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October 8, 2003

Patients With Viral Infections Who Demand Antibiotics—ReplyPatients With Viral Infections Who Demand Antibiotics—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(14):1851. doi:10.1001/jama.290.14.1851-a

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.

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