Postexposure prophylaxis anthrax

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. 

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). 

Many of the medical products reviewed here find multiple applications. Thus procaine compounded with benzylpenicillin, penicillin G is an antimicrobial veterinary drug, approved in the US as a postexposure prophylaxis following inhalation of anthrax, providing that the strains do not have penicillin resistance. 

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

Shephard CW, Sorano-Gabarro, M, ZeU, ER, et al. Antimicrobial Postexposure Prophylaxis for Anthrax Adverse Events and Adherence. Emerging Infectious Disease, 8(10) 1124—1137, 2002... 

Friedlander AM, Welkos SL, Pitt MLM, et al. Postexposure prophylaxis against experimental inhalation anthrax. J Infect Dis. 1993 167(5) 1239 1243. 

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. 

Vaccines. Anthrax and smallpox vaccines can be used before exposure and also for postexposuie prophylaxis. A pentavalent (ABODE) botulinum toxoid is currently used for laboratory workers at high risk of exposure. It is not effective for postexposure prophylaxis. Vaccines are not currently available for plague, tularemia, or viral hemorrhagic fevers. 

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. 

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