Bacillus anthracis: Difference between revisions

Bacillus anthracis
	Photomicrograph of Bacillus anthracis (fuchsin-methylene blue spore stain).; Photomicrograph of Bacillus anthracis (fuchsin-methylene blue spore stain).
Scientific classification
Kingdom:	Bacteria;
Phylum:	Firmicutes;
Class:	Bacilli;
Order:	Bacillales;
Family:	Bacillaceae;
Genus:	Bacillus;
Species:	B. anthracis;
Binomial name
	Bacillus anthracis; Cohn 1872

← Older edit Newer edit →

VisualWikitext

Revision as of 18:05, 28 July 2015

File:B anthracis diagram en.png

Structure of Bacillus anthracis.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]

Overview

Bacillus anthracis is a Gram-positive, facultatively anaerobic, rod-shaped bacterium of the genus Bacillus. An endospore forming bacterium, B. anthracis is a natural soil-dwelling organism, as well as the causative agent of anthrax.^[1]

Each cell is about 1 by 6 μm in size.

Historical background

B. anthracis was the first bacterium conclusively demonstrated to cause disease, by Robert Koch in 1877.^[2] The species name anthracis is from the Greek anthrakis (ἄνθραξ), meaning coal and referring to the most common form of the disease, cutaneous anthrax, in which large black skin lesions are formed.

Pathogenicity

Under conditions of environmental stress, B. anthracis bacteria naturally produce endospores which rest in the soil and can survive for decades in this state. When ingested by a cattle, sheep, or other herbivores, the bacteria begin to reproduce inside the animal and eventually kill it, then continue to reproduce in its carcass. Once the nutrients are exhausted, new endospores are produced and the cycle repeats.^[3]

B. anthracis has at least 89 known strains, ranging from highly virulent strains with biological warfare and bioterrorism applications (Ames and Vollum) to benign strains used for inoculations (Sterne). The strains differ in presence and activity of various genes, determining their virulence and production of antigens and toxins. The form associated with the 2001 anthrax attacks produced both toxin (consisting of three proteins: the protective antigen, the edema factor and the lethal factor) and a capsule (consisting of a polymer of glutamic acid). Infection with anthrax requires the presence of all three of these exotoxins.^[4]

The bacterium can be cultivated in ordinary nutrient medium under aerobic or anaerobic conditions.

Treatment

Infections with B. anthracis can be treated with β-lactam antibiotics such as penicillin, and others which are active against Gram-positive bacteria.^[5]

Treatment

Antimicrobial therapy

Bacillus anthracis treatment

1. Treatment for cutaneous anthrax, without systemic involvement^[6]

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (1): Ciprofloxacin 500 mg PO bid for 7-10 days

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (2): Doxycycline 100 mg PO bid for 7-10 days

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (3): Levofloxacin 750 mg PO qd for 7-10 days

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (4): Moxifloxacin 400 mg PO qd for 7-10 days

Alternative regimen (1): Clindamycin 600 mg PO tid for 7-10 days

Alternative regimen (2): Amoxicillin 1 g PO tid (for penicillin-susceptible strains) for 7-10 days

Alternative regimen (3): Penicillin VK 500 mg PO qid (for penicillin-susceptible strains) for 7-10 days

Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.

2. Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck^[6]

2.1 Systemic anthrax with possible/confirmed meningitis

2.1.1 Bactericidal agent (fluoroquinolone)

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h for 2-3 weeks

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2-3 weeks

Preferred regimen (3): Moxifloxacin 400 mg IV q24h for 2-3 weeks AND

2.1.2 Bactericidal agent (ß-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Meropenem 2 g IV q8h for 2-3 weeks

Preferred regimen (2): Imipenem 1 g IV q6h for 2-3 weeks

Preferred regimen (3): Doripenem 500 mg IV q8h for 2-3 weeks

Preferred regimen (4): Penicillin G 4 MU IV q4h (for penicillin-susceptible strains) for 2-3 weeks

Preferred regimen (5): Ampicillin 3 g IV q6h (for penicillin-susceptible strains) for 2-3 weeks AND

2.1.3 Protein synthesis inhibitor

Preferred regimen (1): Linezolid 600 mg IV q12h for 2-3 weeks

Preferred regimen (2): Clindamycin 900 mg IV q8h for 2-3 weeks

Preferred regimen (3): Rifampin 600 mg IV q12h for 2-3 weeks

Preferred regimen (4): Chloramphenicol 1 g IV q6-8h for 2-3 weeks

Note (1): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.

Note (2): Increased risk for seizures associated with Imipenem/Cilastatin treatment.

Note (3): Linezolid should be used with caution in patients with thrombocytopenia because it might exacerbate it. Linezolid use for > 14 days has additional hematopoietic toxicity.

Note (4): Rifampin is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.

2.2 Systemic anthrax when meningitis has been excluded

2.2.1 Bactericidal agent

Preferred regimen (1): Ciprofloxacin 400 mg IV q8hfor 2 weeks

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2 weeks

Preferred regimen (3): Moxifloxacin 400 mg q24h for 2 weeks

Preferred regimen (4): Meropenem 2 g IV q8h for 2 weeks

Preferred regimen (5): Imipenem 1 g IV q6h for 2 weeks

Preferred regimen (6): Doripenem 500 mg IV q8h for 2 weeks

Preferred regimen (7): Vancomycin 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) for 2 weeks

Preferred regimen (8): Penicillin G 4 MU IV q4h (penicillin-susceptible strains) for 2 weeks

Preferred regimen (9): Ampicillin 3 g IV q6h (penicillin-susceptible strains) for 2 weeks AND

2.2.2 Protein synthesis inhibitor

Preferred regimen (1): Clindamycin 900 mg IV q8h for 2 weeks

Preferred regimen (2): Linezolid 600 mg IV q12h for 2 weeks

Preferred regimen (3): Doxycycline 200 mg IV initially, then 100 mg IV q12h for 2 weeks

Preferred regimen (4): Rifampin 600 mg IV q12h for 2 weeks

Note: Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.

3. Specific considerations

3.1 Treatment of anthrax for pregnant Women

3.1.1 Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis ^[7]

3.1.1.1 A bactericidal agent (fluoroquinolone)

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h for 2–3 weeks

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2–3 weeksOR

3.1.1.2 A bactericidal agent (ß-lactam)

3.1.1.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen: Meropenem 2 g q8h for 2–3 weeks

3.1.1.2.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Ampicillin 3 g IV q6h for 2–3 weeks

Alternative regimen (2): Penicillin G 4 MU IV q4h for 2–3 weeks OR

3.1.1.3 A protein synthesis Inhibitor

Preferred regimen (1): Clindamycin 900 IV mg q8h for 2–3 weeks

Preferred regimen (2): Rifampin 600 IV mg q12h for 2–3 weeks

Note: At least one antibiotic with transplacental passage is recommended.

