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Primary Prevention

Well-timed and effective postexposure prophylaxis can potentially save thousands of lives. Postexposure prophylaxis of asymptomatic persons should ideally start as soon as possible after exposure because its effectiveness decreases with delay in implementation.

After exposure to anthrax, it is recommended 60 days of antibiotic drug prophylaxis for immediate protection and a 3-dose series of Anthrax Vaccine Adsorbed (AVA) for long-term protection.[1] To ensure adequate and continued protection, everyone exposed to aerosolized Bacillus anthracis spores should receive a full 60 days of postexposure prophylaxis antibiotic drugs, whether they are unvaccinated, partially vaccinated, or fully vaccinated.[2]

Antibiotic Drugs

Ciprofloxacin, levofloxacin, and doxycycline are FDA-approved for the antibiotic drug portion of postexposure prophylaxis for inhalation anthrax in adults ≥18 years of age.

No safety data are available for levofloxacin use beyond 30 days; thus, oral ciprofloxacin and doxycycline are recommended as first-line antibiotic drugs for postexposure prophylaxis. Alternative antibiotic drugs that might be used for postexposure prophylaxis, if first-line agents are not tolerated or are unavailable, include:

Vaccine

There is evidence of seroconversion after 3 doses of AVA. The vaccine should be administered subcutaneously at diagnosis and 2 and 4 weeks later.[1] AVA is not FDA-approved for postexposure prophylaxis and could be made available under an Investigational New Drug protocol or an Emergency Use Authorization in a declared emergency.

Prophylaxis Regimen

▸ Click on the following categories to expand treatment regimens.[3][4][5]

PEP for Infection with B. anthracis

  ▸  Adult Patients

  ▸  Pediatric Patients

  ▸  Pregnant Patients

PEP, Adult Patients
Preferred Regimen
Ciprofloxacin 500 mg PO q12h
OR
Doxycycline 100 mg PO q12h
OR
Levofloxacin 750 mg PO q24h
OR
Moxifloxacin 400 mg PO q24h
OR
Clindamycin 600 mg PO q8h
OR
Alternative Regimen

OR
Amoxicillin 1 g PO q8h
OR
Penicillin VK 500 mg PO q6h
PEP, Pediatric Patients
Preferred Regimen
Ciprofloxacin 30 mg/kg/day PO q12h, max: 500 mg/dose
OR
Levofloxacin 16 mg/kg/day PO q12h, max: 250 mg/dose (<50 kg)
OR
Levofloxacin 500 mg PO q24h (≥50 kg)
OR
Doxycycline 4.4 mg/kg/day PO q12h, max: 100 mg/dose (<45 kg)
OR
Doxycycline 100 mg/dose PO q12h (≥45 kg)
Alternative Regimen
Clindamycin 30 mg/kg/day PO q8h, max: 600 mg/dose
OR
Penicillin VK 50–75 mg/kg/day PO q6–8h
OR
Amoxicillin 75 mg/kg/day PO q8h, max: 1 g/dose
PEP, Pregnant Patients
Preferred Regimen
Ciprofloxacin 500 mg PO q12h

References

  1. 1.0 1.1 Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC) (2010). "Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009". MMWR Recomm Rep. 59 (RR-6): 1–30. PMID 20651644.
  2. "Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults".
  3. Hendricks, Katherine A. (2014-02). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerging Infectious Diseases. 20 (2). doi:10.3201/eid2002.130687. ISSN 1080-6059. PMC 3901462. PMID 24447897. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  4. Bradley, John S. (2014-04-28). "Pediatric Anthrax Clinical Management". Pediatrics. doi:10.1542/peds.2014-0563. ISSN 1098-4275. PMID 24777226. Unknown parameter |coauthors= ignored (help)
  5. Meaney-Delman, Dana (2014-02). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerging Infectious Diseases. 20 (2). doi:10.3201/eid2002.130611. ISSN 1080-6059. PMC 3901460. PMID 24457117. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)