Anthrax prophylaxis

Within the critical care environment, ciprofloxacin may form part of a regimen for hospital-acquired pneumonia and it has been recommended for anthrax prophylaxis. Care must be taken when coprescribing ciprofloxacin with warfarin or theophyllines as the... 

Centers for Disease Control and Prevention (CDC). Update adverse events associated with anthrax prophylaxis among postal employees— New Jersey, New York City, and the District of Columbia metropohtan area, 2001. MMWR Morb Mortal Wkly Rep 2001 50(47) 1051M. 

Partridge, R, Alexander, J, Lawrence, T, and Suner, S. Medical Counterbioterrorism The Response to Provide Anthrax Prophylaxis to New York City US Postal Service Employees. Annals of Emergency Medicine, 41(4) 441-446, 2003... 

Ciprofloxacin An antibiotic drug useful in treating bacterial infections the recommended antibiotic for treating anthrax infections as well as prophylaxis in a biological warfare setting. 

Allergic reactions (e.g., rashes, urticaria, and eosino-philia) have been observed. These drugs have occasionally been associated with cholestatic jaundice, blood dyscrasias, hemolytic anemia, hypoglycemia, and nephrotoxicity. Recently the use of ciprofloxacin for prophylaxis protection against anthrax infection has been associated with damage to muscle ligaments. 

Two tetracyclines have sufficiently distinctive features to warrant separate mention. Doxycycline, with its longer half-hfe and lack of nephrotoxicity, is a popular choice for patients with preexisting renal disease or those who are at risk for developing renal insufficiency. The lack of nephrotoxicity is related mainly to biliary excretion, which is the primary route of doxycycline elimination. Doxycycline is the preferred parenteral tetracycline Doxycycline is a potential first-hne agent in the prophylaxis of anthrax after exposure. Doxycycline is the treatment of choice for the primary stage of Lyme disease in adults and children older than 8 years. 

D. Although ciprofloxacin is the primary agent recommended for prophylaxis against anthrax, doxycycline is an equally effective agent. Amoxicillin (A) is not as effective. The macrolides (B) and (C) also are not as effective. Clindamycin (E) is not indicated for this use. 

Doxycydine (Adoxa, Periostal-, Oracea, Vibramycin, Vibra-Tabs) [Anribiotic/Tetracycline] Uses Broad-spectrum antibiotic acne vulgaris, uncomplicated GC, Chlamydia sp, PID, Lyme Dz, skin Infxns, anthrax, malaria prophylaxis Action Tetracycline bacteriostatic X- protein synth Dose Adults. 100 mg PO ql2h on 1st d, then 100 mg PO daily bid or 100 mg IV ql2h acne daily dosing, Chlamydia 7d, Lyme Dz 14—21 d, PID 14 d Peds >8 y 5 mg/kg/24 h PO, to a max of 200 mg/d - daily-bid Caution [D, +] Hepatic impair Contra Children <8 y, severe hepatic dysfxn Disp Tabs, caps, syrup, susp, inj SE D, GI disturbance, photosens Interactions T Effects OF digoxin, warfarin 1 effects W/ antacids, Fe, barbiturates, carbamazepine, phenytoins, food 4-effects OF penicillins EMS Monitor for signs of electrolyte disturbances and hypovolemia d/t D monitor for S/Sxs of super Infxn T risk of photosensitivity Rxns antibiotic of choice for the Tx and prophylaxis of anthrax exposure expired tetracyclines have been known to cause nephrotox OD May cause adverse GI effects symptomatic and supportive... 

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. 

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

Postexposure prophylaxis is not recommended for contacts of patients infected with B. anthracis, or for health care workers who may treat anthrax patients. It is also not recommended for the prophylaxis of cutaneous anthrax. It is currently only indicated for persons who may have been exposed to airspace contaminated with aerosolized B. anthracis (Bell, Kozarsky, Stephens, 2002). The duration of therapy is generally determined to be 60 days of either ciprofloxacin or doxy-cycline, with amoxicillin as an option for children and pregnant or lactating women. The U.S. Department of Health and Human Services has recently announced additional options for prophylaxis of inhalational anthrax, especially for those in whom inhalational exposure may have been significant. These options include 60 or 100 days of prophylaxis, as well as 100 days of prophylaxis plus anthrax vaccine as an investigational agent (GDG, 2001a Nass, 2002). 

Bell, D. M., Kozarsky, P. E., Stephens, D. S. (2002). Clinical issues in the prophylaxis, diagnosis, and treatment of anthrax. Emerging Infectious Diseases, 8, 222-225. 

Blank, S., Moskin, L. C., Zucker, J. R.(2003). An ounce of prevention is a ton of work Mass antibiotic prophylaxis for anthrax, New York City, 200f. Emerging Infectious Diseases, 9(6), 615-622. 

Bacr/ iijs anlifirfjcis (anthrax) benzylpenicillin, ciprofloxacin erythromycin ora tetracycline prophylaxis, ciprofloxacin orally for 60 d (inhalacional form) or 7 d (cutaneous form)... 

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). 

The Centers for Disease Control and Prevention. Investigation of bioterrorism-related anthrax and adverse events from antimicrobial prophylaxis. JAMA 2001 286(20) 2536-7. 

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. 

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

Table 2.8 Recommendations for treatment in mass casualty situation or postexposure prophylaxis for prevention of inhalational anthrax after intentional exposure to B. anthracis...

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. 

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