3.1.2 Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded

3.1.2.1 A bactericidal Antimicrobial

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h for 2 weeks

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2 weeks OR

3.1.2.2 A bactericidal Agent (ß-lactam)

3.1.2.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen: Meropenem 2 g q8h for 2 weeks OR

3.1.2.2.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Ampicillin 3 g IV q6h for 2 weeks

Alternative regimen (2): Penicillin G 4 MU IV q4h for 2 weeks OR

3.1.2.3 A protein synthesis inhibitor

Preferred regimen (1): Clindamycin 900 IV mg q8h for 2 weeks

Preferred regimen (2): Rifampin 600 IV mg q12h for 2 weeks

3.1.3 Oral antimicrobial treatment for cutaneous anthrax without systemic involvement

3.1.3.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen: Ciprofloxacin 400 mg IV q8h

Note: Duration of treatment is 60 days

3.2 Treatment for anthrax in childern ^[8]

3.2.1 Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)

3.2.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid (not to exceed 500 mg/dose) for 7-10 days

Preferred regimen (2):

If patients body weight is < 45 kg: Doxycycline 4.4 mg/kg/day PO bid (not to exceed 100 mg/dose) for 7-10 days

If patients body weight is = 45 kg: Doxycycline 100 mg/dose PO bid for 7-10 days

Preferred regimen (3): Clindamycin 30 mg/kg/day PO tid (not to exceed 600 mg/dose) for 7-10 days

Preferred regimen (4):

If patients body weight is < 50 kg: Levofloxacin 16 mg/kg/day PO bid (not to exceed 250 mg/dose) for 7-10 days

If patients body weight is > 50 kg: Levofloxacin 500 mg PO qd for 7-10 days

3.2.1.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1):Amoxicillin 75 mg/kg/day PO tid (not to exceed 1 g/dose) for 7-10 days

Alternative regimen (2): Penicillin VK 50-75 mg/kg/day PO tid or qid for 7-10 days

3.2.2 Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)

3.2.2.1 A bactericidal antimicrobial

3.2.2.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose) for 14 days

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 14 days

Preferred regimen (3):

If patients body weight is < 50 kg: Levofloxacin 20 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 14 days

If patients body weight is > 50 kg: Levofloxacin 500 mg IV q24h for 14 days

Preferred regimen (4): Imipenem/Cilastatin 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 14 days

Preferred regimen (5): Vancomycin 60 mg/kg/day IV divided q8h (follow serum concentrations) for 14 days

3.2.2.1.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Penicillin G 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose) for 14 days

Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 14 days AND

3.2.2.2 A protein synthesis inhibitor

Preferred regimen (1): Clindamycin, 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose) for 14 days

Preferred regimen (2): (non-CNS infection dose)

If patient is < 12 y old: Linezolid 30 mg/kg/day IV divided q8h for 14 days

If patient is = 12 y old: Linezolid 30 mg/kg/day IV divided q12h (not to exceed 600 mg/dose) for 14 days

Preferred regimen (3):

If patients body weight is < 45 kg: Doxycycline 4.4 mg/kg/day IV loading dose (not to exceed 200 mg) THEN Doxycycline 4.4 mg/kg/day IV divided q12h (not to exceed 100 mg/dose) for 14 days

If patients body weight is =45 kg: Doxycycline 200 mg IV loading dose THEN Doxycycline 100 mg IV given q12h for 14 days

Preferred regimen (4): Rifampin 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 14 days

Note: Duration of therapy for 14 days or longer until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.

3.2.3 Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older

3.2.3.1 A bactericidal antimicrobial (fluoroquinolone)

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose) for 2–3 wks

Preferred regimen (2):

If patients body weight is < 50 kg: Levofloxacin 16 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 2–3 wks

If patients body weight is > 50 kg: Levofloxacin 500 mg IV q24h for 2–3 wks

Preferred regimen (3):

If patients age is 3 months to < 2 years: Moxifloxacin 12 mg/kg/day IV, divided q12h (not to exceed 200 mg/dose) for 2–3 wks

If patients age is 2-5 years: Moxifloxacin 10 mg/kg/day IV divided q1h (not to exceed 200 mg/dose) for 2–3 wks

If patients age is 6–11 years: Moxifloxacin 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks

If patients age is 12–17 years, = 45 kg body weight: Moxifloxacin 400 mg IV q24h for 2–3 wks

If patients age is 12–17 years, < 45 kg body weight: Moxifloxacin 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks AND

3.2.3.2 A bactericidal antimicrobial (ß-lactam or glycopeptide)

3.2.3.2.1 For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown:

Preferred regimen (1): Meropenem 120 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 2–3 wks

Preferred regimen (2): Imipenem/Cilastatin 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 2–3 wks

Preferred regimen (3): Doripenem 120 mg/kg/day IV divided q8h (not to exceed 1 g/dose) for 2–3 wks

Preferred regimen (4): Vancomycin 60 mg/kg/day IV divided q8h for 2–3 wks

3.2.3.2.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Penicillin G 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose) for 2–3 wks

Alternative regimen (2): Ampicillin 400 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 2–3 wks AND

3.2.3.3 A protein synthesis inhibitor

Preferred regimen (1):

If patients age is < 12 y old: Linezolid 30 mg/kg/day IV divided q8h for 2–3 wk

If patients age is = 12 y old: Linezolid 30 mg/kg/day,IV divided q12h (not to exceed 600 mg/dose) for 2–3 wk

Preferred regimen (2): Clindamycin 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose) for 2–3 wk

Preferred regimen (3): Rifampin 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 2–3 wk

Preferred regimen (4): Chloramphenicol 100 mg/kg/day IV divided q6h for 2–3 wk

Note (1): Duration of therapy for 2–3 wk or greater, until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.

Note (2): A 400-mg dose of Ciprofloxacin IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.

3.2.4 Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)

3.2.4.1 A bactericidal antimicrobial

3.2.4.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid (not to exceed 500 mg/dose)

Preferred regimen (2):

If patients body weight is < 50 kg: Levofloxacin 16 mg/kg/day PO bid (not to exceed 250 mg/dose)

If patients body weight is = 50 kg: Levofloxacin 500 mg PO qd

3.2.4.1.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid (not to exceed 1 g/dose)

Alternative regimen (2): Penicillin VK 50–75 mg/kg/day PO tid or qds AND

3.2.4.2 A protein synthesis inhibitor:

Preferred regimen (1):Clindamycin 30 mg/kg/day PO tid (not to exceed 600 mg/dose)

Preferred regimen (2):

If the patients body weight is < 45 kg: Doxycycline 4.4 mg/kg/day PO bid (not exceed 100 mg/dose)

If the patients body weight is = 45 kg: Doxycycline 100 mg PO bid

Preferred regimen (3): (non-CNS infection dose):

If the patients age is < 12 yrs old: Linezolid 30 mg/kg/day PO tid

If the patients age is = 12 yrs old: Linezolid 30 mg/kg/day PO bid (not to exceed 600 mg/dose)

Note: Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.

