Postexposure Antibiotic Prophylaxis

Treatment begun with streptomycin, gentamicin, doxycycline, or ciprofloxacin during the incubation period and continuing for 14 days may prevent symptomatic infection (43). A small study in volunteers showed that oral tetracycline given within 24h of an aerosol exposure and continued for 14 or 28 days was fully protective, whereas two out of ten volunteers treated for only 5 days developed symptomatic tularemia after stopping treatment. Once pubUc health officials become aware that 

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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. 

Antibiotics should be continued for 60 days in patients with anthrax infection. Postexposure antibiotic prophylaxis is recommended after exposure to anthrax, plague, and tularemia. 

If a patient has been exposed to rabies, the treatment objectives consist of thorough irrigation of the wound, tetanus prophylaxis, antibiotic prophylaxis (if indicated), and immunization. Postexposure prophylaxis immunization consists of both passive antibody administration and vaccine administration. 

Given the limited supply of vaccine, and the lack of reported cases in people given antibiotic prophylaxis following the 2001 attacks, Working Group on Civilian Biodefense continues to recommend that 60 days of antibiotics is sufficient protection postexposure. 

After a patient has been exposed to rabies, the treatment objectives consist of thorough irrigation of the wound, tetanus prophylaxis, antibiotic prophylaxis, if indicated, and immunization. Prompt, thorough irrigation of the wound with soap or iodine solution may reduce the development of rabies. Postexposure prophylaxis immunization consists of the administration of both passive antibody and vaccine. The only exceptions to antibody administration are patients who have been immunized previously and have the appropriate degree of documented rabies antibody titers. 

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. 

Glanders No vaccine available Antibiotic regimens vary Postexposure prophylaxis may No large therapeutic... 

The use of erythromycin in postexposure prophylaxis for pertussis in 200 infants was followed by an increased number of cases of infantile hypertrophic pyloric stenosis, and all seven cases had taken erythromycin prophylacti-cally (33). A case review and cohort study supported these preliminary findings (34). In a retrospective study in 314 029 children, very early exposure to erythromycin (at 3-13 days of life) was associated with a nearly eightfold increased risk of pyloric stenosis (35). There was no increased risk in infants exposed to erythromycin after 13 days of hfe or in infants exposed to antibiotics other than erythromycin. 

In an attack resulting in mass casualties, resources may be insufficient to provide the intravenous treatment outlined in Table 2.7. Instead, only oral antibiotics may be available. Table 2.8 outlines the recommendations for mass treatment with oral antibiotics. These recommendations are the same as those for postexposure prophylaxis for people without active disease. 

Alternative Postexposure Prophylaxis Regimens with Antibiotics with and without Vaccine... 

Estimates of the impact of the delay in postexposure prophylaxis or treatment on survival are not known. For gastrointe.stinal anthrax, the case-fatality rate is estimated to be 2.5%-60% and the effect of early antibiotic treatment on that case-fatality rate is not defined. 

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