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Diagnosis and Treatment of Streptococcal Pharyngitis-Reply

Marvin S. Krober, MD; James W. Bass, MD; George N. Michels, MS
JAMA. 1985;254(7):909. doi:10.1001/jama.1985.03360070045013.
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In Reply.—  We are well aware of the limitations on the use of bacitracin disks on primary plates for identification of group A streptococci1 and used subcultures when necessary for accurate identification. As rapid diagnostic techniques of adequate sensitivity and specificity become available,2 these will indeed represent a significant advance in the diagnosis of streptococcal pharyngitis.Fuchs has obtusely suggested that the analysis of our data be restricted only to those patients with a fourfold rise in antibody titer. There is, in fact, a statistically significant difference in the symptomatic response of penicillin-treated vs placebo-treated patients when the analysis is limited to this group. However, we disagree with the exclusion of those patients with positive cultures and absence of fourfold rise in antibody titer. We believe, along with Wannamaker,3 that penicillin treatment may suppress the serologic response to group A streptococcal infection.We agree with Odio and,

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