3.2.5 Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)

3.2.5.1 Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)

3.2.5.1.1 Bactericidal antimicrobial (fluoroquinolone) therapy

3.2.5.1.1.1 For 32–34 weeks gestational age

For 0–1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

For 1–4 weeks of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

3.2.5.1.1.2 For 34–37 week gestational age

For 0–1 wk of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2):Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

For 1–4 wk of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

3.2.5.1.1.3 Term newborn infant

For 0–1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 10 mg/kg/day IV q24h for 2–3 weeks

For 1–4 weeks of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 10 mg/kg/day IV q24h for 2–3 weeks AND

3.2.5.1.2 A bactericidal antimicrobial (ß-lactam)

3.2.5.1.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown:

3.2.5.1.2.1.1 For 32–34 weeks gestational age

For 0–1 week of Age :

Preferred regimen (1): Meropenem 60 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 50 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Doripenem 20 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 wk of Age :

Preferred regimen (1): Meropenem 90 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 75 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Doripenem 30 mg/kg/day IV divided q8h for 2–3 weeks

3.2.5.1.2.1.2 For 34–37 week gestational age

For 0–1 week of Age :

Preferred regimen (1): Meropenem 60 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 50 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Doripenem 20 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of Age :

Preferred regimen (1): Meropenem 90 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 75 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Doripenem 30 mg/kg/day IV divided q8h for 2–3 weeks

3.2.5.1.2.1.3 Term newborn infant

For < 1 week of age

Preferred regimen (1):Meropenem 60 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 50 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Doripenem 20 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1):Meropenem 90 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 75 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Doripenem 30 mg/kg/day IV divided q8h for 2–3 weeks

3.2.5.1.2.2 Alternatives for penicillin-susceptible strains

3.2.5.1.2.2.1 For 32–34 weeks gestational age

For 0–1 week of age

Alternative regimen (1):Penicillin G 200000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 100 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age :

Alternative regimen (1): Penicillin G 300000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day divided IV q12h for 2–3 weeks

3.2.5.1.2.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Penicillin G 300000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q12h for 2–3 weeks

3.2.5.1.2.2.3 Term newborn infant

For 0–1 week of age

Alternative regimen (1): Penicillin G 300000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q12h for 2–3 weeks AND

3.2.5.1.3 A protein synthesis inhibitor

3.2.5.1.3.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Linezolid 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Clindamycin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 25 mg/kg/day IV q24h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 50 mg/kg/day IV q12h for 2–3 weeks

3.2.5.1.3.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 25 mg/kg/day IV q24h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1):Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 50 mg/kg/day IV q12h for 2–3 weeks

3.2.5.1.3.3 Term newborn infant

For < 1 week of age

Preferred regimen (1):Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 25 mg/kg/day IV q24h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 weeks

Preferred regimen (3): Rifampin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 50 mg/kg/day IV q12h for 2–3 weeks

Note :Duration of therapy for 2–3 weeks, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.

3.2.5.2 Therapy for severe anthrax when meningitis can be ruled out

3.2.5.2.1 A bactericidal antimicrobial

3.2.5.2.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.2.1.1.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 40 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 40 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 50 mg/kg/day IV divided q12h for 2-3 weeks

3.2.5.2.1.1.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 50 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 75 mg/kg/day IV divided q8h for 2-3 weeks

3.2.5.2.1.1.3 Term newborn infant

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 50 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Preferred regimen (1):Ciprofloxacin 30 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 75 mg/kg/day IV divided q8h for 2-3 weeks

Vancomycin IV (dosing based on serum creatinine for infants of 32 wk gestational age). Follow vancomycin serum concentrations to modify dose.

If Serum creatinine < 0.7 then Vancomycin 15 mg/kg/dose IV q12h for 2-3 weeks

If Serum creatinine 0.7 -0.9 then Vancomycin 20 mg/kg/dose IV q24h for 2-3 weeks

If Serum creatinine 1–1.2 then Vancomycin 15 mg/kg/dose IV q24h for 2-3 weeks

If Serum creatinine 1.3–1.6 then Vancomycin 10 mg/kg/dose IV q24h for 2-3 weeks

If Serum creatinine > 1.6 then Vancomycin mg/kg/dose IV q48h for 2-3 weeks

Note: Begin treatment with a 20 mg/kg loading dose OR

3.2.5.2.1.2 Alternatives for penicillin-susceptible strains

3.2.5.2.1.2.1 For 32–34 weeks gestational age

For < 1 week of age

Alternative regimen (1): Penicillin G 200000 U/kg/day IV divided q12h for 2-3 weeks

Alternative regimen (2): Ampicillin 100 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 300000 U/kg/day IV divided q8h for 2-3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q8h for 2-3 weeks

3.2.5.2.1.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Penicillin G 300000 U/kg/day IV divided q8h for 2-3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q8h for 2-3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 U/kg/day IV divided q6h for 2-3 weeks
Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q6h for 2-3 weeks

3.2.5.2.1.2.3 Term newborn infant

For < 1 week of age

Alternative regimen (1): Penicillin G 300000 U/kg/day IV divided q8h for 2-3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q8h for 2-3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 U/kg/day IV divided q6h for 2-3 weeks

Alternative regimen (2):Ampicillin 200 mg/kg/day IV divided q6h for 2-3 weeks

3.2.5.2.2 A protein synthesis inhibitor

3.2.5.2.2.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 10 mg/kg/day IV divided q12h for 2–3 wks

Preferred regimen (2): Linezolid 20 mg/kg/day IV divided q12h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

For 1–4 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

3.2.5.2.2.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

For 1–4 week of age

Preferred regimen (1): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

3.2.5.2.2.3 Term newborn infant

For 0–1 week of age :

Preferred regimen (1): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Doxycycline 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks

Preferred regimen (4): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

For 1–4 week of age :

Preferred regimen (1): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Doxycycline 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks

Preferred regimen (4): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

Note: Duration of therapy for 2–3 wks, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness

3.2.5.3 Oral follow-up combination therapy for severe anthrax

3.2.5.3.1 A bactericidal antimicrobial

3.2.5.3.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.3.1.1.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

3.2.5.3.1.1.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

3.2.5.3.1.1.3 Term newborn infant

For < 1 week of age

Preferred regimen: Ciprofloxacin 30 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen: Ciprofloxacin 30 mg/kg/day PO bid OR

3.2.5.3.1.2 Alternatives for penicillin-susceptible strains

3.2.5.3.1.2.1 For 32–34 weeks gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 75 mg/kg/day PO bid

3.2.5.3.1.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1):Amoxicillin 75 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid

3.2.5.3.1.2.3 Term newborn infant

For < 1 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid
Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid or qid

3.2.5.3.2 A protein synthesis inhibitor

3.2.5.3.2.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 10 mg/kg/day PO bid

Preferred regimen (2): Linezolid 20 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen (1):Clindamycin 15 mg/kg/day PO bid

Preferred regimen (2):Linezolid 30 mg/kg/day PO bid

3.2.5.3.2.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day PO tid

Preferred regimen (2): Linezolid 30 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1): Clindamycin 20 mg/kg/day PO qid

Preferred regimen (2): Linezolid 30 mg/kg/day PO tid

3.2.5.3.2.3 Term newborn infant

For < 1 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day PO tid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
Preferred regimen (3): Linezolid 30 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1): Clindamycin 20 mg/kg/day PO qid
Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
Preferred regimen (3): Linezolid 30 mg/kg/day PO tid

Note: Duration of therapy to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.

