REPLY
Principles of Judicious Antibiotic Use: Nonspecific Upper Respiratory Tract Infections
Ralph Gonzales, MD, and
Richard E. Besser, MD
7 May 2002 | Volume 136 Issue 9 | Page 709
IN RESPONSE:
Dr. Johnson believes that evidence relating to the cause of purulent secretions associated with acute respiratory tract infections and evidence of response to antibiotic therapy should have been more prominently displayed in our paper. We agree that purulent secretions are a poor predictor of microbial cause and response to antibiotic therapy and that better communication of this fact will aid in improving physician prescribing practices. Our Table was intended to display randomized, controlled trials of nonspecific upper respiratory tract infections and was not intended to reflect the evidence for Principle 3. The other studies Dr. Johnson mentions (1, 2) were not displayed in the Table because they enrolled patients with the diagnosis of "acute bronchitis." Nonetheless, we referred to these studies in our paper because they also address the question of purulence as an indication for antibiotic therapy. We believe the text accompanying Principle 3 reflects the best evidence from studies in adults. We would be interested in additional studies to help bolster this recommendation.
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Author and Article Information
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University of California
San Francisco, San Francisco, CA 94118
Centers for Disease Control and Prevention
Atlanta, GA 30333
1. Stott NC, West RR. Randomised controlled trial of antibiotics in patients with cough and purulent sputum Br Med J. 1976;2:556-9. [PMID: 0000786428].[Medline]
2. Verheij TJ, Hermans J, Mulder JD. Effects of doxycycline in patients with acute cough and purulent sputum: a double blind placebo controlled trial Br J Gen Pract. 1994;44:400-4. [PMID: 0008790652].[Medline]
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