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| __NOTOC__ | | __NOTOC__ |
| {{Yersinia pestis infection}} | | {{Yersinia pestis infection}} |
| {{CMG}}; '''Assistant Editors-In-Chief:''' [[Esther Lee, M.A.]]; {{JS}} | | {{CMG}}; '''Assistant Editors-In-Chief:''' [[Esther Lee, M.A.]]; {{JS}}; {{AJL}} |
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| ==Overview== | | ==Overview== |
| According to treatment experts, a patient diagnosed with suspected plague should be hospitalized and medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of [[lymph gland]], [[blood]], and [[sputum]] samples. [[Antibiotic]] treatment should begin as soon as possible after laboratory specimens are taken. Effective antibiotics are [[streptomycin]], [[gentamicin]] (used when streptomycin is not available), [[tetracyclines]] and [[chloramphenicol]]. (used for critically ill patients, or rarely for suspected neuro-involvement)
| | When a diagnosis of plague is suspected, appropriate specimens for diagnosis should be obtained immediately and antimicrobial therapy should be started. <ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref><ref>{{Cite book | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages = }}</ref> The drug of choice is either [[Streptomycin]] or [[Gentamicin]], but [[Tetracyclines]], [[Fluoroquinolones]], and [[Chloramphenicol]] may also be effective. The treatment regimen should be adjusted depending on the patient's age, medical history, underlying health conditions, and allergies.<ref name=CDC>{{cite web | title = Plague | url = http://www.cdc.gov/plague/healthcare/clinicians.html }}</ref> Upon evidence of [[pneumonia]], patients with suspected plague should be placed in isolation and managed under respiratory droplet precautions.<ref name="pmid8789689">{{cite journal| author=Garner JS| title=Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. | journal=Infect Control Hosp Epidemiol | year= 1996 | volume= 17 | issue= 1 | pages= 53-80 | pmid=8789689 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8789689 }} </ref>. Supportive therapy includes aggressive monitoring and management for the possibility of complications such as [[septic shock]], [[multiple organ failure]], [[acute respiratory distress syndrome]], and [[disseminated intravascular coagulopathy]]. |
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| ==Medical Therapy== | | ==Medical Therapy== |
| When a [[diagnosis]] of human plague is suspected on [[clinical]] and [[epidemiological]] grounds, appropriate specimens for [[diagnosis]] should be obtained immediately and the patient should be started on specific [[antibiotic|antimicrobial therapy]] without waiting for a definitive answer from the laboratory.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref><ref>{{Cite book | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages = }}</ref>
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| Suspect plague patients with evidence of pneumonia should be placed in isolation, and managed under respiratory droplet precautions.<ref name="pmid8789689">{{cite journal| author=Garner JS| title=Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. | journal=Infect Control Hosp Epidemiol | year= 1996 | volume= 17 | issue= 1 | pages= 53-80 | pmid=8789689 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8789689 }} </ref>
| | ====Antibiotic regimens==== |
| | :*1. ''' Plague treatment'''<ref>http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf</ref> |
| | ::* Preferred regimen (1): [[Streptomycin]] 2 g/day IM q12h for at least 10 days |
| | :::* Note: Pediatric dose: [[Streptomycin]] 30 mg/kg/day (up to 2 g/day) IM q6-12h for at least 10 days |
| | ::* Preferred regimen (2): [[Gentamicin]] 3 mg/kg/day IM or IV q8h for at least 10 days |
| | :::* Note: Pediatric dose: [[Gentamicin]] 6-7.5 mg/kg/day IM or IV q8h for at least 10 days - if neonates/infants use 7.5 mg/kg/day. |
| | ::* Alternative regimen (1): [[Chloramphenicol]] 50 mg/kg/day IV or PO q6h for 10 days |
| | ::* Alternative regimen (2): [[Tetracycline]] 2 g/day PO qid for 10 days |
| | :::* Note: Pediatric dose: [[Tetracycline]] 15 mg/kg of loading dose {{then}} 25-50 mg/kg/day (up to 2 g/day) PO qid for 10 days |
| | ::* Alternative regimen (3): [[Sulfadiazine]] 2-4 g loading dose {{then}} 1 g PO q4-6h |
| | ::* Alternative regimen (4): [[Doxycycline]] 200 mg/day PO q12-24h |
| | ::* Note (1): Fluoroquinolones have good effect against Y. pestis in both in vitro and animal studies, but no studies have been published on its use in treating human plague. |
| | ::* Note (2): Other antibiotics have been shown ineffective against plague. |
| | :* 2. '''Plague prophylaxis'''<ref>http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf</ref> |
| | ::* Preferred regimen: [[Tetracycline]] 1-2 g/day PO bid-qid |
