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October 28, 1998

Antibiotics for Children With Upper Respiratory Tract Infections—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(16):1399-1402. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-16-jbk1028

In Reply.—Dr Chen argues that we arbitrarily identified the lay term cold with acute nasopharyngitis. However, our use of the term acute nasopharyngitis as synonymous with the common cold was based on the research taxonomy commonly used for acute respiratory tract illnesses.1 The common cold is identified with acute nasopharyngitis because the predominant feature is inflammation of the nasopharynx, and proven rhinovirus infections frequently (30%-50% of the time) produce pharyngitis symptoms.2 In addition, we do not claim that URIs and bronchitis are "always viral," since Mycoplasma pneumoniae and Chlamydia pneumoniae are uncommon (<10% of the time) bacterial causes of URI and bronchitis syndromes. Nonetheless, until randomized, placebo-controlled trials demonstrate unequivocal efficacy of antimicrobial treatment for colds, URIs, and bronchitis, we believe it is irresponsible to continue to prescribe antibiotics for these conditions in otherwise-healthy patients given the current epidemic in antibiotic-resistant Streptococcus pneumoniae in our communities. Chen also incorrectly states that we failed to take into account preexisting conditions, such as asthma or chronic obstructive lung disease, when in fact our exclusion of these comorbidities was mentioned in our "Methods" section. There were no cases of mitral valve disease or immune deficiency reported in our study sample.

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