Consensus statement ularemia, a bacterial zoono

Immunosuppressed Persons. There

is scant experience in treating tulare- mia in immunocompromised patients. However, considering the greater occur- rence in immunocompetent patients of tularemia relapses and treatment fail- ures following use of bacteriostatic an- timicrobial agents compared with aminoglycosides, streptomycin or gen- tamicin should be used when possible to treat patients with known immune dys- function in either contained casualty or mass casualty situations (Table 2).

POSTEXPOSURE ANTIBIOTIC RECOMMENDATIONS

Persons beginning treatment with strep- tomycin, gentamicin, doxycycline, or ciprofloxacin in the incubation period of tularemia and continuing treat- ment daily for 14 days might be pro- tected against symptomatic infection. In studies of aerosol challenge with in- fective doses of the virulent SCHU S-4 strain of F tularensis, each of 8 volun- teers given oral dosages of tetracy- cline, 1 g/d for 28 days, and each of 8 volunteers given tetracycline, 2 g/d for 14 days, were fully protected when treatment was begun 24 hours follow- ing challenge.27 Two of 10 volunteers given tetracycline, 1 g/d for only 5 days,

developed symptomatic tularemia af- ter antibiotic treatment was stopped.

In the unlikely event that authori-

ties quickly become aware that an F tu- larensis biological weapon has been used and are able to identify and reach exposed persons during the early in- cubation period, the working group rec- ommends that exposed persons be pro- phylactically treated with 14 days of oral doxycycline or ciprofloxacin (Table 3). In a circumstance in which the weapon attack has been covert and the event is discovered only after persons start to become ill, persons potentially ex- posed should be instructed to begin a fever watch. Persons who develop an otherwise unexplained fever or flulike illness within 14 days of presumed ex- posure should begin treatment as out- lined in Tables 2 and 3.

In the laboratory, persons who have

had potentially infective exposures to F tularensis should be administered oral postexposure antibiotic prophylaxis if the risk of infection is high (eg, spill, centrifuge accident, or needlestick). If the risk is low, exposed persons can be placed on a fever watch and treated if they develop symptoms.

Postexposure prophylactic antibi-

otic treatment of close contacts of tu- laremia patients is not recommended since human-to-human transmission of F tularensis is not known to occur.