3.2.5.4 Treatment of cutaneous anthrax without systemic involvement

3.2.5.4.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.4.1.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 10 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen (1):Ciprofloxacin 20 mg/kg/day PO bid
Preferred regimen (2):Clindamycin 15 mg/kg/day PO tid

3.2.5.4.1.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 15 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 20 mg/kg/day PO qid

3.2.5.4.1.3 Term newborn infant

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 15 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1):Ciprofloxacin 30 mg/kg/day PO bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 20 mg/kg/day PO qid

3.2.5.4.2 Alternatives for penicillin-susceptible strains

3.2.5.4.2.1 For 32–34 weeks gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid
Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid

3.2.5.4.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid
Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO bid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO bid

3.2.5.4.2.3 Term newborn infant

For < 1 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid
Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid or qid
Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.

Bacillus anthracis, postexposure prophylaxis

1. For adults^[6]

1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 500 mg IV q12h

Preferred regimen (2): Doxycycline 100 mg IV q12h

Preferred regimen (3): Levofloxacin 750 mg IV q24h

Preferred regimen (4): Moxifloxacin 400 mg IV q24h

Preferred regimen (5): Clindamycin 600 mg IV q8h

1.2 Alternatives for penicillin-susceptible strain

Preferred regimen (1): Amoxicillin 1 g IV q8h

Preferred regimen (2): Penicillin VK 500 mg IV q6h

2. For children = 1 month^[8]

2.1 For penicillin-resistant strains or prior to susceptibility testing

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid (not to exceed 500 mg/dose)

Preferred regimen (2):

If patients body weight < 45 kg: Doxycycline 4.4 mg/kg/day PO bid (not to exceed 100 mg/dose)

If patients body weight > 45 kg: Doxycycline 100 mg/dose PO bid

Preferred regimen (3): Clindamycin 30 mg/kg/day PO tid (not to exceed 900 mg/dose)

Preferred regimen (4):

If patients body weight < 50 kg: Levofloxacin 16 mg/kg/day PO bid (not to exceed 250 mg/dose)

If patients body weight > 50 kg: Levofloxacin 500 mg PO qd

2.2 For penicillin-susceptible strains

Preferred regimen (1): Amoxicillin 75 mg/kg/day PO tid (not to exceed 1 g/dose)

Preferred regimen (2): Penicillin VK 50-75 mg/kg/day PO bid or tid

Note: Duration of Therapy is 60 days after exposure

3. For children < 1 month

3.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.1.1 For 32–34 weeks gestational age

3.1.1.1 For < 1 week of Age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 10 mg/kg/day PO bid

3.1.1.2 For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 15 mg/kg/day PO tid

3.1.2 For 34–37 week gestational age

3.1.2.1 For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 15 mg/kg/day PO tid

3.1.2.2 For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 20 mg/kg/day PO tid

3.1.3 Term newborn infant

3.1.3.1 For < 1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 15 mg/kg/day PO tid

3.1.3.2 For 1–4 week of Age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 20 mg/kg/day PO qid

3.2 Alternatives for penicillin-susceptible strains

3.2.1 For 32–34 weeks gestational age

3.2.1.1 For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid

Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid

3.2.1.2 For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid

3.2.2 For 34–37 week gestational age

3.2.2.1 For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid

Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid

3.2.2.2 For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid

3.2.3 Term newborn infant

3.2.3.1 For < 1 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid

3.2.3.2 For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO bid or tid

Note: Duration of therapy is 60 days from exposure

References

↑ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. ISBN 0-8385-8529-9.
↑ Madigan M, Martinko J (editors). (2005). Brock Biology of Microorganisms (11th ed. ed.). Prentice Hall. ISBN 0-13-144329-1.CS1 maint: Extra text (link)
↑ Turnbull PCB (1996). Bacillus. In: Barron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.CS1 maint: Extra text (link)
↑ Dixon TC, Meselson M, Guillemin J, Hanna PC (1999). "Anthrax". N. Engl. J. Med. 341 (11): 815–26. PMID 10477781.
↑ Barnes JM (1947). "Penicillin and B. anthracis". J Path Bacteriol. 194: 113.
↑ ^6.0 ^6.1 ^6.2 Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.
↑ Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA; et al. (2014). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130611. PMC 3901460. PMID 24457117.
↑ ^8.0 ^8.1 Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D; et al. (2014). "Pediatric anthrax clinical management". Pediatrics. 133 (5): e1411–36. doi:10.1542/peds.2014-0563. PMID 24777226.

Gallery

Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]
Bacillus anthracis. From Public Health Image Library (PHIL). ^[1]

References

↑ ^1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 "Public Health Image Library (PHIL)".

Template:WikiDoc Sources

[Sherris-1] Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. ISBN 0-8385-8529-9.

[Brock-2] Madigan M, Martinko J (editors). (2005). Brock Biology of Microorganisms (11th ed. ed.). Prentice Hall. ISBN 0-13-144329-1.CS1 maint: Extra text (link)

[Baron-3] Turnbull PCB (1996). Bacillus. In: Barron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.CS1 maint: Extra text (link)

[4] Dixon TC, Meselson M, Guillemin J, Hanna PC (1999). "Anthrax". N. Engl. J. Med. 341 (11): 815–26. PMID 10477781.

[5] Barnes JM (1947). "Penicillin and B. anthracis". J Path Bacteriol. 194: 113.

[pmid24447897-6] 6.0 ^6.1 ^6.2 Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.

[pmid24457117-7] Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA; et al. (2014). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130611. PMC 3901460. PMID 24457117.

[pmid24777226-8] 8.0 ^8.1 Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D; et al. (2014). "Pediatric anthrax clinical management". Pediatrics. 133 (5): e1411–36. doi:10.1542/peds.2014-0563. PMID 24777226.

[PHIL-9] 1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 "Public Health Image Library (PHIL)".

