Yersinia pestis infection medical therapy: Difference between revisions

	Yersinia pestis infection Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Yersinia Pestis Infection from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
Treatment
Medical Therapy
Primary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Yersinia pestis infection medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Yersinia pestis infection medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Yersinia pestis infection medical therapy
CDC on Yersinia pestis infection medical therapy
Yersinia pestis infection medical therapy in the news
Blogs on Yersinia pestis infection medical therapy
Directions to Hospitals Treating Yersinia pestis infection
Risk calculators and risk factors for Yersinia pestis infection medical therapy

VisualWikitext

Latest revision as of 00:46, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editors-In-Chief: Esther Lee, M.A.; João André Alves Silva, M.D. [2]; Alison Leibowitz [3]

Overview

When a diagnosis of plague is suspected, appropriate specimens for diagnosis should be obtained immediately and antimicrobial therapy should be started. ^[1]^[2] The drug of choice is either Streptomycin or Gentamicin, but Tetracyclines, Fluoroquinolones, and Chloramphenicol may also be effective. The treatment regimen should be adjusted depending on the patient's age, medical history, underlying health conditions, and allergies.^[3] Upon evidence of pneumonia, patients with suspected plague should be placed in isolation and managed under respiratory droplet precautions.^[4]. Supportive therapy includes aggressive monitoring and management for the possibility of complications such as septic shock, multiple organ failure, acute respiratory distress syndrome, and disseminated intravascular coagulopathy.

Medical Therapy

Antibiotic regimens

1. Plague treatment^[5]

Preferred regimen (1): Streptomycin 2 g/day IM q12h for at least 10 days

Note: Pediatric dose: Streptomycin 30 mg/kg/day (up to 2 g/day) IM q6-12h for at least 10 days

Preferred regimen (2): Gentamicin 3 mg/kg/day IM or IV q8h for at least 10 days

Note: Pediatric dose: Gentamicin 6-7.5 mg/kg/day IM or IV q8h for at least 10 days - if neonates/infants use 7.5 mg/kg/day.

Alternative regimen (1): Chloramphenicol 50 mg/kg/day IV or PO q6h for 10 days
Alternative regimen (2): Tetracycline 2 g/day PO qid for 10 days

Note: Pediatric dose: Tetracycline 15 mg/kg of loading dose THEN 25-50 mg/kg/day (up to 2 g/day) PO qid for 10 days

Alternative regimen (3): Sulfadiazine 2-4 g loading dose THEN 1 g PO q4-6h
Alternative regimen (4): Doxycycline 200 mg/day PO q12-24h
Note (1): Fluoroquinolones have good effect against Y. pestis in both in vitro and animal studies, but no studies have been published on its use in treating human plague.
Note (2): Other antibiotics have been shown ineffective against plague.

2. Plague prophylaxis^[6]

Preferred regimen: Tetracycline 1-2 g/day PO bid-qid

Note: Pediatric dose: Tetracycline 25-50 mg/kg/day (up to 2 g/day) PO qid for 10 days

Alternative regimen (1): Doxycycline 100-200 mg/day PO q12-24h
Alternative regimen (2): Sulfamethoxazole-Trimethoprim 1.6 g/day PO bid

Note: Pediatric dose: Sulfamethoxazole-Trimethoprim 40 mg/kg/day PO bid

Other Classes of Antibiotics

Other cases of antibiotics, such as penicillins, cephalosporins, and macrolides have demonstrated to be ineffective or of variable effect in the treatment of plague and should not be used for this purpose.^[1]

Supportive Therapy

Clinicians must prepare for intense supportive management of plague complications, utilizing the latest developments for dealing with Gram-negative sepsis.^[7] Aggressive monitoring and management should be instituted for the possibility of:^[1]

Treatment of Plague During Pregnancy and in Children

With prompt and proper therapy, complications of plague in pregnancy can be prevented.

