Dr Fox correctly points out that the original decision algorithm of Tompkins et al,1 strictly interpreted, applied to populations with differing rates of throat culture positivity and not to individuals stratified by preculture probability of a positive test. Other work by Tompkins' group,2 however, applied this algorithm to individual patient care decisions. Also, in their 1977 article,1 Tompkins et al cited successful efforts to assign individual patients to high and low culture-rate groups and suggested that "use of selected clinical findings may be an appropriate method for clinicians to choose cost-effective treatment for their patients." Thus, even in low-prevalence populations such as ours, there will be patients whose probability of streptococcal disease is sufficiently high to warrant a throat culture, or treatment without prior culture.Regarding Dr Fox' suggestion that testing for antistreptococcal antibodies would have enabled us to detect carriers at low cost, it
Cebul RD, Poses RM. Cost-effectiveness and the Management of Pharyngitis-Reply. JAMA. 1987;257(16):2169. doi:10.1001/jama.1987.03390160053024
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