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travariceal delivery of sclerosant to the lung. Although higher volumes of sclerosant with use of intravariceal delivery may not be as well tolerated, this issue was not addressed in our retrospective study. Frederick A. Zeller, M.D.

Prophylactic Recommendations for Bite Wounds 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 review' 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 grampositive 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. Conrad J. Wilkowske, M.D. Robert E. Van Scoy, M.D. REFERENCE

1. Goldstein EJC: Bite wounds and infection. Clin Infect Dis 14:633-638, 1992

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Prophylactic recommendations for bite wounds.

502 Mayo CUn Proc, May 1992, Vol 67 LETfERS travariceal delivery of sclerosant to the lung. Although higher volumes of sclerosant with use of intra...
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