The selection of antibiotics during pregnancy is confounded by the potential adverse effects of three of the most effective drugs:

Streptomycin may be ototoxic and nephrotoxic to the fetus.
Tetracycline has an adverse effect on the developing teeth and bones of a fetus.
Chloramphenicol carries a low risk of "gray baby" syndrome or bone marrow suppression.
A judiciously administered aminoglycoside is effective and safe for both the mother and fetus, and in children. Because of its intravenous and intramuscular administration and its low risk of adverse effects, gentamicin is the preferred antibiotic for treating plague during pregnancy.^[8]

References

↑ ^1.0 ^1.1 ^1.2 "Plague manual--epidemiology, distribution, surveillance and control". Wkly Epidemiol Rec. 74 (51–52): 447. 1999. PMID 10635759.
↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
↑ "Plague".
↑ Garner JS (1996). "Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee". Infect Control Hosp Epidemiol. 17 (1): 53–80. PMID 8789689.
↑ http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf
↑ http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf
↑ Wheeler, Arthur P.; Bernard, Gordon R. (1999). "Treating Patients with Severe Sepsis". New England Journal of Medicine. 340 (3): 207–214. doi:10.1056/NEJM199901213400307. ISSN 0028-4793.
↑ Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E; et al. (2000). "Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense". JAMA. 283 (17): 2281–90. PMID 10807389.

Template:WikiDoc Sources

[pmid10635759-1] 1.0 ^1.1 ^1.2 "Plague manual--epidemiology, distribution, surveillance and control". Wkly Epidemiol Rec. 74 (51–52): 447. 1999. PMID 10635759.

[2] Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.

[CDC-3] "Plague".

[pmid8789689-4] Garner JS (1996). "Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee". Infect Control Hosp Epidemiol. 17 (1): 53–80. PMID 8789689.

[5] ttp://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf

[6] ttp://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf

[WheelerBernard1999-7] Wheeler, Arthur P.; Bernard, Gordon R. (1999). "Treating Patients with Severe Sepsis". New England Journal of Medicine. 340 (3): 207–214. doi:10.1056/NEJM199901213400307. ISSN 0028-4793.

