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To the Editor: Dr McIsaac and colleagues¹ reported that empirical treatment of adults with high risk of group A streptococcal (GAS) pharyngitis was associated with a higher rate of unnecessary prescriptions than with use of a diagnostic test. We feel that these results cannot be generalized to the population of adults with suspected GAS pharyngitis, as the study's calculated antibiotic prescription rates are derived from a subpopulation of adults with a higher prevalence of GAS pharyngitis. In order to make adequate comparisons between the study's results and the American College of Physicians–American Society of Internal Medicine/American Academy of Family Physicians/US Centers for Disease Control and Prevention (ACP-ASIM/AAFP/CDC) principles of appropriate antibiotic use for acute pharyngitis in adults, we believe that the authors should have also cited our explicit rationale contained in the 2001 CDC principles² for the 3 options for antibiotic treatment strategies in adults. Based on our assumption of . . . [Full Text of this Article]

Ralph Gonzales, MD, MSPH
ralphg@medicine.ucsf.edu
UCSF School of Medicine
San Francisco, Calif

Richelle J. Cooper, MD, MSHS; Jerome R. Hoffman, MA, MD
UCLA School of Medicine
Los Angeles, Calif

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