To the Editor.—
Cebul and Poses,1 in their article on cost-effective pharyngitis management, state that Tompkins et al2 proposed decision rules "with the performance of throat cultures reserved for patients whose probabilities of streptococcal disease Were between 5% and 20%" [italics added]. In contrast, the recommendations of Tompkins et al deal with treatment based on the rate of positive cultures for streptococcal pharyngitis in the community. To quote Tompkins et al, "The recommended management of patients in the general population might also be revised. One can select the most cost-effective penicillin strategy for a patient population whose approximate throat culture rate is known... if the rate is less than 5%, no intervention is appropriate" [italics added]. Therefore, application of the rules of Tompkins et al to Cebul and Poses' population (with a positivity rate of <5%) would dictate that the most cost-effective strategy is no cultures or antibiotics.
Fox GN. Cost-effectiveness and the Management of Pharyngitis. JAMA. 1987;257(16):2167-2168. doi:10.1001/jama.1987.03390160053022