Ciprofloxacin anthrax

Fluoroquinolones Not approved by the United States Food and Drug Administration for use in children except for anthrax (ciprofloxacin). MRSA, methicillin-resistant 5. aureus MSSA, methicillin-sensitive 5. aureus. 

The anthrax bioterrorist attacks that followed the events of September 11th 2001 resulted in a renewed interest BadUus anthracis, the causative agent of this disease. Research has focused on the development of better vaccines than the one currently available. It has been estimated that the aerosolized release of 100 kg of anthrax spores upwind of Washington DC would cause mortalities of 130,000-3,000,000 [63]. Nonetheless, wild-type Bacillus anthracis is susceptible to conventional antibiotics, including penicillin, oxyfloxacin and ciprofloxacin. The problem lies not with the bacterial infection itself, but with three proteins released by the bacteria - protective antigen (PA, 83 kDa), lethal factor (LF, 90 kDa) and edema factor (EF, 89 kDa) -known as anthrax toxins [63]. 

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. 

In January 2001, at least 25 similar threats were received across Canada and the U.S. A typical case occurred at a Wal-Mart in Victoria, British Columbia, when a letter claiming to contain anthrax was received. Fortunately the letter did not contain anthrax, but before that could be conclusively established, the clerk who opened the letter received a precautionary dose of ciprofloxacin. 

Currently, the FDA approved treatment for anthrax is ciprofloxacin, doxycycline, and penicillin. 

Generally, ciprofloxacin should be continued for 2 days after the signs and symptoms of infection have disappeared, except for inhalational anthrax (postexposure). 

Begin drug administration as soon as possible after suspected or confirmed exposure to B. anthracis spores. This indication is based on a surrogate endpoint, ciprofloxacin serum concentrations achieved in humans, reasonably likely to predict clinical benefit. Total duration c ciprofloxacin administration (IV, IR, or oral) for inhalational anthrax (postexposure) is 60 days. 

Anthrax A (Bacillus anfhracis) Animals— herbivores 1-5 days No Standa d (invasive procedures should be avoided) Inhalation— fever, dry cough,resp distress, meningitis cutaneous-skin ulcer Dea h may occur about 24-36 h post exposure Ciprofloxacin, doxycycline A vaccine is available... 

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. 

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. 

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... 

Anthrax Suspected exposure Ciprofloxacin or doxycycline Proposed effective... 

Bacillus anthracis Anthrax pneumonia Ciprofloxacin or doxycycline plus a penicillin another [alternative] agent Clarithromycin clindamycin chloramphenicol imipenem rifampin vancomycin... 

The fluoroquinolone subclass of antibiotics is inspired by nalidixic acid (A.35), an older antibiotic commonly used for urinary tract infections (Figure A.10). Depending on the type of infection, fluoroquinolones inhibit DNA gyrase and/or topoisomerase IV. Both enzymes are vital for DNA replication and bacterial reproduction. Both ciprofloxacin (Cipro, A.36) and levofloxacin (Levaquin, A.37) are examples of fluoroquinolone antibiotics. Ciprofloxacin received national attention in the United States in 2001. Ciprofloxacin was used to treat many anthrax-infected patients after letters containing anthrax spores were sent through the U.S. postal service. 

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. 

The American Academy of Pediatrics recommends that doxycycline not be used in children less than 9 years of age because of retarded skeletal growth in infants and discolored teeth in infants and toddlers (Inglesby et al., 2002). Because of the serious nature of anthrax infection, however, Inglesby and colleagues (2002) recommend that doxycycline, instead of ciprofloxacin, be used in children if antibiotic susceptibility testing, exhaustion of drug supplies, or adverse reactions preclude the use of ciprofloxacin. 

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). 

The treatment of anthrax is with ciprofloxacin or doxy-cycline plus additional antimicrobials and adjunctive... 

Ciprofloxacin or doxycycline, 60-100 d course, anthrax vaccine THERAPY... 

Anthrax Bioport vaccine Ciprofloxacin 400 mg IV Ciprofloxacin 500 mg PO bid Potential alternates... 

At the time of writing, the recommended initial therapy for inhalational, oral, and gastrointestinal anthrax in adults is 400 mg of ciprofloxacin every 12 h or 100 mg of doxycycline every 12 h, administered intravenously (Inglesby et al, 2002). In addition to these treatments, one or two... 

Recommended first line treatment -inhalational, GI, and oropharyngeal anthrax Ciprofloxacin (use in combination with one or two additional antimicrohials listed helow) IV treatment initially (400 mg q 12h) in combination with one or two additional antimicrobial/ Switch to oral dosing IV treatment initially when appropriate (10-15 mg/kg q 12 h) (500 mg PO BID) in combination with one or two additional antimicrobials Switch to oral when appropriate (500 mg PO BID) Same for adults ... 

Therapeutic treatment protocol for immunocompromised persons is the same for immunocompromised adults and children Ciprofloxacin or doxycycline are first line therapeutics for all forms of anthrax... 

---