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March 27, 1978

Antibiotic Usage

Author Affiliations

C. S. Wilson Memorial Hospital Johnson City, NY

JAMA. 1978;239(13):1280. doi:10.1001/jama.1978.03280400020003

To the Editor.—  The recent evaluation by Castle et al (237:2819-2822, 1977) of antibiotic usage at a university hospital is reminiscent of similar reports1,2 and deserves comment from a perspective not generally seen in print. Castle's group found that 64% of "total antibiotic therapy" was "not indicated" or else was "inappropriately administered." Happily, they avoided the use of popular but gratuitously insulting adjectives such as "irrational," but as an infectious disease specialist who has repeatedly labored to understand and evaluate antimicrobial therapy administered by other physicians, I must say that I find this critical assessment still excessively severe.In the first place, Castle et al do not provide the reader with the explicit criteria one hopes they employed in evaluating antibiotic usage in the 50 patients they reviewed retrospectively. One simply cannot trust one's own knowledge, wisdom, and fairness to suffice in making judgments such as "disagree with the