viral in origin. Nonetheless, he did not strongly advise physicians not to yield to emotional patient pressure and expectations. Although decision making should be a joint venture between patient and physician, that does not abrogate physicians' responsibility to do no harm and to use the best available information.

Aside from causing an increase in resistant pathogens in the environment, which is a public health issue, there is the potential for harm whenever any medication is administered. In the case of antibiotics these include gastrointestinal upset, rashes, allergic reactions, and overgrowth of other microbes.

An alternative approach is to provide symptomatic treatment as Gonzales describes (eg, bronchodilators, analgesic-antipyretics, nasal decongestants, and a cough suppressant-expectorant) plus a prescription for an antibiotic to be filled if the patient's symptoms do . . . [Full Text of this Article]

Robert Matz, MD
Department of Medicine
Mount Sinai School of Medicine
New York, NY

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