Academic Mischief

The article by Soyka et al.1 on the misuse of antibiotics strongly states that the only occasions for the use of antibiotics in upper respiratory tract infections are the following: (1) acute bacterial otitis media, (2) acute pharyngitis due to β-hemolytic streptococci, proven by culture, and (3) prophylaxis for rheumatic fever, cystic fibrosis, and, perhaps, after splenectomy. This argument conveniently ignores the observations of clinicians and the correlation of some substantial medical literature. The group at Boston City Hospital2 reported the admission of 30 patients with cough, fever, and nasal congestion, who, on routine blood cultures, had pneumococcal bacteremia.