Microsoft word - treatment of inhalational anthrax table.doc

Patient Category
Initial IV Therapy †‡
Oral Regimens (continue therapy for 60 days [IV and PO
combined])
Patients should be treated with IV therapy initially. § or
Treatment can be switched to oral therapy when clinically and
Ciprofloxacin, 500 mg PO twice daily
or
Doxycycline, 100 mg PO twice daily
One or two additional antimicrobials (agents with in vitro activity include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin) †† Ciprofloxacin, 10 to 15 mg/kg every 12 h, not to exceed 1 Patients should be treated with IV therapy initially. § Treatment can be switched to oral therapy when clinically or
Doxycycline**§§: >8 yr and > 45 kg: 100 mg every 12 h >8 yr and ≤ 45 kg: 2.2 mg/kg every 12 h Ciprofloxacin, 10 to 15 mg/kg PO every 12 h, not to exceed 1 g/day
or
Doxycycline §§:
and
>8 yr and >45 kg: 100 mg PO every 12 h >8 yr and ≤ 45 kg: 2.2 mg/kg PO every 12 h ≤8 yr: 2.2 mg/kg PO every 12 h One or two additional antimicrobials (see agents listed under therapy for adults) †† Same as for nonpregnant adults (high death rate from the Patients should be treated with IV therapy initially. § infection outweighs risk posed by antimicrobial agent) Treatment can be switched to PO when clinically appropriate. Oral therapy regiments are the same as for nonpregnant adults. Same as for nonimmunocompromised persons and Same as for nonimmunocompromised persons and Abbreviations: IV, intravenously; PO, orally. These treatment recommendations were made during U.S. 2001 anthrax outbreak. In other situations, antimicrobial susceptibility testing should be used to guide therapy decisions. † Ciprofloxacin or doxycycline should be considered an essential part of first-line therapy for inhalational anthrax. ‡ Steroids may be considered and adjunct therapy for patients with severe edema (Doust et al. Corticosteroid in treatment of malignant edema of chest wall and neck [anthrax]. Dis Chest 1968;53:773-4) and for meningitis based on experience with bacterial meningitis of other etiologies. § Initial therapy my be altered based on clinical course of patient; one or two antimicrobial agents (e.g. ciprofloxacin or doxycycline) may be adequate as patient improves. ** If meningitis is suspected, doxycycline may be less than optimal because of poor central nervous system penetration. †† Because of concerns of constitutive and inducible beta-lactamases in Bacillus anthracis isolates, penicillin and ampicillin should not be used alone. Consultation with an infectious disease specialist is advised. ‡‡ If intravenous ciprofloxacin is not available, oral ciprofloxacin may be acceptable because it is rapidly and well absorbed from gastrointestinal tract with no substatial loss by first-pass metabolism. Maximum serum concentrations are attained 1 to 2 hours after oral doing but may no be achieved if vomiting or ileus is present. §§ American Academy of Pediatrics recommends treatment of young children with tetracyclines for serious infections (eg, Rocky Mountain Spotted Fever). *** Although tetracyclines are not recommended for pregnant women, their use may be indicated for life-threatening illness. Adverse effects on developing teeth and bones are dose-related; therefore, doxycycline might be used for a short time (7 to 14 days) before 6 months of gestation. Adapted from CDC. Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antibicrobial therapy, October 2001. MMWR 2001:50(42):909-19

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