A Penicillin Shot Without Culturing the Child's Throat

ENTHUSIASM for throat cultures varies widely among physicians in practice. Some rely solely and precariously on their clinical acumen. Although clinical findings are important in diagnosing streptococcal sore throat, they are not sufficiently distinctive to provide the basis for a foolproof diagnosis.1,2The batting average among experienced physicians in predicting which sore throats will be culture-positive for β-hemolytic streptococci is poor (only slightly better than 50% without cultures, about 75% if they have the advantage of culture results from other patients). Red throats are nonspecific. Exudate occurs frequently in streptococcal pharyngitis, but it may not appear until the second day and may also be found in viral infections. In infants, exudative pharyngitis is rarely streptococcal in cause. Anterior cervical nodes that are tender to palpation are one of the most reliable clinical indicators of streptococcal infection,3but they are not present in all patients. The rash we associate