Cost-effectiveness and the Management of Pharyngitis-Reply

In Reply.—  Dr Fox correctly points out that the original decision algorithm of Tompkins et al,¹ strictly interpreted, applied to populations with differing rates of throat culture positivity and not to individuals stratified by preculture probability of a positive test. Other work by Tompkins' group,² however, applied this algorithm to individual patient care decisions. Also, in their 1977 article,¹ Tompkins et al cited successful efforts to assign individual patients to high and low culture-rate groups and suggested that "use of selected clinical findings may be an appropriate method for clinicians to choose cost-effective treatment for their patients." Thus, even in low-prevalence populations such as ours, there will be patients whose probability of streptococcal disease is sufficiently high to warrant a throat culture, or treatment without prior culture.Regarding Dr Fox' suggestion that testing for antistreptococcal antibodies would have enabled us to detect carriers at low cost, it