| | :::* Note: Pediatric dose: [[Tetracycline]] 25-50 mg/kg/day (up to 2 g/day) PO qid for 10 days |
| | ::* Alternative regimen (1): [[Doxycycline]] 100-200 mg/day PO q12-24h |
| | ::* Alternative regimen (2): [[Sulfamethoxazole-Trimethoprim]] 1.6 g/day PO bid |
| | :::* Note: Pediatric dose: [[Sulfamethoxazole-Trimethoprim]] 40 mg/kg/day PO bid |
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| ===Specific Therapy=== | | ====Other Classes of Antibiotics==== |
| ====Aminoglycosides====
| | Other cases of [[antibiotics]], such as [[penicillins]], [[cephalosporins]], and [[macrolides]] have demonstrated to be ineffective or of variable effect in the treatment of plague and should not be used for this purpose.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref> |
| '''Streptomycin''' is the most effective [[antibiotic]] against [[Yersinia pestis]] and the [[drug]] of choice for treatment of [[plague]], particularly the pneumonic form. Therapeutic effect may be expected with ''30 mg/kg/day'' (up to a total of 2 g/day) in divided doses given [[intramuscularly]], to be continued for a full course of 10 days of therapy or until 3 days after the temperature has returned to normal.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref><ref>{{Cite book | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages = }}</ref><ref name="pmid13139207">{{cite journal| author=SMADEL JE, WOODWARD TE, AMIES CR, GOODNER K| title=Antibiotics in the treatment of bubonic and pneumonic plague in man. | journal=Ann N Y Acad Sci | year= 1952 | volume= 55 | issue= 6 | pages= 1275-84 | pmid=13139207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13139207 }} </ref><ref name="MeyerQuan1952">{{cite journal|last1=Meyer|first1=K. F.|last2=Quan|first2=S. F.|last3=McCrumb|first3=F. R.|last4=Larson|first4=A.|title=EFFECTIVE TREATMENT OF PLAGUE|journal=Annals of the New York Academy of Sciences|volume=55|issue=6|year=1952|pages=1228–1274|issn=00778923|doi=10.1111/j.1749-6632.1952.tb22687.x}}</ref><ref name="pmid1262715">{{cite journal| author=Butler T, Levin J, Linh NN, Chau DM, Adickman M, Arnold K| title=Yersinia pestis infection in Vietnam. II. Quantiative blood cultures and detection of endotoxin in the cerebrospinal fluid of patients with meningitis. | journal=J Infect Dis | year= 1976 | volume= 133 | issue= 5 | pages= 493-9 | pmid=1262715 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1262715 }} </ref>
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| '''Gentamicin''' has been found to be effective in animal studies, and is used to treat human plague patients.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref>
| | ==Supportive Therapy== |
| | Clinicians must prepare for intense supportive management of plague [[complications]], utilizing the latest developments for dealing with [[Gram-negative]] [[sepsis]].<ref name="WheelerBernard1999">{{cite journal|last1=Wheeler|first1=Arthur P.|last2=Bernard|first2=Gordon R.|title=Treating Patients with Severe Sepsis|journal=New England Journal of Medicine|volume=340|issue=3|year=1999|pages=207–214|issn=0028-4793|doi=10.1056/NEJM199901213400307}}</ref> Aggressive monitoring and management should be instituted for the possibility of:<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref> |
| | * [[Septic shock]] |
| | * [[Multiple organ failure]] |
| | * [[Adult respiratory distress syndrome]] ([[ARDS]]) |
| | * [[Disseminated intravascular coagulopathy]] |
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| ====Chloramphenicol==== | | ==Treatment of Plague During Pregnancy and in Children== |
| [[Chloramphenicol]] is a suitable alternative to [[aminoglycosides]] in the treatment of bubonic or septicaemic plague and is the drug of choice for treatment of patients with [[Yersinia pestis]] invasion of tissue spaces into which other drugs pass poorly or not at all (such as plague [[meningitis]], [[pleuritis]], or [[endophthalmitis]]. Dosage should be '''50 mg/kg/day''' administered in divided doses either parenterally or, if tolerated, orally for 10 days. [[Chloramphenicol]] may be used adjunctively with [[aminoglycosides]].<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref>
| | With prompt and proper therapy, [[complications]] of plague in [[pregnancy]] can be prevented. |
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| ====Tetracyclines====
| | The selection of [[antibiotics]] during [[pregnancy]] is confounded by the potential [[adverse effects]] of three of the most effective drugs: |
| This group of [[antibiotics]] is [[bacteriostatic]] but effective in the primary treatment of patients with uncomplicated plague. An oral loading dose of '''15 mg/kg''' tetracycline (not to exceed 1 g total) should be followed by '''25-50 mg/kg/day''' (up to a total of 2 g/day) for 10 days. [[Tetracyclines]] may also be used adjunctively with other [[antibiotics]].<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref>
