Use of Throat Cultures-Reply

In Reply.—  Our finding that most physicians start antimicrobial therapy for sore throats before culture results are known and often continue antimicrobial therapy even when culture results are negative is indeed disturbing, as pointed out by Drs Kangos and Grossman. We did not, however, conclude that pharyngitis cases should not be evaluated or that culture-confirmed Streptococcus infection should not be treated. While we agree that primary care physicians should reevaluate their strategy in the management of pharyngitis, it should be recognized that repeated admonitions¹ to obtain culture results before starting antimicrobial therapy have been largely unheeded.Our main conclusion is that public health programming should be reconsidered. Given existing treatment practice and the present low rate of acute rheumatic fever, one must ask if scarce public health resources expended on free throat cultures are achieving benefits commensurate with the costs. One possible implication of our study is that free