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January 28, 1998

Antibiotic Prescribing and Respiratory Tract Infections

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(4):271-273. doi:10.1001/jama.279.4.271

To the Editor.—The Editorial by Dr Schwartz and colleagues1 on preventing the emergence of antibiotic resistance is good advice, as far as it goes. However, Schwartz et al neglect the aspect of cost to the individual patient. No one comes to my office with a documented rhinovirus infection. Patients come with cough, head congestion, or sore throat, with or without fever. Many of the working poor have no insurance and can barely afford the cost of an office visit, let alone extensive laboratory work or a follow-up visit. If there is any possibility that a primary or secondary bacterial condition exists as evidenced by, for example, purulent nasal discharge, red throat plus fever, or severe ear pain, the risks of untreated disease outweigh the individual risk of developing resistant bacteria.