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[1]

@@ Line 42: / Line 42: @@
 ===Antimicrobial therapy===
-:* [[Bacillus anthracis]], treatment
+:*  '''Bacillus anthracis treatment'''
-::* (A) '''Treatment for cutaneous anthrax, without systemic involvement'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown): [[Ciprofloxacin]] 500 mg PO q12h {{or}} [[Doxycycline]] 100 mg PO q12h {{or}} [[Levofloxacin]] 750 mg PO q24h {{or}} [[Moxifloxacin]] 400 mg PO q24h
-:::* Alternative regimen: [[Clindamycin]] 600 mg PO q8h {{or}} [[Amoxicillin]] 1 g PO q8h (for penicillin-susceptible strains) {{or}} [[Penicillin VK]] 500 mg PO q6h (for penicillin-susceptible strains)
-:::: Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.
-::* (B) '''Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
+::* 1. '''Treatment for cutaneous anthrax, without systemic involvement'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-:::* (B-1) '''Systemic anthrax with possible/confirmed meningitis'''
-::::* (1) Bactericidal agent (fluoroquinolone): '''[[Ciprofloxacin]] 400 mg IV q8h''' ({{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h) {{and}}
-::::* (2) Bactericidal agent (β-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Meropenem]] 2 g IV q8h''' {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Penicillin G]] 4 MU IV q4h (for penicillin-susceptible strains) {{or}} [[Ampicillin]] 3 g IV q6h (for penicillin-susceptible strains) {{and}}
-::::* (3) Protein synthesis inhibitor: '''[[Linezolid]] 600 mg IV q12h''' {{or}} [[Clindamycin]] 900 mg IV q8h {{or}} [[Rifampin]] 600 mg IV q12h {{or}} [[Chloramphenicol]] 1 g IV q6-8h
-::::: Note (1): Duration of treatment: ≥ 2-3 weeks until clinical criteria for stability are met (Preferred drugs are indicated in boldface).
-::::: Note (2): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-::::: Note (3): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
-::::: Note (4): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
-::::: Note (5): [[Linezolid]] should be used with caution in patients with thrombocytopenia because it might exacerbate it. [[Linezolid]] use for > 14 days has additional hematopoietic toxicity.
-::::: Note (6): [[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
-::::: Note (7): [[Chloramphenicol]] should only be used if other options are not available because of toxicity concerns.
-:::* (B-2) '''Systemic anthrax when meningitis has been excluded'''
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (1): [[Ciprofloxacin]] 500 mg PO bid for 7-10 days
-::::* (1) Bactericidal agent: '''[[Ciprofloxacin]] 400 mg IV q8h''' {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg q24h {{or}} [[Meropenem]] 2 g IV q8h {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Vancomycin]] 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) {{or}} [[Penicillin G]] 4 MU IV q4h (penicillin-susceptible strains) {{or}} [[Ampicillin]] 3 g IV q6h (penicillin-susceptible strains) {{and}}
-::::* (2) Protein synthesis inhibitor: '''[[Clindamycin]] 900 mg IV q8h''' {{or}} '''[[Linezolid]] 600 mg IV q12h''' {{or}} [[Doxycycline]] 200 mg IV initially, then 100 mg IV q12h {{or}} [[Rifampin]] 600 mg IV q12h
-::::: Note (1): Duration of treatment: for 2 weeks until clinical criteria for stability are met (Preferred drugs are indicated in boldface).
-::::: Note (2): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-::::: Note (3): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
-::::: Note (4): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
-::::: Note (5): [[Linezolid]] should be used with caution in patients with thrombocytopenia because it might exacerbate it. [[Linezolid]] use for > 14 days has additional hematopoietic toxicity.
-::::: Note (6): [[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
-::::: Note (7): A single 10-14 days course of [[Doxycycline]] is not routinely associated with tooth staining.
-::* Specific considerations
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (2): [[Doxycycline]] 100 mg PO bid for 7-10 days
-:::* '''Treatment of anthrax for pregnant Women'''
-::::* (A) Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis <ref name="pmid24457117">{{cite journal| author=Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA et al.| title=Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24457117 | doi=10.3201/eid2002.130611 | pmc=PMC3901460 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24457117  }} </ref>
-:::::* (1)''' A Bactericidal Agent (Fluoroquinolone)''': '''[[Ciprofloxacin]]''' 400 mg IV q8h is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
-:::::* (2).''' A Bactericidal Agent (β-lactam)'''
-::::::* (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Meropenem]] 2 g q8h''',{{or}}
-::::::* (b). Alternatives for penicillin-susceptible strains: [[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
-:::::* (3).''' A Protein Synthesis Inhibitor''': '''[[Clindamycin]] 900 IV mg q8h''',{{or}}  [[Rifampin]] 600 IV mg q12h
-:::::: Note (1): At least one antibiotic with transplacental passage is recommended.
-:::::: Note (2): Duration of treatment is for ≥2–3 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-::::* (B) Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (3): [[Levofloxacin]] 750 mg PO qd for 7-10 days
-:::::* (1).''' A Bactericidal Antimicrobial''': '''[[Ciprofloxacin]] 400 mg IV q8h''' is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
-:::::* (2).''' A Bactericidal Agent (β-lactam)'''
-::::::* (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Meropenem]] 2 g q8h''',{{or}}
-::::::* (b). Alternatives for penicillin-susceptible strains:[[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
-:::::* (3).''' A Protein Synthesis Inhibitor''':[[Clindamycin]] 900 IV mg q8h,{{or}}  [[Rifampin]] 600 IV mg q12h
-::::::Note (1): At least one antibiotic with transplacental passage is recommended.
-::::::Note (2):Duration of treatment: for ≥2 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness
-::::*(C) Oral antimicrobial treatment for cutaneous anthrax without systemic involvement
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (4): [[Moxifloxacin]] 400 mg PO qd for 7-10 days
-:::::* (a).For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Ciprofloxacin]] 400 mg IV q8h''' is preferred.
-::::::Note (1): duration of treatment is 60 days
-::::::Note (2): Recommendations are specific to cutaneous anthrax in the setting of bioterrorism.
-:::* '''Treatment for anthrax in childern''' <ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
+:::* Alternative regimen (1): [[Clindamycin]] 600 mg PO tid for 7-10 days
-::::* '''(1). Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)'''
-:::::* (A). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose)''' {{or}} [[Doxycycline]], <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose) ≥45 kg: 100 mg/dose, PO, given q12h {{or}} [[Clindamycin]], 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) {{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h {{or}}
-:::::* (B). Alternatives for penicillin-susceptible strains: '''[[Amoxicillin]], 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose)''' {{or}} [[Penicillin VK]], 50-75 mg/kg/day, PO, divided q6h to q8h
