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To the Editor.—
The article by Shapiro and co-workers represents an important area of investigation, seemed to be well done, and was presented clearly. However, it is representative of an important deficiency in antimicrobial research in this country, the fact that almost all of this type of research is supported by the pharmaceutical industry. Because of this, although the purpose of the research was and is of tremendous importance, it had the essential failing of not testing the correct antibiotic or antibiotics. There is no good evidence that a cephalosporin, such as the one tested in the study by Shapiro and co-workers, cefazolin, would be any more effective as prophylaxis than would be a generic and far less expensive antibiotic such as ampicillin. The authors allude to that fact in the penultimate paragraph of the article. Although they do not state why they did not test ampicillin, the reason is
Waldman RH. Cost of Antibiotics. JAMA. 1983;250(13):1694. doi:10.1001/jama.1983.03340130023013
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