to the editor: I read with interest the article¹ on bioterrorism agents in the May 1, 2003 issue of American Family Physician. This timely piece offered useful advice to assist family physicians on an important topic. I would like to recommend some information not included in the article.

First, the method of diagnosis that is described in Table 1¹ for plague should include culture of bubo aspirate (for bubonic plague) in addition to sputum, blood, and cerebrospinal fluid cultures for pneumonic and septicemic plague.

Second, Table 2¹ only describes the treatment for inhalational anthrax. There is a separate treatment regimen for cutaneous anthrax.² Furthermore, clinicians can consider extending the usual 60-day anthrax prophylaxis to 100 days based on the possibility that disease may occur up to 100 days after exposure.³

IN REPLY: We appreciate Dr. Campos-Outcalt's pointing out the additional information on bioterrorism infections. He correctly notes that a culture of bubo aspirate should be done if a bubo is present. However, in a bioterrorism attack, persons will be more likely to have pulmonic plague rather than bubonic plague, and this is why we chose not to list this culture in Table 1 of our article.¹ Cutaneous anthrax treatment is not listed in Table 2 of our article¹ because any case of cutaneous anthrax seen during a bioterrorist attack is treated as presumed inhalation anthrax until proven otherwise.