All of the cases in our retrospective study were chosen because they had clinical sore throat and cultures of the posterior pharynx that were positive for group A β-hemolytic Streptococcus; ASO titers were not obtained. Although we agree with Bisno1 that the throat culture is the most effective test for differentiating streptococcal from nonstreptococcal sore throat, it is possible that some of our patients had viral sore throat with streptococcal colonization.The purpose of our study was to ascertain if the time of administration of penicillin could be shown to have an effect on the duration of the clinical illness seen in our hospital. It could not.Dr Weissbluth is correct: ours was a retrospective study. However, if no effect is shown, it seems unnecessary to use placebo controls. We are in full agreement with Komaroff's2 strategy for immediate treatment.
Gauld JR, Morrison RE. Streptococcal Pharyngitis-Reply. JAMA. 1979;242(16):1735. doi:10.1001/jama.1979.03300160019010