Postexposure anthrax antibiotics

Antibiotics should be continued for 60 days in patients with anthrax infection. Postexposure antibiotic prophylaxis is recommended after exposure to anthrax, plague, and tularemia. 

In a contained casualty setting, children with inhalation anthrax can receive intravenous antibiotics in a mass casualty setting and as postexposure prophylaxis, children can receive oral antibiotics (Inglesby et al., 2002). Doxycycline is dispensed in a tablet that children may not be able to swallow however, it can be ground and mixed with food or drink to make it palatable. Palatable foods and drinks for mixing doxycycline include chocolate pudding, chocolate milk, low-fat chocolate milk, simple syrup with sour apple flavor. 

Because of the uncertainty about spore survival, the lack of effectiveness of antibiotics against the spore form, and recent studies in nonhuman primates demonstrating the effectiveness of postexposure antibiotic prophylaxis in combination with vaccine, physicians may consider two other options for postexposure prophylactic therapy. The first option is a longer period of 100 days of antimicrobial prophylaxis alone. The second alternative option is a combination of antimicrobial prophylaxis plus three doses of anthrax vaccine administered over 4 weeks. 

There is a vaccine available for the prevention of anthrax, but it is only available to those who are at significant risk for anthrax exposure, such as military personnel and veterinarians. Postexposure treatment of individuals is with a course of antibiotics before symptoms appear if exposure is suspected, or as soon as symptoms are noted. Prompt treatment is usually effective however, success is dependent upon exposure dosage, route of exposure, and individual susceptibility factors. 

Levofloxacin is a fluoroquinolone/ophthalmic/antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, nosocomial pneumonia, community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infection (UTI), inhalational anthrax (postexposure), and acute pyelonephritis caused by susceptible strains of specific microorganisms. Ophthalmic use is for the treatment of conjunctivitis caused by susceptible strains of aerobic Gram-positive and aerobic Gram-negative microorganisms. 

Estimates of the impact of the delay in postexposure prophylaxis or treatment on survival are not known. For gastrointe.stinal anthrax, the case-fatality rate is estimated to be 2.5%-60% and the effect of early antibiotic treatment on that case-fatality rate is not defined. 

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