[pmid10807389-8] Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E; et al. (2000). "Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense". JAMA. 283 (17): 2281–90. PMID 10807389.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Yersinia pestis infection}}
-{{CMG}}; '''Assistant Editors-In-Chief:''' [[Esther Lee, M.A.]]; {{JS}}
+{{CMG}}; '''Assistant Editors-In-Chief:''' [[Esther Lee, M.A.]]; {{JS}}; {{AJL}}
 ==Overview==
-According to treatment experts, a patient diagnosed with suspected plague should be hospitalized and medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of [[lymph gland]], [[blood]], and [[sputum]] samples. [[Antibiotic]] treatment should begin as soon as possible after laboratory specimens are taken. Effective antibiotics are [[streptomycin]], [[gentamicin]] (used when streptomycin is not available), [[tetracyclines]] and [[chloramphenicol]]. (used for critically ill patients, or rarely for suspected neuro-involvement)
+When a diagnosis of plague is suspected, appropriate specimens for diagnosis should be obtained immediately and antimicrobial therapy should be started. <ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> The drug of choice is either [[Streptomycin]] or [[Gentamicin]], but [[Tetracyclines]], [[Fluoroquinolones]], and [[Chloramphenicol]] may also be effective.  The treatment regimen should be adjusted depending on the patient's age, medical history, underlying health conditions, and allergies.<ref name=CDC>{{cite web | title = Plague | url = http://www.cdc.gov/plague/healthcare/clinicians.html }}</ref>  Upon evidence of [[pneumonia]], patients with suspected plague should be placed in isolation and managed under respiratory droplet precautions.<ref name="pmid8789689">{{cite journal| author=Garner JS| title=Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. | journal=Infect Control Hosp Epidemiol | year= 1996 | volume= 17 | issue= 1 | pages= 53-80 | pmid=8789689 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8789689  }} </ref>.  Supportive therapy includes aggressive monitoring and management for the possibility of complications such as [[septic shock]], [[multiple organ failure]], [[acute respiratory distress syndrome]], and [[disseminated intravascular coagulopathy]].
 ==Medical Therapy==
-When a [[diagnosis]] of human plague is suspected on [[clinical]] and [[epidemiological]] grounds, appropriate specimens for [[diagnosis]] should be obtained immediately and the patient should be started on specific [[antibiotic|antimicrobial therapy]] without waiting for a definitive answer from the laboratory.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
-Suspect plague patients with evidence of pneumonia should be placed in isolation, and managed under respiratory droplet precautions.<ref name="pmid8789689">{{cite journal| author=Garner JS| title=Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. | journal=Infect Control Hosp Epidemiol | year= 1996 | volume= 17 | issue= 1 | pages= 53-80 | pmid=8789689 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8789689  }} </ref>
+====Antibiotic regimens====
+:*1. ''' Plague treatment'''<ref>http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf</ref>
+::* Preferred regimen (1): [[Streptomycin]] 2 g/day IM q12h for at least 10 days
+:::* Note: Pediatric dose: [[Streptomycin]] 30 mg/kg/day (up to 2 g/day) IM q6-12h for at least 10 days
+::* Preferred regimen (2): [[Gentamicin]] 3 mg/kg/day IM or IV q8h for at least 10 days
+:::* Note: Pediatric dose: [[Gentamicin]] 6-7.5 mg/kg/day IM or IV q8h for at least 10 days - if neonates/infants use 7.5 mg/kg/day.
+::* Alternative regimen (1): [[Chloramphenicol]] 50 mg/kg/day IV or PO q6h for 10 days
+::* Alternative regimen (2): [[Tetracycline]]  2 g/day PO qid for 10 days
+:::* Note: Pediatric dose: [[Tetracycline]] 15 mg/kg of loading dose {{then}} 25-50 mg/kg/day (up to 2 g/day) PO qid for 10 days
+::* Alternative regimen (3): [[Sulfadiazine]] 2-4 g loading dose {{then}} 1 g PO q4-6h
+::* Alternative regimen (4): [[Doxycycline]] 200 mg/day PO q12-24h
+::* Note (1): Fluoroquinolones have good effect against Y. pestis in both in vitro and animal studies, but no studies have been published on its use in treating human plague.
+::* Note (2): Other antibiotics have been shown ineffective against plague.
+:* 2. '''Plague prophylaxis'''<ref>http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf</ref>
+::* Preferred regimen: [[Tetracycline]]  1-2 g/day PO bid-qid
+:::* Note: Pediatric dose: [[Tetracycline]] 25-50 mg/kg/day (up to 2 g/day) PO qid for 10 days
+::* Alternative regimen (1): [[Doxycycline]] 100-200 mg/day PO q12-24h
+::* Alternative regimen (2): [[Sulfamethoxazole-Trimethoprim]] 1.6 g/day PO bid
+:::* Note: Pediatric dose: [[Sulfamethoxazole-Trimethoprim]] 40 mg/kg/day PO bid
-===Specific Therapy===
+====Other Classes of Antibiotics====
-====Aminoglycosides====
+Other cases of [[antibiotics]], such as [[penicillins]], [[cephalosporins]], and [[macrolides]] have demonstrated to be ineffective or of variable effect in the treatment of plague and should not be used for this purpose.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
