Cutaneous Anthrax Without Systemic Involvement
Systemic Anthrax with Possible/Confirmed Meningitis
Systemic Anthrax Without Meningitis
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Cutaneous Anthrax, Pediatric Patients
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Preferred Regimen
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▸ Ciprofloxacin 30 mg/kg/day PO q12h, max: 500 mg/dose OR ▸ Levofloxacin 16 mg/kg/day PO q12h, max: 250 mg/dose (<50 kg) OR ▸ Levofloxacin 500 mg PO q24h (≥50 kg) OR ▸ Doxycycline 4.4 mg/kg/day PO q12h, max: 100 mg/dose (<45 kg) OR ▸ Doxycycline 100 mg/dose PO q12h (≥45 kg)
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Alternative Regimen
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▸ Clindamycin 30 mg/kg/day PO q8h, max: 600 mg/dose OR ▸ Penicillin VK 50–75 mg/kg/day PO q6–8h OR ▸ Amoxicillin 75 mg/kg/day PO q8h, max: 1 g/dose
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Cutaneous Anthrax, Pregnant Patients
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Preferred Regimen
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▸ Ciprofloxacin 500 mg PO q12h
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Systemic Anthrax with Meningitis, Pediatric Patients
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Preferred Regimen
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▸ Ciprofloxacin 30 mg/kg/day IV q8h, max: 400 mg/dose OR ▸ Levofloxacin 20 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg) OR ▸ Levofloxacin 500 mg IV q24h (≥50 kg) OR ▸ Meropenem 60 mg/kg/day IV q12h, max: 2 g/dose OR ▸ Imipenem/Cilastatin 100 mg/kg/day IV q6h, max: 1 g/dose OR ▸ Vancomycin 60 mg/kg/day IV q8h
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PLUS
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▸ Clindamycin 30 mg/kg/day PO q8h, max: 600 mg/dose OR ▸ Linezolid 30 mg/kg/day IV q8h, max: 1 g/dose (<12 yr) OR ▸ Linezolid 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr) OR ▸ Doxycycline 4.4 mg/kg/day IV q12h, max: 100 mg/dose (<45 kg) OR ▸ Doxycycline 200 mg IV x1 then 100 mg IV q12h, max: 200 mg/dose (≥45 kg) OR ▸ Rifampin 20 mg/kg/day IV q12h, max: 300 mg/dose
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Alternative Regimen
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▸ Penicillin G 0.4 MU/kg/day IV q4h, max: 4 MU/dose OR ▸ Ampicillin 200 mg/kg/day IV q6h, max: 900 mg/dose
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PLUS
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▸ Clindamycin 30 mg/kg/day PO q8h, max: 600 mg/dose OR ▸ Linezolid 30 mg/kg/day IV q8h, max: 1 g/dose (<12 yr) OR ▸ Linezolid 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr) OR ▸ Doxycycline 4.4 mg/kg/day IV q12h, max: 100 mg/dose (<45 kg) OR ▸ Doxycycline 200 mg IV x1 then 100 mg IV q12h, max: 200 mg/dose (≥45 kg) OR ▸ Rifampin 20 mg/kg/day IV q12h, max: 300 mg/dose
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Systemic Anthrax Without Meningitis, Pediatric Patients
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Preferred Regimen
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▸ Ciprofloxacin 30 mg/kg/day IV q8h, max: 400 mg/dose OR ▸ Levofloxacin 16 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg) OR ▸ Levofloxacin 500 mg IV q24h (≥50 kg) OR ▸ Moxifloxacin 12 mg/kg/day IV q12h, max: 200 mg/dose (3 mo–2 yr) OR ▸ Moxifloxacin 10 mg/kg/day IV q12h, max: 200 mg/dose (2 yr–5 yr) OR ▸ Moxifloxacin 8 mg/kg/day IV q12h, max: 200 mg/dose (6 yr–11 yr) OR ▸ Moxifloxacin 8 mg/kg/day IV q12h, max: 200 mg/dose (12 yr–17 yr, <45 kg) OR ▸ Moxifloxacin 400 mg IV q24h (12 yr–17 yr, ≥45 kg)
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PLUS
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▸ Meropenem 120 mg/kg/day IV q8h, max: 2 g/dose OR ▸ Imipenem/Cilastatin 100 mg/kg/day IV q6h, max: 1 g/dose OR ▸ Doripenem 120 mg/kg/day IV q8h, max: 1 g/dose OR ▸ Vancomycin 60 mg/kg/day IV q8h
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PLUS
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▸ Linezolid 30 mg/kg/day IV q8h, max: 600 mg/dose (<12 yr) OR ▸ Linezolid 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr) OR ▸ Clindamycin 40 mg/kg/day IV q8h, max: 900 mg/dose OR ▸ Rifampin 20 mg/kg/day IV q12h, max: 300 mg/dose OR ▸ Chloramphenicol 100 mg/kg/day IV q6h
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Alternative Regimen
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▸ Ciprofloxacin 30 mg/kg/day IV q8h, max: 400 mg/dose OR ▸ Levofloxacin 16 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg) OR ▸ Levofloxacin 500 mg IV q24h (≥50 kg) OR ▸ Moxifloxacin 12 mg/kg/day IV q12h, max: 200 mg/dose (3 mo–2 yr) OR ▸ Moxifloxacin 10 mg/kg/day IV q12h, max: 200 mg/dose (2 yr–5 yr) OR ▸ Moxifloxacin 8 mg/kg/day IV q12h, max: 200 mg/dose (6 yr–11 yr) OR ▸ Moxifloxacin 8 mg/kg/day IV q12h, max: 200 mg/dose (12 yr–17 yr, <45 kg) OR ▸ Moxifloxacin 400 mg IV q24h (12 yr–17 yr, ≥45 kg)
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PLUS
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▸ Penicillin G 0.4 MU/kg/day IV q4h, max: 4 MU/dose OR ▸ Ampicillin 400 mg/kg/day IV q6h, max: 3 g/dose
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PLUS
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▸ Linezolid 30 mg/kg/day IV q8h, max: 600 mg/dose (<12 yr) OR ▸ Linezolid 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr) OR ▸ Clindamycin 40 mg/kg/day IV q8h, max: 900 mg/dose OR ▸ Rifampin 20 mg/kg/day IV q12h, max: 300 mg/dose OR ▸ Chloramphenicol 100 mg/kg/day IV q6h
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