| | * [[Streptomycin]] may be [[ototoxic]] and [[nephrotoxic]] to the [[fetus]]. |
| | | * [[Tetracycline]] has an [[adverse effect]] on the developing [[teeth]] and [[bones]] of a [[fetus]]. |
| ====Sulfonamides====
| | * [[Chloramphenicol]] carries a low risk of "[[Gray baby syndrome|gray baby]]" syndrome or [[bone marrow]] suppression. |
| [[Sulfonamides]] have been used extensively in plague treatment and [[prevention]]: however, some studies have shown higher [[mortality]], increased [[complications]], and longer duration of [[fever]] as compared with the use of [[streptomycin]], [[chloramphenicol]] or [[tetracycline]] [[antibiotics]]. [[Sulfadiazine]] is given as a loading dose of '''2-4 g''' followed by a dose of '''1 g every 4-6 hours for a period of 10 days'''. In children, the oral loading dose is '''75 mg/kg''', followed by '''150 mg/kg/day orally in six divided doses'''. The combination drug [[trimethoprim-sulfamethoxazole]] has been used both in treatment and prevention of plague.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref>
| | * A judiciously administered [[aminoglycoside]] is effective and safe for both the mother and [[fetus]], and in children. Because of its [[intravenous]] and [[intramuscular]] administration and its low risk of [[adverse effects]], [[gentamicin]] is the preferred [[antibiotic]] for treating plague during pregnancy.<ref name="pmid10807389">{{cite journal| author=Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E et al.| title=Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. | journal=JAMA | year= 2000 | volume= 283 | issue= 17 | pages= 2281-90 | pmid=10807389 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807389 }} </ref> |
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| ====Fluoroquinolones====
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| [[Fluoroquinolones]], such as [[ciprofloxacin]], have been shown to have good effect against [[Yersinia pestis|Y. pestis]] in both in vitro and animal studies. [[Ciprofloxacin]] is [[bacteriocidal]] and has broad spectrum activity against most [[Gram-negative]] [[aerobic bacteria]], including [[Enterobacteriaceae]] and [[Pseudomonas aeruginosa]], as well as against many [[Gram-positive bacteria]]. Although it has been used successfully to treat humans with [[Francisella tularensis]] infection, no studies have been published on its use in treating human plague.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref>
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| ====Other classes of antibiotics====
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| Other cases of [[antibiotics]], such as [[penicillins]], [[cephalosporins]], and [[macrolides]] have been shown to be ineffective or of variable effect in treatment of plague and they should not be used for this purpose.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref>
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| ==Treatment Regimen==
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| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL><ref>{{Cite journal | doi = 10.3201/eid2002.130687 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Hendricks | first = Katherine A. | coauthors = Mary E. Wright, Sean V. Shadomy, John S. Bradley, Meredith G. Morrow, Andy T. Pavia, Ethan Rubinstein, Jon-Erik C. Holty, Nancy E. Messonnier, Theresa L. Smith, Nicki Pesik, Tracee A. Treadwell, William A. Bower, Workgroup on Anthrax Clinical Guidelines | title = Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24447897 | pmc = PMC3901462 }}</ref><ref>{{Cite journal | doi = 10.1542/peds.2014-0563 | issn = 1098-4275 | last = Bradley | first = John S. | coauthors = Georgina Peacock, Steven E. Krug, William A. Bower, Amanda C. Cohn, Dana Meaney-Delman, Andrew T. Pavia, AAP COMMITTEE ON INFECTIOUS DISEASES and DISASTER PREPAREDNESS ADVISORY COUNCIL | title = Pediatric Anthrax Clinical Management | journal = Pediatrics | date = 2014-04-28 | pmid = 24777226 }}</ref><ref>{{Cite journal | doi = 10.3201/eid2002.130611 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Meaney-Delman | first = Dana | coauthors = Marianne E. Zotti, Andreea A. Creanga, Lara K. Misegades, Etobssie Wako, Tracee A. Treadwell, Nancy E. Messonnier, Denise J. Jamieson, Workgroup on Anthrax in Pregnant and Postpartum Women | title = Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24457117 | pmc = PMC3901460 }}</ref>
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| '''Systemic Anthrax with Possible/Confirmed Meningitis'''
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| '''Systemic Anthrax Without Meningitis'''
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| ▸ '''Adult Patients'''
