Cutaneous anthrax treatment

Punch biopsies can confirm cutaneous anthrax if Gram stain and culture results are negative, due to antibiotic treatment (Godyn et al., 2005), and a suspicion of cutaneous anthrax remains (Celia, 2002). The center of the eschar, the erythematous region, and the skin margin should all be included in the biopsy when an eschar is present (Godyn et al., 2005). 

Godyn, J.J., Reyes, L., Sideritis, R., Hazra, A. (2005). Cutaneous anthrax conservative or surgical treatment Adv. Skin Wound Care 18 146-50. 

Penicillin is the drug of choice for anthrax. Cutaneous anthrax without toxicity or systemic symptoms may be treated with oral penicillin. If evidence of spreading infection or systemic symptoms is present, then intravenous therapy with high-dose penicillin (2 million units administered every 6 h) may be initiated until a clinical response is obtained. Effective therapy will reduce edema and systemic symptoms but will not change the evolution of the skin lesion itself. Treatment should be continued for 7 to 10 days. 

Early treatment of cutaneous anthrax is usually curative, and early treatment of all forms is important for I ecovery. Patients with cutaneous anthrax have reported case fatality rales of 20% w ithout antibiotic treatment and less than 1% with it. Although case-fatality estimates tor inhalational anthrax are based on iocoinpleie information, the rate is extremely high, approximately 75%, even with all possible supportive care including appropriate antibiotics. 

W hat is the treatment for patients with inhalational and cutaneous anthrax ... 

Treatment protocols for cases of inhalational and cutaneous anthrax associated with tliis bioterrorist attack are found in the MMWR, 10/26/2001 50(42), 909-919. 

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... 

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