Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-A-1 – Anthrax ( Bacillus anthracis )

Table 2: Anthrax – Antibiotic Therapy for Mass Casualty Settings or Post- Exposure Prophylaxis

Mass Casualty Setting or Post -Exposure Prophylaxis Patient Category Antibiotic

Comment

Adults, including pregnant women and immunocompromised

Preferred treatment: *Ciprofloxacin 500 mg PO q 12 hours, or *Doxycycline 1 100 mg PO q 12 hours Therapy if strain is susceptible: Amoxicillin 500 mg PO q 8 hours Preferred treatment: *Ciprofloxacin 15 – 20 mg/kg PO q 12 hours (not to exceed 1 gm/day), or *Doxycycline 2  > 8 years and > 45 kg : give 200 mg loading dose, the 100 mg q 12 hours;  > 8 years and = 45 kg : give 4.4mg/kg loading dose then 2.2 – 4.4 mg/kg/day in 2 divided doses;  = 8 years: same as > 8 years and = 45 kg, Therapy if strain is susceptible: Amoxicillin  If = 20 kg: give 500 mg PO q 8 hour; or  If < 20 kg: give 40 mg/kg divided into 3 doses to be taken q 8 hours

Duration of therapy is 60 days

Children The use of tetracyclines and fluoroquinolones in children has well known adverse effects. These risks must be weighed carefully against the risk of developing life- threatening disease. If a release of B anthracis is confirmed, children should be prophylaxed initially with ciprofloxacin or doxycycline but therapy should be changed to amoxicillin as soon as penicillin susceptibility is confirmed.

Duration of therapy is 60 days

* Antibiotics supplied as part of the National Pharmaceutical Stockpile (NPS) 1. Although tetracyclines are not recommended during pregnancy, its use may be indicated for life- threatening infections. Adverse affects on developing teeth and bone are dose related, therefore, doxycycline might be used for short course therapy (7 – 14 days) prior to the 6 th month of gestation. After the 6 th month, professional consultation should be obtained. 2. In 1991, the American Academy of Pediatrics amended their recommendation to allow treatment of young children with tetracyclines for serious infections for which doxycycline may be indicatedsuch as Rocky Mountain Spotted Fever. Doxycycline is preferred for its twice-a-day dosing and low incidence of gastrointestinal side effects.

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