Volume 26, Number 12—December 2020
Synopsis
Control and Prevention of Anthrax, Texas, USA, 2019
Table 1
Oral antimicrobial drugss for postexposure prophylaxis and treatment of localized cutaneous anthrax*
Postexposure prophylaxis alone or after oral or intravenous therapy | Monotherapy for localized cutaneous anthrax | |
---|---|---|
Antimicrobial drugs before susceptibility testing | For all strains, regardless of penicillin susceptibility or if susceptibility is unknown | |
Ciprofloxacin 500 mg every 12 h | Ciprofloxacin 500 mg every 12 h | |
OR | OR | |
Doxycycline 100 mg every 12 h | Doxycycline 100 mg every 12 h | |
OR | OR | |
Levofloxacin 750 mg every 24 h | Levofloxacin 750 mg every 24 h | |
OR | OR | |
Moxifloxacin 400 mg every 24 h | Moxifloxacin 400 mg every 24 h | |
OR | OR | |
Clindamycin† 600 mg every 8 h | Clindamycin† 600 mg every 8 h | |
OR | OR | |
For penicillin-susceptible strains | For penicillin-susceptible strains | |
Amoxicillin 1 g every 8 h | Amoxicillin 1 g every 8 h | |
OR | OR | |
Penicillin VK 500 mg every 6 h |
Penicillin VK 500 mg every 6 h |
|
Because patients who have had aerosol exposures might still have residual spores in their lungs even after treatment, oral postexposure prophylaxis is recommended as follows: for noncases (i.e., no treatment) without AVA, 60 d; with AVA for healthy adults 18–65 y, 14 d after the 3rd dose of AVA; with AVA for children <18 y, adults >65 y, pregnant women, and adults with underlying conditions, 60 d. For cases (i.e., following treatment) after finishing oral or intravenous treatment, patients exposed to aerosolized spores should finish out a 60-d course of antimicrobials (i.e., 60 d minus the duration of treatment) | Duration of therapy for naturally acquired cases, 7 d |
*Bold type indicates preferred agent. Nonbolded type indicates alternative selections, which are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable. †Based on in vitro susceptibility data, rather than studies of clinical efficacy.