+:::* Alternative regimen (2): [[Amoxicillin]] 1 g PO tid (for penicillin-susceptible strains) for 7-10 days
-:::::: Note (1): Duration of therapy for naturally acquired infection: 7-10 days and for a biological weapon-related event: will require additional prophylaxis for inhaled spores, to complete an antimicrobial course of up to 60 days from onset of illness.
-:::::: Note (2): Bold font for preferred antimicrobial agent.
-:::::: Note (3): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or first-line therapy is unavailable.
-:::::: Note (4): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-:::::: Note (5): Italicized font indicates FDA approval for the indication in the pediatric population.
-:::::: Note (6): A single 10- to 14-day course of doxycycline is not routinely associated with tooth staining.
-:::::: Note (7): Be aware of the possibility of emergence of penicillin-resistance during monotherapy with amoxicillin or penicillin.
-::::* '''(2). Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)'''
+:::* Alternative regimen (3): [[Penicillin VK]] 500 mg PO qid (for penicillin-susceptible strains) for 7-10 days
-:::::* (A). A bactericidal antimicrobial
-::::::* (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Ciprofloxacin]], 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose)''' {{or}} [[Meropenem]], 60 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) {{or}} [[Levofloxacin]] <50 kg: 20 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose >50 kg: 500 mg, IV, q24h {{or}} [[Imipenem]]/[[Cilastatin]],a 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) {{or}} [[Vancomycin]], 60 mg/kg/day, IV, divided q8h (follow serum concentrations)
-::::::* (b). Alternatives for penicillin-susceptible strains: '''[[Penicillin G]], 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose)''' {{or}} [[Ampicillin]], 200 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) {{and}}
-:::::* (B). A Protein Synthesis Inhibitor: '''[[Clindamycin]], 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose)''' {{or}} [[Linezolid]] (non-CNS infection dose): <12 y old: 30 mg/kg/day, IV, divided q8h ≥12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) {{or}} [[Doxycycline]] <45 kg: 4.4 mg/kg/day, IV, loading dose (not to exceed 200 mg); ≥45 kg: 200 mg, IV, loading dose then <45 kg: 4.4 mg/kg/day, IV, divided q12h   (not to exceed 100 mg/dose); ≥45 kg: 100 mg, IV, given q12h {{or}} Rifampin,d 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)
+:::* Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.
-:::::: Note (1): Duration of therapy for 14 days or longer until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-:::::: Note (2): Systemic anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-:::::: Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. A normal CSF may not completely exclude deep brain hemorrhage/abscess.
-:::::: Note (4): Bold font for preferred antimicrobial agent.
-:::::: Note (5): Normal font for  alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
-:::::: Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-:::::: Note (7): Increased risk of seizures associated with [[Imipenem]]/[[Cilastatin]] therapy.
-:::::: Note (8): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it.[[Linezolid]] use for >14 days carries additional hematopoietic toxicity.
-:::::: Note (9): A single 14-day course of [[Doxycycline]] is not routinely associated with tooth staining.
-:::::: Note (10): [[Rifampin]] is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy
-::::* '''(3).Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older'''
+::* 2. '''Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-:::::* (A). A bactericidal antimicrobial (fluoroquinolone): [[Ciprofloxacin]], 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose){{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose); >50 kg: 500 mg, IV, q24h {{or}} [[Moxifloxacin]] 3 months to <2 years: 12 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
-:::::: 2-5 years: 10 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
-::::::6–11 years: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
-:::::: 12–17 years, ≥45 kg body weight: 400 mg, IV, once daily
-:::::: 12–17 years, <45 kg body weight: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose) {{and}}
-:::::* (B). A bactericidal antimicrobial (β-lactam or glycopeptide)
+:::* 2.1 '''Systemic anthrax with possible/confirmed meningitis'''
-::::::* (a). For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown : [[Meropenem]], 120 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) {{or}} [[Imipenem]]/[[Cilastatin]], 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) {{or}} [[Doripenem]], 120 mg/kg/day, IV, divided q8h (not to exceed 1 g/dose) {{or}} [[Vancomycin]], 60 mg/kg/day, IV, divided q8h
-::::::* (b). Alternatives for penicillin-susceptible strains: [[Penicillin G]], 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose) {{or}} [[Ampicillin]], 400 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) {{and}}
+::::* 2.1.1 '''Bactericidal agent''' (fluoroquinolone)
+:::::* Preferred regimen (1): '''[[Ciprofloxacin]] 400 mg IV q8h''' for 2-3 weeks
+:::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2-3 weeks
+:::::* Preferred regimen (3): [[Moxifloxacin]] 400 mg IV q24h for 2-3 weeks {{and}}
+::::* 2.1.2 '''Bactericidal agent (ß-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::::* Preferred regimen (1): '''[[Meropenem]] 2 g IV q8h''' for 2-3 weeks
+:::::* Preferred regimen (2): [[Imipenem]] 1 g IV q6h for 2-3 weeks
+:::::* Preferred regimen (3): [[Doripenem]] 500 mg IV q8h for 2-3 weeks
+:::::* Preferred regimen (4): [[Penicillin G]] 4 MU IV q4h (for penicillin-susceptible strains) for 2-3 weeks
+:::::* Preferred regimen (5): [[Ampicillin]] 3 g IV q6h (for penicillin-susceptible strains) for 2-3 weeks {{and}}
+::::* 2.1.3 '''Protein synthesis inhibitor'''
+:::::* Preferred regimen (1): '''[[Linezolid]] 600 mg IV q12h''' for 2-3 weeks
+:::::* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h for 2-3 weeks
+:::::* Preferred regimen (3): [[Rifampin]] 600 mg IV q12h for 2-3 weeks
+:::::* Preferred regimen (4): [[Chloramphenicol]] 1 g IV q6-8h for 2-3 weeks
+:::::* Note (1): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
+:::::* Note (2): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
+:::::* Note (3): [[Linezolid]] should be used with caution in patients with thrombocytopenia because it might exacerbate it. [[Linezolid]] use for > 14 days has additional hematopoietic toxicity.
+:::::* Note (4): [[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
+:::* 2.2 '''Systemic anthrax when meningitis has been excluded'''
+::::* 2.2.1 '''Bactericidal agent'''
+:::::* Preferred regimen (1): '''[[Ciprofloxacin]] 400 mg IV q8h'''for 2 weeks
+:::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2 weeks
+:::::* Preferred regimen (3): [[Moxifloxacin]] 400 mg q24h for 2 weeks
+:::::* Preferred regimen (4): [[Meropenem]] 2 g IV q8h for 2 weeks
+:::::* Preferred regimen (5): [[Imipenem]] 1 g IV q6h for 2 weeks
+:::::* Preferred regimen (6): [[Doripenem]] 500 mg IV q8h for 2 weeks
+:::::* Preferred regimen (7): [[Vancomycin]] 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) for 2 weeks
