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Letters |

Antibiotic Prescribing and Respiratory Tract Infections—Reply

Ralph Gonzales, MD, MSPH; John F. Steiner, MD, MPH; Merle A. Sande, MD
JAMA. 1998;279(4):271-273. doi:10.1001/jama.279.4.271.
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In Reply.—Dr Jacques states that recent reports of vancomycin-resistant S aureus, as well as other antibiotic-resistant hospital-acquired infections, are driving the "call for physicians, especially those in outpatient practice, to modify their prescribing patterns." As stated in our article, in the outpatient setting, the emergence of penicillin-resistant Streptococcus pneumoniae , rather than hospital-acquired pathogens, is the major motivation for renewing the efforts of ambulatory physicians to reduce unnecessary antibiotic use. Focusing on ambulatory prescribing practices is important, because the development of resistance, carriage, spread, and infection with S pneumoniae occurs primarily in the outpatient setting.1 Reports from Iceland and Finland support the notion that reducing antibiotic use in ambulatory practice can translate into decreased prevalence of antibiotic resistance observed in community bacteria.2,3 There is no need to absolve physicians practicing in either setting. Significant improvements in antibiotic prescribing practices in both inpatient and outpatient settings are necessary to avert a major public health crisis.


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