To the Editor.—The Editorial by Dr Schwartz
and colleagues1 on preventing the emergence
of antibiotic resistance is good advice, as far as it goes. However, Schwartz
et al neglect the aspect of cost to the individual patient. No one comes to
my office with a documented rhinovirus infection. Patients come with cough,
head congestion, or sore throat, with or without fever. Many of the working
poor have no insurance and can barely afford the cost of an office visit,
let alone extensive laboratory work or a follow-up visit. If there is any
possibility that a primary or secondary bacterial condition exists as evidenced
by, for example, purulent nasal discharge, red throat plus fever, or severe
ear pain, the risks of untreated disease outweigh the individual risk of developing
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