Antibiotic therapy anthrax

Symptoms of the acute phase are acute respiratory distress, breathing difficulty, profuse sweating, turning bluish in color, high temperature, and increased pulse and respiratory rate with chest sounds. If an x-ray is performed, mediastinal widening (swelling of lymph nodes under the breastbone) is very characteristic. Shock and death usually follow within 24 to 36 hours after the onset of respiratory distress. The fatality rate from inhalation anthrax ranges from 65 to 90% even with antibiotic therapy.3... 

In 2001, 11 people in the United States were diagnosed with confirmed or probable cases of cutaneous anthrax (Inglesby et al., 2002). One of these victims was a 7-month-old infant, who probably contracted the spores at his mother s workplace (Freedman et al., 2002). The previously healthy infant experienced severe systemic illness, despite early antibiotic therapy and hospitalization that included microangiopathic hemolytic anemia with renal involvement, coagulopathy, and hyponatremia (Freedman et al., 2002). The patient was hospitalized for 17 days, and his symptoms resolved 30 days after admission (Freedman et al., 2002). Fortunately, the infant survived. 

Post-exposure antibiotic therapies for plague and anthrax are generally effective if administered within a day or so after exposure. There is no approved therapy for smallpox, but cidofavir and possibly vaccinia-immune globulin (VIG) are showing some promise. 

The most useful microbiologic test for anthrax is a standard blood culture, which should show growth within 6-24 h. Blood cultures are likely to be positive early in the course of illness. In the October 2001 inhalational anthrax cases, aU patients who had not received antibiotic therapy had blood cultures positive for 5. anthracis. However, blood rapidly becomes sterile after initiation of antibiotic therapy, so the sensitivity of blood cultures declines significantly for patients with prior antibiotic therapy (9). Clinicians should order blood cultures only for patients in situations where they suspect bacteremia and not routinely on all patients with ILI symptoms who have no probable exposure to anthrax. When ordering blood cultures, clinicians must alert the laboratory to the possibility of anthrax, so that the lab performs appropriate biochemical testing and species identification. 

Treatment of anthrax involves antibiotic therapy for several weeks. Inhalation anthrax must be treated right away because the bacteria spread rapidly. Ciprofloxacin, doxycy-cline, penicillin and others are some of the antibiotics used to prevent the disease from progressing to the entire body. Series of vaccinations and boosters that are available may be administered as preventative measures against anthrax for any possible biological warfare attack. 

Finding a positive surface or air sample does not mean that employees of a facility are at risk tor anthrax. Heavily contaminated surfaces may pose a. small risk for cutaneous anthrax, which can be minimized by clean-up. Laboratory test results of environmental surface samples should not be the only criterion for starting, continuing, or stopping preventive antibiotic therapy for inhalational disease. 

When inhaiational anthrax i.s suspected, physicians prescribe antibiotics to treat the disease. To be effective, antibiotic therapy should be initiated as soon as possible after exposure. Other treatment includes supportive care in hospital. Q. anthracis usually responds effectively to several antibiotics including penicillin, do,xycycline, and fluoroquinolones (such as ciprofloxacin). 

The effect of a biological weapon on a population can be seen in the recent terrorist attack on the east coast of the United States in September 2001. Anthrax spores were delivered through the mail and resulted in 11 cases of inhalational anthrax and 12 cases of the cutaneous form of the disease. Even on this small scale, the effect on the public health system was enormous, and an estimated 32,000 people received prophylactic antibiotic therapy. 

Penicillin is the recommended treatment of inhalational anthrax, but tetracycline, erythromycin, and chloramphenicol have been used with success (Friedlander, 1997). A variety of other antibiotics have shown invitro activity, and current military doctrine calls for initiating treatment with oral ciprofloxacin or doxycycline as soon as exposure to anthrax spores is suspected and introducing intravenous ciprofloxacin at the earliest signs of infection or disease (Franz et al., 1997). It is essential to start antibiotic therapy before or very soon after such signs appear, if a high mortality rate is to be avoided. Other therapies for shock, volume deficit, and adequacy of airway may be necessary. The vaccination series should also be administered to victims not immunized in the previous 6 months. 

As soon as the first case of anthrax was confirmed in Florida, a relatively new drug gained notoriety—Cipro . This fluoroquinolone (ciprofloxacin) became the mode of therapy for those people exposed to the anthrax bacillus (approved by the FDA for anthrax on July 28, 2000). Despite appeals for restraint in the use of Cipro, pharmacies in Mexican border towns reported being cleaned out of the antibiotic by Americans searching for the readily available and relatively cheap drug. Only time will tell if inappropriate, irrational use of Cipro results in loss of effectiveness in treating anthrax infection. However, the CDC did determine that 19 percent of 490 people in Florida experienced side effects 1-2 weeks after beginning therapy with Cipro. 

There are three regimens available to protect people from anthrax Preexposure vaccine, postexposme prophylactic therapy with antibiotics, and postexposme... 

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. 

Ciprofloxacin is a fluoroquinolone antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of infections of the lower respiratory tract, skin and skin structure, bones and joints, urinary tract gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms typhoid fever uncomplicated cervical and urethral gonorrhea women with acute uncomplicated cystitis acute sinusitis nosocomial pneumonia chronic bacterial prostatitis complicated intra-abdominal infections reduction of incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis. Cipro IV Used for empirical therapy for febrile neutropenic patients. 

Intravenous ciprofloxacin or doxycycline is recommended for treatment of anthrax, usually as part of a cocktail of antibiotics (CDC, 2001a,b). Multiple antibiotics are usually indicated in anthrax cases with signs of septicemia, extensive edema, or for cases with cutaneous lesions in the head and neck (Brook, 2002). Penicillin may be included in the antibiotic cocktail but is not recommended as a stand-alone therapy due to B. anthracis p-lactamase production. B. anthracis can express p-lactamase variants, penicillinases and cepha-losporinases, which would undermine a lone-penicillin therapy (Lightfoot et al., 1990). B. anthracis has shown in vitro resistance to cephaloporins and trimethoprim-sulfamethoxazole (Inglesby et al., 2002). Corticosteroid therapy may help treat edema from head and neck lesions or prevent airway obstruction. Table 29.3 contains... 

Table 4.5 Initio type of infection. antibiotic treatment regimens for anthrax infection by age and durotion of therapy shou d be 60 days° ...

Change fo oral therapy as soon as possible if patient s condition improves. Amoxicillin 500 mg (adult dose) or 80 mgAg (child dose) p.o. t.d.s. if organism is found to be penicillin-sensitive. Additional antibiotics shown to have in vitro activity against anthrax may include rifampicin, vancomycin, gentamicin, chloramphenicol, clindamycin, penicillin, amoxicillin, meropenem or imipenem (depending upon sensitivities). ... 

---