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
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| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cutaneous Anthrax, Adult Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg PO q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600 mg PO q8h'''''<BR> OR <BR> ▸ '''''[[Penicillin VK]] 500 mg PO q6h'''''<BR> OR <BR> ▸ '''''[[Amoxicillin]] 1 g PO q8h'''''
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cutaneous Anthrax, Pediatric Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day PO q12h, max: 500 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 16 mg/kg/day PO q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg PO q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 4.4 mg/kg/day PO q12h, max: 100 mg/dose (<45 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg/dose PO q12h (≥45 kg)'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 600 mg/dose'''''<BR> OR <BR> ▸ '''''[[Penicillin VK]] 50–75 mg/kg/day PO q6–8h'''''<BR> OR <BR> ▸ '''''[[Amoxicillin]] 75 mg/kg/day PO q8h, max: 1 g/dose'''''
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cutaneous Anthrax, Pregnant Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax with Meningitis, Adult Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Imipenem]] 1 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 500 mg IV q8h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1 g IV q6–8h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1 g IV q6–8h'''''
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax with Meningitis, Pediatric Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day IV q8h, max: 400 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 20 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 60 mg/kg/day IV q12h, max: 2 g/dose'''''<BR> OR <BR> ▸ '''''[[Imipenem/Cilastatin]] 100 mg/kg/day IV q6h, max: 1 g/dose'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 60 mg/kg/day IV q8h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 600 mg/dose'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 1 g/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 4.4 mg/kg/day IV q12h, max: 100 mg/dose (<45 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg IV x1 then 100 mg IV q12h, max: 200 mg/dose (≥45 kg)'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 0.4 MU/kg/day IV q4h, max: 4 MU/dose'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6h, max: 900 mg/dose'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 600 mg/dose'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 1 g/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 4.4 mg/kg/day IV q12h, max: 100 mg/dose (<45 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg IV x1 then 100 mg IV q12h, max: 200 mg/dose (≥45 kg)'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose'''''
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax with Meningitis, Pregnant Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax Without Meningitis, Adult Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg q8h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g q8h'''''<BR> OR <BR> ▸ '''''[[Imipenem]] 1 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 500 mg q8h'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 60 mg/kg/day IV q8h, trough: 15–20 μg/mL'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg q8h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg x1 then 100 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg q8h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg x1 then 100 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg q12h'''''
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax Without Meningitis, Pediatric Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day IV q8h, max: 400 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 16 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 12 mg/kg/day IV q12h, max: 200 mg/dose (3 mo–2 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 10 mg/kg/day IV q12h, max: 200 mg/dose (2 yr–5 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (6 yr–11 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (12 yr–17 yr, <45 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h (12 yr–17 yr, ≥45 kg)'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 120 mg/kg/day IV q8h, max: 2 g/dose'''''<BR> OR <BR> ▸ '''''[[Imipenem/Cilastatin]] 100 mg/kg/day IV q6h, max: 1 g/dose'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 120 mg/kg/day IV q8h, max: 1 g/dose'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 60 mg/kg/day IV q8h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 600 mg/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 40 mg/kg/day IV q8h, max: 900 mg/dose'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 100 mg/kg/day IV