+:::::* Preferred regimen (8): [[Penicillin G]] 4 MU IV q4h (penicillin-susceptible strains) for 2 weeks
+:::::* Preferred regimen (9): [[Ampicillin]] 3 g IV q6h (penicillin-susceptible strains) for 2 weeks {{and}}
+::::* 2.2.2 '''Protein synthesis inhibitor'''
+:::::* Preferred regimen (1): '''[[Clindamycin]] 900 mg IV q8h''' for 2 weeks
+:::::* Preferred regimen (2): '''[[Linezolid]] 600 mg IV q12h''' for 2 weeks
+:::::* Preferred regimen (3): [[Doxycycline]] 200 mg IV initially, then 100 mg IV q12h for 2 weeks
+:::::* Preferred regimen (4): [[Rifampin]] 600 mg IV q12h for 2 weeks
+:::::* Note: Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
+::* 3. '''Specific considerations'''
+:::* 3.1 '''Treatment of anthrax for pregnant Women'''
+::::* 3.1.1 '''Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis''' <ref name="pmid24457117">{{cite journal| author=Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA et al.| title=Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24457117 | doi=10.3201/eid2002.130611 | pmc=PMC3901460 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24457117  }} </ref>
+:::::* 3.1.1.1 ''' A bactericidal agent (fluoroquinolone)'''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 400 mg IV q8h for 2–3 weeks
+::::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2–3 weeks{{or}}
+:::::* 3.1.1.2 ''' A bactericidal agent (ß-lactam)'''
+::::::* 3.1.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::::::* Preferred regimen: '''[[Meropenem]] 2 g q8h''' for 2–3 weeks
+::::::* 3.1.1.2.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* Alternative regimen (1): [[Ampicillin]] 3 g IV q6h for 2–3 weeks
+:::::::* Alternative regimen (2): [[Penicillin G]] 4 MU IV q4h for 2–3 weeks {{or}}
+:::::* 3.1.1.3 ''' A protein synthesis Inhibitor'''
+::::::* Preferred regimen (1): '''[[Clindamycin]] 900 IV mg q8h''' for 2–3 weeks
+::::::* Preferred regimen (2): [[Rifampin]] 600 IV mg q12h for 2–3 weeks
+::::::* Note: At least one antibiotic with transplacental passage is recommended.
+::::* 3.1.2 '''Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded'''
+:::::* 3.1.2.1 ''' A bactericidal Antimicrobial'''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 400 mg IV q8h''' for 2 weeks
+::::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2 weeks {{or}}
+:::::* 3.1.2.2 ''' A bactericidal Agent (ß-lactam)'''
+::::::* 3.1.2.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::::::* Preferred regimen: '''[[Meropenem]] 2 g q8h''' for 2 weeks  {{or}}
+::::::* 3.1.2.2.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* Alternative regimen (1): [[Ampicillin]] 3 g IV q6h for 2 weeks
+:::::::* Alternative regimen (2): [[Penicillin G]] 4 MU IV q4h for 2 weeks {{or}}
+:::::* 3.1.2.3 ''' A protein synthesis inhibitor'''
+::::::* Preferred regimen (1): [[Clindamycin]] 900 IV mg q8h for 2 weeks
+::::::* Preferred regimen (2): [[Rifampin]] 600 IV mg q12h for 2 weeks
+::::* 3.1.3 '''Oral antimicrobial treatment for cutaneous anthrax without systemic involvement'''
+:::::* 3.1.3.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::::* Preferred regimen: '''[[Ciprofloxacin]] 400 mg IV q8h'''
+::::::* Note: Duration of treatment is 60 days
+:::* 3.2 '''Treatment for anthrax in childern''' <ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
+::::* 3.2.1 '''Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)'''
+:::::* 3.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 30 mg/kg/day PO bid (not to exceed 500 mg/dose)''' for 7-10 days
+::::::* Preferred regimen (2):
+:::::::* If patients body weight is < 45 kg: [[Doxycycline]] 4.4 mg/kg/day PO bid (not to exceed  100 mg/dose) for 7-10 days
+:::::::* If patients body weight is = 45 kg: [[Doxycycline]]  100 mg/dose PO bid for 7-10 days
+::::::* Preferred regimen (3): [[Clindamycin]] 30 mg/kg/day PO tid (not to exceed  600 mg/dose) for 7-10 days
+::::::* Preferred regimen (4):
+:::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 16 mg/kg/day PO bid (not to exceed  250 mg/dose) for 7-10 days
+:::::::* If patients body weight is > 50 kg: [[Levofloxacin]] 500 mg PO qd for 7-10 days
+:::::* 3.2.1.2 '''Alternatives for penicillin-susceptible strains'''
+::::::* Alternative regimen (1):'''[[Amoxicillin]] 75 mg/kg/day PO tid (not to exceed 1 g/dose)''' for 7-10 days
+::::::* Alternative regimen (2): [[Penicillin VK]] 50-75 mg/kg/day PO tid or qid for 7-10 days
+::::* 3.2.2 ''' Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)'''
+:::::* 3.2.2.1 '''A bactericidal antimicrobial'''
+::::::* 3.2.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose)''' for 14 days
+:::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 14 days
+:::::::* Preferred regimen (3):
+::::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 20 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 14 days
+::::::::* If patients body weight is > 50 kg: [[Levofloxacin]] 500 mg IV q24h for 14 days
+:::::::* Preferred regimen (4): [[Imipenem]]/[[Cilastatin]] 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 14 days
+:::::::* Preferred regimen (5): [[Vancomycin]] 60 mg/kg/day IV divided q8h (follow serum concentrations) for 14 days
+::::::* 3.2.2.1.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* Alternative regimen (1): '''[[Penicillin G]] 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose)''' for 14 days
+:::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 14 days {{and}}
+:::::* 3.2.2.2 '''A protein synthesis inhibitor'''
+::::::* Preferred regimen (1): '''[[Clindamycin]], 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose)''' for 14 days
+::::::* Preferred regimen (2):  (non-CNS infection dose)
+:::::::* If patient is < 12 y old: [[Linezolid]] 30 mg/kg/day IV divided q8h for 14 days
+:::::::* If patient is = 12 y old: [[Linezolid]] 30 mg/kg/day IV divided q12h (not to exceed 600 mg/dose) for 14 days
+::::::* Preferred regimen (3):
+:::::::* If patients body weight is < 45 kg: [[Doxycycline]] 4.4 mg/kg/day IV loading dose (not to exceed 200 mg) {{then}} [[Doxycycline]] 4.4 mg/kg/day IV divided q12h   (not to exceed 100 mg/dose) for 14 days
+:::::::* If patients body weight is =45 kg: [[Doxycycline]] 200 mg IV loading dose {{then}} [[Doxycycline]] 100 mg IV given q12h for 14 days
+::::::* Preferred regimen (4): [[Rifampin]] 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 14 days
+::::::* Note: Duration of therapy for 14 days or longer until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
+::::* 3.2.3 '''Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older'''
+:::::* 3.2.3.1 '''A bactericidal antimicrobial''' (fluoroquinolone)
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose) for 2–3 wks
+::::::* Preferred regimen (2):
+:::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 16 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 2–3 wks
+:::::::* If patients body weight is > 50 kg: [[Levofloxacin]] 500 mg IV q24h for 2–3 wks
+::::::* Preferred regimen (3):
+:::::::* If patients age is 3 months to < 2 years: [[Moxifloxacin]]  12 mg/kg/day IV, divided q12h (not to exceed 200 mg/dose) for 2–3 wks
+:::::::* If patients age is 2-5 years: [[Moxifloxacin]] 10 mg/kg/day IV divided q1h (not to exceed 200 mg/dose) for 2–3 wks
