Inhalational anthrax treatment

Treatment (See Inhalational Anthrax Treatment Protocol at http //www.cdc.gov/ mmwr/preview/mmwrhtinl/m in5042al.htm for specific therapy)... 

Decontamination Soap and water, or diluted sodium hypochlorite solution (0.5 percent). Drainage and secretion precautions are necessary. After invasive procedures or autopsy, decontaminate instruments and surfaces with 0.5 percent sodium hypochlorite or with a sporici Anthrax, after symptoms have became apparent, can be very deadly. Although the death rate for dermal anthrax is roughly about five to 20 percent, the fatality rate for inhalation anthrax after symptoms progress is almost always fatal, regardless of treatment. 

Centers for Disease Control and Prevention. (2001a). Additional options for preventive treatment for persons exposed to inhalational anthrax. Morbidity and Mortality Weekly Report, 50, 1142, 1151. 

The mortality rate of occupationally acquired inhalational anthrax cases in the United States had been 89%, but most of these cases occurred before the development of critical care units, and in some cases, before the advent of antibiotics. In the October 2001 attacks, five of 11 patients with inhalational anthrax died. This recent experience suggests that early diagnosis and treatment is critical to improving survival. 

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

B. anthracis typically is susceptible to penicillin, amoxicillin, erythromycin, doxycycline, ciprofloxacin, and chloramphenicol. The bioterrorism-related strain was susceptible to the fluoroquinolones, rifampin, tetracycline, vancomycin, imipenem, meropenem, chloramphenicol, clindamycin, and the aminoglycosides. However, the strain was resistant to third-generation cephalosporins and trimethoprim-sulfamethoxazole. Ciprofloxacin or doxycycline plus one or two of the aforementioned antibiotics is the currently recommended regimen for the treatment of inhalational anthrax, but doxycycline is not recommended for the treatment of anthrax meningitis owing to poor CNS penetration and recent in vitro resistance. ... 

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. 

Levofloxacin is a fluoroquinolone/ophthalmic/antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, nosocomial pneumonia, community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infection (UTI), inhalational anthrax (postexposure), and acute pyelonephritis caused by susceptible strains of specific microorganisms. Ophthalmic use is for the treatment of conjunctivitis caused by susceptible strains of aerobic Gram-positive and aerobic Gram-negative microorganisms. 

Diagnosis and Treatment Skin anthrax may be diagnosed from the biopsy of the sore and performing microscopic examination of the organism. Inhalation anthrax however, is difficult to diagnose. Chest x-ray, lab cultures and blood tests should be carried out. Rapid laboratory tests may be carried out to diagnose anthrax. Such tests include polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA) and direct fluorescent antibody (DFA) methods. 

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. 

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. 

Because inhalational anthrax in humans is so rare, w e cannot be certain about the risk of reinfection therefore, CDC recommends that another course of antibiotic treatment be given promptly if a person is reexpused to Bacillus anthracis. In animal studies of inhalational anthrax, animals given anthrax vaccine and antibiotics after exposure did not develop anthrax when reexposed 4 months after the original exposures, while animals treated with antibiotics alone became ill when reexpo.sed. 

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. 

The death rate from inhalation anthrax is close to 100 percent for those left untreated. For smallpox the death rate is considerably lower— perhaps 30 to 40 percent— but no effective treatment currently exists, and worse still, the disease is exceedingly contagious. Smallpox has ravaged human society at least from the beginning of recorded history, killing untold hundreds of millions and scarring for life untold hundreds of millions more. If ever there was a disease that deserved the name scourge, smallpox is it. 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

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