Bisno and colleagues highlight the rationale for our study,1 though we believe they draw attention away from the major problem in the treatment of adults with pharyngitis by focusing on patients meeting 4 Centor criteria. In our study, these patients made up only 2% of the sample and accounted for only 4% of antibiotic prescribing. Bisno and colleagues have written that “adults who meet none or only 1 of the 4 Centor criteria should not be tested or treated because of the very low probability of streptococcal infection, ”2(p127) a statement that agrees with the ACP guideline. Management of these patients is the major problem, having accounted for 57% of testing and 44% of antibiotic prescribing.
Linder JA, Bates DW. Treatment of Adults With Acute Pharyngitis in Primary Care Practice—Reply. Arch Intern Med. 2006;166(20):2292. doi:10.1001/archinte.166.20.2292-a