q6h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day IV q8h, max: 400 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 16 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 12 mg/kg/day IV q12h, max: 200 mg/dose (3 mo–2 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 10 mg/kg/day IV q12h, max: 200 mg/dose (2 yr–5 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (6 yr–11 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (12 yr–17 yr, <45 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h (12 yr–17 yr, ≥45 kg)'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 0.4 MU/kg/day IV q4h, max: 4 MU/dose'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 400 mg/kg/day IV q6h, max: 3 g/dose'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 600 mg/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 40 mg/kg/day IV q8h, max: 900 mg/dose'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 100 mg/kg/day IV q6h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax Without Meningitis, Pregnant Patients}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h'''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''
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| ==Supportive therapy==
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| The clinician must prepare for intense supportive management of plague [[complications]], utilizing the latest developments for dealing with [[Gram-negative]] [[sepsis]].<ref name="WheelerBernard1999">{{cite journal|last1=Wheeler|first1=Arthur P.|last2=Bernard|first2=Gordon R.|title=Treating Patients with Severe Sepsis|journal=New England Journal of Medicine|volume=340|issue=3|year=1999|pages=207–214|issn=0028-4793|doi=10.1056/NEJM199901213400307}}</ref> Aggressive monitoring and management of possible [[septic shock]], [[multiple organ failure]], [[adult respiratory distress syndrome]] ([[ARDS]]) and [[disseminated intravascular coagulopathy]] should be instituted.<ref name="pmid10635759">{{cite journal| author=| title=Plague manual--epidemiology, distribution, surveillance and control. | journal=Wkly Epidemiol Rec | year= 1999 | volume= 74 | issue= 51-52 | pages= 447 | pmid=10635759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635759 }} </ref> | |
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| ==Treatment of plague during pregnancy and in children==
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| With correct and early therapy, [[complications]] of plague in [[pregnancy]] can be prevented.
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| The choice of [[antibiotics]] during [[pregnancy]] is confounded by the potential [[adverse effects]] of three of the most effective drugs.
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| * [[Streptomycin]] may be [[ototoxic]] and [[nephrotoxic]] to the [[fetus]] . | |
| * [[Tetracycline]] has an [[adverse effect]] on developing [[teeth]] and [[bones]] of the [[fetus]]. | |
| * [[Chloramphenicol]] carries a low risk of "[[Gray baby syndrome|gray baby]]" syndrome or [[bone marrow]] suppression. | |
| * An [[aminoglycoside]] judiciously administered is effective and safe for both mother and [[fetus]], and in children. Because of its safety, [[intravenous]] or [[intramuscular]] administration, and ability to have blood concentrations monitored, [[gentamicin]] is the preferred [[antibiotic]] for treating plague in pregnancy.<ref name="pmid10807389">{{cite journal| author=Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E et al.| title=Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. | journal=JAMA | year= 2000 | volume= 283 | issue= 17 | pages= 2281-90 | pmid=10807389 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807389 }} </ref> | |
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| Persons who have been in close contact with a plague patient, particularly a patient with plague pneumonia, should be identified and evaluated. The [[U.S. Public Health Service]] requires that all cases of suspected plague be reported immediately to local and state health departments and that the diagnosis be confirmed by [[CDC]]. As required by the International Health Regulations, [[CDC]] reports all U.S. plague cases to the [[World Health Organization]]. Early treatment of [[pneumonic plague]] is essential. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. Several types of [[antibiotics]] are effective for curing the disease and for preventing it.
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| Antibiotic treatment for 7 days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection. However, antibiotic treatment alone is insufficient for some patients, who may also require circulatory, ventilator, or [[kidney|renal]] support.
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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