-'''Streptomycin''' is the most effective [[antibiotic]] against [[Yersinia pestis]] and the [[drug]] of choice for treatment of [[plague]], particularly the pneumonic form. Therapeutic effect may be expected with ''30 mg/kg/day'' (up to a total of 2 g/day) in divided doses given [[intramuscularly]], to be continued for a full course of 10 days of therapy or until 3 days after the temperature has returned to normal.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref><ref name="pmid13139207">{{cite journal| author=SMADEL JE, WOODWARD TE, AMIES CR, GOODNER K| title=Antibiotics in the treatment of bubonic and pneumonic plague in man. | journal=Ann N Y Acad Sci | year= 1952 | volume= 55 | issue= 6 | pages= 1275-84 | pmid=13139207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13139207  }} </ref><ref name="MeyerQuan1952">{{cite journal|last1=Meyer|first1=K. F.|last2=Quan|first2=S. F.|last3=McCrumb|first3=F. R.|last4=Larson|first4=A.|title=EFFECTIVE TREATMENT OF PLAGUE|journal=Annals of the New York Academy of Sciences|volume=55|issue=6|year=1952|pages=1228–1274|issn=00778923|doi=10.1111/j.1749-6632.1952.tb22687.x}}</ref><ref name="pmid1262715">{{cite journal| author=Butler T, Levin J, Linh NN, Chau DM, Adickman M, Arnold K| title=Yersinia pestis infection in Vietnam. II. Quantiative blood cultures and detection of endotoxin in the cerebrospinal fluid of patients with meningitis. | journal=J Infect Dis | year= 1976 | volume= 133 | issue= 5 | pages= 493-9 | pmid=1262715 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1262715  }} </ref>
-'''Gentamicin''' has been found to be effective in animal studies, and is used to treat human plague patients.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
+==Supportive Therapy==
+Clinicians must prepare for intense supportive management of plague [[complications]], utilizing the latest developments for dealing with [[Gram-negative]] [[sepsis]].<ref name="WheelerBernard1999">{{cite journal|last1=Wheeler|first1=Arthur P.|last2=Bernard|first2=Gordon R.|title=Treating Patients with Severe Sepsis|journal=New England Journal of Medicine|volume=340|issue=3|year=1999|pages=207–214|issn=0028-4793|doi=10.1056/NEJM199901213400307}}</ref>  Aggressive monitoring and management should be instituted for the possibility of:<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
+* [[Septic shock]]
+* [[Multiple organ failure]]
+* [[Adult respiratory distress syndrome]] ([[ARDS]])
+* [[Disseminated intravascular coagulopathy]]
-====Chloramphenicol====
+==Treatment of Plague During Pregnancy and in Children==
-[[Chloramphenicol]] is a suitable alternative to [[aminoglycosides]] in the treatment of bubonic or septicaemic plague and is the drug of choice for treatment of patients with [[Yersinia pestis]] invasion of tissue spaces into which other drugs pass poorly or not at all (such as plague [[meningitis]], [[pleuritis]], or [[endophthalmitis]]. Dosage should be '''50 mg/kg/day''' administered in divided doses either parenterally or, if tolerated, orally for 10 days. [[Chloramphenicol]] may be used adjunctively with [[aminoglycosides]].<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
+With prompt and proper therapy, [[complications]] of plague in [[pregnancy]] can be prevented.
-====Tetracyclines====
+The selection of [[antibiotics]] during [[pregnancy]] is confounded by the potential [[adverse effects]] of three of the most effective drugs:
-This group of [[antibiotics]] is [[bacteriostatic]] but effective in the primary treatment of patients with uncomplicated plague. An oral loading dose of '''15 mg/kg''' tetracycline (not to exceed 1 g total) should be followed by '''25-50 mg/kg/day''' (up to a total of 2 g/day) for 10 days. [[Tetracyclines]] may also be used adjunctively with other [[antibiotics]].<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
+* [[Streptomycin]] may be [[ototoxic]] and [[nephrotoxic]] to the [[fetus]].
+* [[Tetracycline]] has an [[adverse effect]] on the developing [[teeth]] and [[bones]] of a [[fetus]].
-====Sulfonamides====
+* [[Chloramphenicol]] carries a low risk of "[[Gray baby syndrome|gray baby]]" syndrome or [[bone marrow]] suppression.
-[[Sulfonamides]] have been used extensively in plague treatment and [[prevention]]: however, some studies have shown higher [[mortality]], increased [[complications]], and longer duration of [[fever]] as compared with the use of [[streptomycin]], [[chloramphenicol]] or [[tetracycline]] [[antibiotics]]. [[Sulfadiazine]] is given as a loading dose of '''2-4 g''' followed by a dose of '''1 g every 4-6 hours for a period of 10 days'''. In children, the oral loading dose is '''75 mg/kg''', followed by '''150 mg/kg/day orally in six divided doses'''. The combination drug [[trimethoprim-sulfamethoxazole]] has been used both in treatment and prevention of plague.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
+* A judiciously administered [[aminoglycoside]] is effective and safe for both the mother and [[fetus]], and in children. Because of its [[intravenous]] and [[intramuscular]] administration and its low risk of [[adverse effects]], [[gentamicin]] is the preferred [[antibiotic]] for treating plague during pregnancy.<ref name="pmid10807389">{{cite journal| author=Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E et al.| title=Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. | journal=JAMA | year= 2000 | volume= 283 | issue= 17 | pages= 2281-90 | pmid=10807389 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807389  }} </ref>
-====Fluoroquinolones====
