To the Editor: Markowitz's article in the January, 1963, issue of American Journal of Diseases of Children serves to confirm previous findings of the predominance of group A hemolytic streptococci in bacterial pharyngotonsillitis and of the significance of pneumococcus and Hemophilus influenzae in otitis media. In four years of using sheep blood agar for throat cultures and confining the use of penicillin to patients with cultures positive for β-hemolytic streptococcus I can recall only one case of complications following failure to use penicillin with a "normal" throat culture.
I would suggest a simplification of Markowitz's recommendations. First, to confine the use of throat cultures to pharyngotonsillitis and make penicillin the drug of first resort when β-hemolytic streptococcus (and pneumococcus?) are predominant. Secondly, to forsake nasopharyngeal culture in otitis media since an overwhelming percentage with "normal flora" eventually required treatment. This would restrict the bacteriology to one medium and one or