Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: In response to Dr Hall, there have
indeed been significant advances in the types of viruses detected and the
turnaround time for test results. However, for "rapid" viral tests to have
a broad impact on the management of common ARIs in the general population,
the tests should be inexpensive, accurate, and available at the bedside. With
the exception of the rapid influenza test, all other "rapid" viral tests have
at least a 2- to 12-hour turnaround time for results, require a clinical laboratory
for processing, and are relatively expensive. Currently available influenza
tests appear to have modest sensitivity (about 70%) and high specificity (about
90%-95%),1 although the contribution of
reference and spectrum biases to these results has not been adequately addressed.
Given that most of these studies were performed in patients hospitalized with
influenza or in patients with high clinical suspicion of influenza, the sensitivity
of these rapid tests in an unselected ambulatory population with influenza-like
illness is likely to be lower than reported in the published literature. In
addition, there are no studies demonstrating that these tests are sufficiently
superior to clinical judgment to warrant their routine use.
Gonzales R. Patients With Viral Infections Who Demand Antibiotics—ReplyPatients With Viral Infections Who Demand Antibiotics—Reply. JAMA. 2003;290(14):1851. doi:10.1001/jama.290.14.1851-a