Cost-effectiveness and the Management of Pharyngitis

To the Editor.— Recent increases in the number and complexity of articles on how to treat sore throat1,2lead to a state of confusion that cries out for simplification. In 1965, physicians in Boulder, Colo, began a throat culture program in the schools that lasted three years. We were inspired by Becker and colleagues3in Casper, Wyo. Streptococcal infections diminished rapidly in Boulder without the sort of citywide effort that these workers described. We have had very few cases of rheumatic fever since 1975, but in 1980 a 40-year-old man died of streptococcal septicemia after a two-day illness, but without having had a sore throat. In 1982, a 49-year-old man with rheumatoid arthritis developed a productive cough and was treated with erythromycin. When he developed a severe sore throat and purpura, antibiotic therapy was stopped and steroid therapy was expanded, because the Stevens-Johnson syndrome was suspected. He died