Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-B – PLAGUE ( YERSINIA PESTIS ) Recommendations 1 for the treatment of patients with pneumonic plague in a contained and mass casualty setting and for post-exposure prophylaxis. 2 Table 1: Plague – Antibiotic Therapy for Contained Casualty Settings Contained casualty setting: assumes a limited number of persons seeking treatment. Start IV therapy as soon as diagnosis is suspected Patient Category Recommended Therapy Adults Preferred Therapy *Gentamicin 5 mg/kg IM or IV 1 time daily or *Gentamicin 2 mg/kg loading dose followed by 1.7 mg/kg IM or IV 3 times daily 3 Alternative Choices

*Doxycycline 100 mg IV 2 times daily *Ciprofloxacin 400 mg IV 2 times daily 4 Chloramphenicol 25 mg/kg IV 4 times daily 5

Children 6

Preferred Therapy *Gentamicin 2.5 mg/kg IM or IV 3 times daily 3 Alternative Choices *Doxycycline = 45 kg give adult dose < 45 kg give 2.2 mg/kg IV 2 times daily (Maximum 200 mg daily) *Ciprofloxacin 15 mg/kg 2 times daily 4 Chloramphenicol 15 mg/kg IV 4 times daily 5 Preferred Therapy *Gentamicin 5mg/kg IM or IV 1 time daily or *Gentamicin 2 mg/kg loading dose followed by 1.7 mg/kg IM or IV 3 times daily 3 Alternative Choices

Pregnant Women 7

*Doxycycline 100 mg IV 2 times daily *Ciprofloxacin 400 mg IV 2 times daily 4 Table 2: Plague – Antibiotic Therapy for Mass Casualty Settings and Post- exposure Prophylaxis Mass Casualty Setting and Post-exposure Prophylaxis 8 Adults Preferred Choices

*Doxycycline 100 mg orally 2 times daily 9 *Ciprofloxacin 500 mg orally 2 times daily 4 Alternate Choice Chloramphenicol 25 mg/kg orally 4 times daily 5

Children 6

Preferred Choices *Doxycycline 9 If = 45 kg give adult oral dose

If < 45 kg give 2.2 mg/kg orally 2 times daily *Ciprofloxacin 20 mg/kg orally 2 times daily 4

Pregnant Women 7 Preferred Choices *Ciprofloxacin 500 mg orally 2 times daily 4 *Doxycycline 100 mg orally 2 times daily 9 Alternate choice Chloramphenicol 25 mg/kg 4 times daily 5 * Antibiotic supplied as part of the National Pharmaceutical Stockpile (NPS)

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