Consensus statement ularemia, a bacterial zoono

Mass Casualty Situation

Doxycycline and ciprofloxacin, admin- istered orally, are the preferred choices for treatment in the mass casualty set- ting, for both adults and children (TABLE 3). The ciprofloxacin dosage for children should not exceed 1 g/d. In a mass casualty situation, the working group believes the benefits to children from short courses of doxycycline or fluoroquinolones (Table 3) outweigh the risks of their use.

Since it is unknown whether drug-

resistant organisms might be used in a bioterrorist event, antimicrobial sus- ceptibility testing of isolates should be conducted quickly and treatments al- tered according to test results and clini- cal responses.

Antibiotics for treating patients in-

fected with tularemia in a bioterror- ism scenario are included in a na- tional pharmaceutical stockpile

Table 2. Working Group Consensus Recommendations for Treatment of Patients With Tularemia in a Contained Casualty Setting*

Contained Casualty Recommended Therapy

Adults

Preferred choices

Streptomycin,1g IM twice daily Gentamicin, 5 mg/kg IM or IV once daily†

Alternative choices

Doxycycline, 100 mg IV twice daily Chloramphenicol, 15 mg/kg IV 4 times

daily†

Ciprofloxacin, 400 mg IV twice daily†

Children

Preferred choices

Streptomycin, 15 mg/kg IM twice daily (should not exceed 2 g/d)

Gentamicin, 2.5 mg/kg IM or IV 3 times

daily† Alternative choices

Doxycycline; if weight ≥45 kg, 100 mg IV

twice daily; if weight <45 kg, give 2.2 mg/kg IV twice daily

Chloramphenicol, 15 mg/kg IV 4 times

daily†

Ciprofloxacin, 15 mg/kg IV twice daily†‡

Pregnant Women

Preferred choices

Gentamicin, 5 mg/kg IM or IV once daily† Streptomycin,1g IM twice daily

Alternative choices

Doxycycline, 100 mg IV twice daily Ciprofloxacin, 400 mg IV twice daily†

*Treatment with streptomycin, gentamicin, or ciprofloxa- cin should be continued for 10 days; treatment with doxy- cycline or chloramphenicol should be continued for 14-21 days. Persons beginning treatment with intramuscular (IM) or intravenous (IV) doxycycline, ciprofloxacin, or chlor- amphenicol can switch to oral antibiotic administration when clinically indicated.

†Not a US Food and Drug Administration–approved use.

‡Ciprofloxacin dosage should not exceed 1 g/d in children.

Table 3. Working Group Consensus Recommendations for Treatment of Patients With Tularemia in a Mass Casualty Setting and for Postexposure Prophylaxis*

Mass Casualty Recommended Therapy

Adults

Preferred choices

Doxycycline, 100 mg orally twice daily Ciprofloxacin, 500 mg orally twice daily†

Children

Preferred choices

Doxycycline; if ≥45 kg, give 100 mg orally twice daily; if <45 kg, give 2.2 mg/kg orally twice daily

Ciprofloxacin, 15 mg/kg orally twice daily†‡

Pregnant Women

Preferred choices

Ciprofloxacin, 500 mg orally twice daily† Doxycycline, 100 mg orally twice daily

*One antibiotic, appropriate for patient age, should be cho- sen from among alternatives. The duration of all rec- ommended therapies in Table 3 is 14 days.

†Not a US Food and Drug Administration–approved use.

‡Ciprofloxacin dosage should not exceed 1 g/d in children.

MANAGEMENT OF TULAREMIA AS A BIOLOGICAL WEAPON

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