It has been brought to our attention that the prophylactic recommendations for bite wounds listed in Table 1 in our article “Prophylactic Use of Antimicrobial Agents in Adult Patients,” which was published in the March 1992 issue of the Mayo Clinic Proceedings (pages 288 to 292), could be improved. Amoxicillin-clavulanic acid (Augmentin) provides coverage for all the organisms found in bite wounds that penicillin covers and is also effective against Staphylococcus aureus and anaerobic bacteria, especially those anaerobes found in human bites, which are likely to be producers of penicillinase. A recent review1Goldstein EJC Bite wounds and infection.Clin Infect Dis. 1992; 14: 633-638Crossref PubMed Scopus (333) Google Scholar of bite wounds and infections lists the antimicrobial susceptibilities of bacteria frequently isolated from animal bite wounds and discusses antimicrobial treatment. For patients who are allergic to penicillin, erythromycin may be ineffective against many strains of Pasteurella multocida. Tetracyclines are active against P. multocida but not as active against aerobic gram-positive cocci, and they cannot be administered to children or pregnant women. Trimethoprim-sulfamethoxazole is inactive against anaerobic bacteria and contraindicated in the early and late stages of pregnancy. Clindamycin is inactive against P. multocida. Therefore, combinations of these drugs may need to be used in those patients unable to take amoxicillin-clavulanic acid.

The expectorated sputum and transtracheal aspiration bacterial culture data presented by Murray and Washington were reanalyzed after removing several species unlikely to cause pneumonia in adults. After these exclusions, mean numbers of species isolated per specimen were not excessive. Those specimens with more than 25 leukocytes per field (groups 3, 4, and 5) has similar numbers of isolates per specimen (1.04, 1.05, and 1.05) compared with those with fewer than 25 leukocytes per field (groups 1, 0.57, and 2, 0.59). For this reason and others, it is recommended that expectorated sputum samples be accepted for bacterial culture if they contain more than 25 leukocytes per field.