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In Comment

Milton M. Howell, MD
JAMA. 1974;227(9):1032. doi:10.1001/jama.1974.03230220022005.
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THIS IS a timely discussion of a remediable problem in present-day practice. It appears to be more an editorial than a scientific paper. As such, I am willing to concede the authors some editorial prerogative and poetic license, since I can agree from experience with most of their conclusions.

I do believe that they have indulged in "overkill," and that their reasoning and quotations stretch extrapolative gymnastics to their ultimate. Their quotation from McCabe in the New England Journal of Medicine article, which takes a reported incidence of Gram-negative bacteremia of 1/100 in several major centers and projects 100,000 fatalities a year nationwide, approaches a journalistic quality usually reserved for medical articles in lay magazines.

In another instance they suggest, without producing substantiating evidence, that the rate of adverse antibiotic reactions may be the same in ambulatory patients as that already documented in hospitalized populations. As a physician who has


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