Introduction

The bacteriology of infected bite wounds is diverse and includes aerobic and anaerobic organisms from veterinary, environmental, and skin sources (1-6). Human and animal bites can result in infectious complications including cellulitis, septic arthritis, and osteomyelitis (1,5). Annually they account for approximately 1% of emergency department visits and numerous physician office visits and hospital admissions, often as a result of infection and related problems. Streptococci, Staphylococcus aureus, Staphylococcus intermedius, Pasteurella multocida, Capnocytophaga canimorsus, and oral anaerobes of the Prevotella and Porphyromonas species are frequently isolated from animal bite wounds (Fig. 1). Streptococci, 5. aureus, Haemophilus influenzae, Eikenella corrodens, and oral anaerobes are often isolated from human bite wounds. Empirical treatment of infected human and animal bite wounds should include broad coverage against these common pathogens.

Erythromycin has been used in the penicillin-allergic patient as an alternative therapy, but it has relatively poor activity against certain bite

Percentage

Pasteurella Streptococci Staphylococcus Fusobacterium Bacteroides Porphyromonas Prevotella Peptostreplococd Enterococci

Klebs iella/En terobacter Others

Figure I Approximate frequency of various bacteria growing in infected cat and dog bite wounds. (Adapted from Ref, 1.)

would isolates such as P. multocida, E. corrodens, and many oral anaerobes (6). Previous studies of the activity of the macrolides clarithromycin and roxithromycin and the azalide azithromycin against common bite wound isolates have been reported (2-4). This study reviews and assesses their comparative therapeutic potential and effectiveness as alternatives to erythromycin.

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Osteoarthritis

Osteoarthritis

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