Anthrax
Treatment
Acute
Primary options
» levofloxacin
: 750 mg intravenously every 24
hours
-or-
» moxifloxacin
: 400 mg intravenously every
24 hours
-or-
» meropenem
: 2 g intravenously every 8
hours
-or-
» imipenem/cilastatin
: 1 g intravenously every
6 hours
Dose refers to imipenem component.
-or-
» doripenem
: 500 mg intravenously 8 hours
-or-
» vancomycin
: 60 mg/kg/day intravenously
given in divided doses every 8 hours
--AND--
» doxycycline
: 200 mg intravenously initially,
followed by 100 mg intravenously every 12
hours
-or-
» rifampicin
: 600 mg intravenously every 12
hours
-or-
» chloramphenicol
: 1000 mg intravenously
every 6-8 hours
»
Second-line agents that can replace
intravenous ciprofloxacin, benzylpenicillin, or
ampicillin as initial intravenous therapy include
the following drugs: levofloxacin, moxifloxacin,
meropenem, imipenem/cilastatin, doripenem,
or vancomycin. Second-line agents that can
replace clindamycin or linezolid as initial
intravenous therapy include the following agents:
doxycycline or rifampicin; chloramphenicol is
only indicated if safer alternatives fail.
[60]
»
Although quinolone therapy is not generally
recommended for pregnant patients, current
recommendations support the use of
ciprofloxacin for severe cutaneous anthrax,
inhalation anthrax, or ingestion anthrax until
antibiotic susceptibilities are available.
[34]
If
B
anthracis
is sensitive, penicillin is the preferred
therapeutic agent. If antibiotic sensitivities,
exhaustion of supplies, or adverse reactions
preclude the use of ciprofloxacin in a pregnant
patient, doxycycline may be used as part of
combination therapy for inhalation anthrax. Risks
of doxycycline use (i.e., fetal toxicity and growth
retardation) must be weighed with the benefits of
therapy.
[34]
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