It was gratifying to read that the authors of this commentary1 on group A streptococcus mention the significant rate of colonization versus infection. Surprisingly, this was not mentioned in the related research article.2 This continuing uncertainty, so appropriate in science, highlights the need for the art of medicine — the art in which clinicians dance with the complexity of uncertainty, balance their sense of whether the child is quite ill (“toxic”) or otherwise medically fragile, converse with parents to assess their resourcefulness and preferences, and balance all of this with the public health issues. I would appreciate a review of the implications of the treatment of carrier states, with respect to group A streptococcus in particular.
Another CMAJ paper,3 examining the potential harms of the use of amoxicillin and amoxicillin–clavulanic acid, also surprised me by treating the two drugs as if they were similar. I understand that the latter is one of the broadest spectrum agents, and one I reserve for very specific situations. I am of the old school, and I still do not even use amoxicillin for group A streptococcus, preferring penicillin V (which is often not even available in the suspension form).