-[[Fluoroquinolones]], such as [[ciprofloxacin]], have been shown to have good effect against [[Yersinia pestis|Y. pestis]] in both in vitro and animal studies. [[Ciprofloxacin]] is [[bacteriocidal]] and has broad spectrum activity against most [[Gram-negative]] [[aerobic bacteria]], including [[Enterobacteriaceae]] and [[Pseudomonas aeruginosa]], as well as against many [[Gram-positive bacteria]]. Although it has been used successfully to treat humans with [[Francisella tularensis]] infection, no studies have been published on its use in treating human plague.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
-====Other classes of antibiotics====
-Other cases of [[antibiotics]], such as [[penicillins]], [[cephalosporins]], and [[macrolides]] have been shown to be ineffective or of variable effect in treatment of plague and they should not be used for this purpose.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
-==Treatment Regimen==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL><ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Plague Treatment'''
-</font>
-</div>
-<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Adult Patients'''
-</font>
-</div>
-<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Children'''
-</font>
-</div>
-<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Pregnant Patients'''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Adult Patients}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]]  1 g IM q12h'''''<BR> OR <BR> ▸ '''''[[Gentamicin]]  5 mg/Kg q24h, or 2 mg/kg loading dose followed by 1.7 mg/kg q8h, IM or IV'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]]  100 mg IV q12h or 200 mg IV q24h'''''<BR> OR <BR>▸ '''''[[Ciprofloxacin]]  400 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]]  25 mg/Kg IV q6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Children}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]] 15 mg/Kg IM q12h (maximum dose, 2 g/day) '''''<BR> OR <BR> ▸ '''''[[Gentamicin]] 2.5 mg/Kg IM or IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] (for children ≥8 years'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 50–75 mg/kg/day PO q6–8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] '''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Pregnant Patients}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] (for children ≥8 years'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] '''''
-|}
-|}
-|}
-==Supportive therapy==
-The clinician must prepare for intense supportive management of plague [[complications]], utilizing the latest developments for dealing with [[Gram-negative]] [[sepsis]].<ref name="WheelerBernard1999">{{cite journal|last1=Wheeler|first1=Arthur P.|last2=Bernard|first2=Gordon R.|title=Treating Patients with Severe Sepsis|journal=New England Journal of Medicine|volume=340|issue=3|year=1999|pages=207–214|issn=0028-4793|doi=10.1056/NEJM199901213400307}}</ref> Aggressive monitoring and management of possible [[septic shock]], [[multiple organ failure]], [[adult respiratory distress syndrome]] ([[ARDS]]) and [[disseminated intravascular coagulopathy]] should be instituted.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759  }} </ref>
-==Treatment of plague during pregnancy and in children==
-With correct and early therapy, [[complications]] of plague in [[pregnancy]] can be prevented.
-The choice of [[antibiotics]] during [[pregnancy]] is confounded by the potential [[adverse effects]] of three of the most effective drugs.
-* [[Streptomycin]] may be [[ototoxic]] and [[nephrotoxic]] to the [[fetus]] .
-* [[Tetracycline]] has an [[adverse effect]] on developing [[teeth]] and [[bones]] of the [[fetus]].
-* [[Chloramphenicol]] carries a low risk of "[[Gray baby syndrome|gray baby]]" syndrome or [[bone marrow]] suppression.
-* An [[aminoglycoside]] judiciously administered is effective and safe for both mother and [[fetus]], and in children. Because of its safety, [[intravenous]] or [[intramuscular]] administration, and ability to have blood concentrations monitored, [[gentamicin]] is the preferred [[antibiotic]] for treating plague in pregnancy.<ref name="pmid10807389">{{cite journal| author=Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E et al.| title=Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. | journal=JAMA | year= 2000 | volume= 283 | issue= 17 | pages= 2281-90 | pmid=10807389 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807389  }} </ref>
-<!--
-Persons who have been in close contact with a plague patient, particularly a patient with plague pneumonia, should be identified and evaluated. The [[U.S. Public Health Service]] requires that all cases of suspected plague be reported immediately to local and state health departments and that the diagnosis be confirmed by [[CDC]]. As required by the International Health Regulations, [[CDC]] reports all U.S. plague cases to the [[World Health Organization]]. Early treatment of [[pneumonic plague]] is essential. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. Several types of [[antibiotics]] are effective for curing the disease and for preventing it.
-Antibiotic treatment for 7 days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection. However, antibiotic treatment alone is insufficient for some patients, who may also require circulatory, ventilator, or [[kidney|renal]] support.
--->
 ==References==
 {{reflist|2}}
+{{WikiDoc Help Menu}}
+{{WikiDoc Sources}}
 [[Category:Dermatology]]
-[[Category:Infectious disease]]
 [[Category:Pulmonology]]
 [[Category:Hematology]]
 [[Category:Disease]]
+[[Category:Infectious Disease Project]]
+[[Category:Needs content]]
-{{WikiDoc Help Menu}}
+[[Category:Infectious disease]]
-{{WikiDoc Sources}}
+[[Category:Emergency medicine]]
+[[Category:Medicine]]