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To the Editor.—
The EDITORIAL on penicillin-resistant staphylococci (229: 1096, 1974) correctly states the problem but doesn't mention a therapeutic strategy more reasonable to the primary care practitioner. The author suggests culture and sensitivity study and initiation of penicillinase-resistant penicillin therapy, and then a switch to penicillin G if a sensitive Staphylococcus is found. The estimated cost of a staphylococcal infection (infected minor laceration, paronychia, boils, bullous impetigo), in the author's hands, is $38 for resistant staphylococci and $35 for sensitive staphylococci.In our hospital bacteriology lab, 97% of S aureus is found to be sensitive to erythromycin. In an illness such as we have described, it is reasonable to assume that the organism will be sensitive to erythromycin; therefore, culture would not be indicated unless the infection failed to respond. With this regimen, a comparable estimate of the cost of illness would be $20.50.Only the rare unresponsive infection
Kuhr MD. Logistics of Staphylococcal Drug Resistance. JAMA. 1974;230(8):1125. doi:10.1001/jama.1974.03240080015010