Antimicrobial prophylaxis, anthrax

Centers for Disease Control and Prevention. (2001). Recommendations for antimicrobial prophylaxis for children and breastfeeding mothers and treatment of children with anthrax. 

Antimicrobial prophylaxis to prevent inhalational anthrax has been recommended for people potentially exposed to Bacillus anthracis as a result of recent bioterrorist attacks. Of 3428 people taking ciprofloxacin, 666 (19%) reported severe nausea, vomiting, diarrhea, or abdominal pain 484 (14%) reported fainting, lightheadedness, or dizziness 250 (7%) reported heartburn or acid reflux and 216 (6%) reported rashes, hives, or an itchy skin. Of those taking ciprofloxacin, 287 (8%) stopped taking it, 116 (3%) because of adverse events, 27 (1%) because of fear of possible adverse events, and 28 (1%) because they did not think it was needed (1-4). 

Centers for Disease Control and Prevention (CDC). Update Investigation of bioterrorism-related anthrax and adverse events from antimicrobial prophylaxis. MMWR Morb Mortal Wkly Rep 2001 50(44) 973-6. 

Continued antimicrobial prophylaxis for inhalational anthrax for 60 days if aerosol exposure to B. anthrads is known or suspected (2). 

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. 

Many of the medical products reviewed here find multiple applications. Thus procaine compounded with benzylpenicillin, penicillin G is an antimicrobial veterinary drug, approved in the US as a postexposure prophylaxis following inhalation of anthrax, providing that the strains do not have penicillin resistance. 

Shephard CW, Sorano-Gabarro, M, ZeU, ER, et al. Antimicrobial Postexposure Prophylaxis for Anthrax Adverse Events and Adherence. Emerging Infectious Disease, 8(10) 1124—1137, 2002... 

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