+:::::::* If patients age is 6–11 years: [[Moxifloxacin]] 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks
+:::::::* If patients age is 12–17 years, = 45 kg body weight: [[Moxifloxacin]] 400 mg IV q24h for 2–3 wks
+:::::::* If patients age is 12–17 years, < 45 kg body weight: [[Moxifloxacin]] 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks {{and}}
+:::::* 3.2.3.2 '''A bactericidal antimicrobial (ß-lactam or glycopeptide)'''
+::::::* 3.2.3.2.1 '''For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown''':
+:::::::* Preferred regimen (1): [[Meropenem]] 120 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 2–3 wks
+:::::::* Preferred regimen (2): [[Imipenem]]/[[Cilastatin]] 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 2–3 wks
+:::::::* Preferred regimen (3): [[Doripenem]] 120 mg/kg/day IV divided q8h (not to exceed 1 g/dose) for 2–3 wks
+:::::::* Preferred regimen (4): [[Vancomycin]] 60 mg/kg/day IV divided q8h for 2–3 wks
+::::::* 3.2.3.2.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* Alternative regimen (1): [[Penicillin G]] 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose) for 2–3 wks
+:::::::* Alternative regimen (2): [[Ampicillin]] 400 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 2–3 wks {{and}}
+::::::* 3.2.3.3 '''A protein synthesis inhibitor'''
+:::::::* Preferred regimen (1):
+::::::::* If patients age is < 12 y old: [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wk
+::::::::* If patients age is = 12 y old: [[Linezolid]] 30 mg/kg/day,IV divided q12h (not to exceed 600 mg/dose) for 2–3 wk
+:::::::* Preferred regimen (2): [[Clindamycin]] 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose)  for 2–3 wk
+:::::::* Preferred regimen (3): [[Rifampin]] 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 2–3 wk
+:::::::* Preferred regimen (4): [[Chloramphenicol]] 100 mg/kg/day IV divided q6h for 2–3 wk
-::::::* (C). A Protein Synthesis Inhibitor: [[Linezolid]] <12 y old: 30 mg/kg/day, IV, divided every 8 h≥12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) {{or}} [[Clindamycin]], 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose)  {{or}} [[Rifampin]], 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)  {{or}} [[Chloramphenicol]], 100 mg/kg/day, IV, divided q6h
 ::::::: Note (1): Duration of therapy for 2–3 wk or greater, until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-::::::: Note (2): Systemic anthrax includes anthrax meningitis; inhalation anthrax; or injection, gastrointestinal, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-::::::: Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. Normal CSF may not completely exclude deep brain hemorrhage/abscess.
-::::::: Note (4): Bold font for preferred antimicrobial agent.
-::::::: Note (5): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
-::::::: Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-::::::: Note (7):  A 400-mg dose of [[Ciprofloxacin]], IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.
-::::::: Note (8): Increased risk of seizures associated with [[Imipenem]]/[[Cilastatin]] therapy.
-::::::: Note (9): [[Doripenem]] is approved in Japan at this dose for the treatment of community-acquired bacterial meningitis.
-::::::: Note (10): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it. Linezolid use for >14 days carries additional hematopoietic toxicity.
-::::::: Note (11): [[Rifampin]] is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy for some strains of staphylococci. Not evaluated for Bacillus anthracis.
-::::::: Note (12) : [[Chloramphenicol]] Should be used only if other options are not available, because of toxicity concerns.
-::::* (4).'''Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)'''
+::::::: Note (2):  A 400-mg dose of [[Ciprofloxacin]] IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.
-:::::* (A). A bactericidal antimicrobial
-:::::: (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: [[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) {{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) ≥50 kg: 500 mg, PO, given q24h {{or}}
+::::* 3.2.4 '''Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)'''
-:::::: (b). Alternatives for penicillin-susceptible strains: [[Amoxicillin]], 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose) {{or}} [[Penicillin VK]], 50–75 mg/kg/day, PO, divided q6h-q8h {{and}}
+:::::* 3.2.4.1 '''A bactericidal antimicrobial'''
+::::::* 3.2.4.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day PO bid (not to exceed 500 mg/dose)
+:::::::* Preferred regimen (2):
+::::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 16 mg/kg/day PO bid (not to exceed 250 mg/dose)
+::::::::* If patients body weight is = 50 kg: [[Levofloxacin]] 500 mg PO qd
+::::::* 3.2.4.1.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid (not to exceed 1 g/dose)
+:::::::* Alternative regimen (2): [[Penicillin VK]] 50–75 mg/kg/day PO tid or qds {{and}}
+:::::* 3.2.4.2 '''A protein synthesis inhibitor''':
+::::::* Preferred regimen (1):[[Clindamycin]] 30 mg/kg/day PO tid (not to exceed 600 mg/dose)
+::::::* Preferred regimen (2):
+:::::::* If the patients body weight is < 45 kg: [[Doxycycline]] 4.4 mg/kg/day PO bid (not exceed 100 mg/dose)
+:::::::* If the patients body weight is = 45 kg: [[Doxycycline]] 100 mg PO bid
+::::::* Preferred regimen (3): (non-CNS infection dose):
+:::::::* If the patients age is < 12 yrs old: [[Linezolid]] 30 mg/kg/day PO tid
+:::::::* If the patients age is = 12 yrs old: [[Linezolid]] 30 mg/kg/day PO bid (not to exceed 600 mg/dose)
+:::::::* Note: Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
+::::* 3.2.5 ''' Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)'''
+:::::* 3.2.5.1 '''Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)'''
+::::::* 3.2.5.1.1 '''Bactericidal antimicrobial (fluoroquinolone) therapy'''
+:::::::*  3.2.5.1.1.1 '''For 32–34 weeks gestational age '''
+::::::::* '''For 0–1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
+::::::::* '''For 1–4 weeks of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
+:::::::*  3.2.5.1.1.2 '''For 34–37 week gestational age '''
+::::::::* '''For 0–1 wk of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2–3 weeks
+:::::::::* Preferred regimen (2):[[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
+::::::::* '''For 1–4 wk of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
+:::::::*  3.2.5.1.1.3 '''Term newborn infant'''
+::::::::* '''For 0–1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 30 mg/kg/day IV divided q12h''' for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 10 mg/kg/day IV q24h for 2–3 weeks
+::::::::* '''For 1–4 weeks of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 30 mg/kg/day IV divided q12h''' for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 10 mg/kg/day IV q24h for 2–3 weeks {{and}}
+::::::* 3.2.5.1.2 '''A bactericidal antimicrobial (ß-lactam)'''
+:::::::* 3.2.5.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''':
+::::::::* 3.2.5.1.2.1.1 '''For 32–34 weeks gestational age'''
+:::::::::* For 0–1 week of Age :
+::::::::::* Preferred regimen (1): '''[[Meropenem]]''' 60 mg/kg/day  IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (2): [[Imipenem]] 50 mg/kg/day  IV divided q12h for 2–3 weeks
+::::::::::* Preferred regimen (3): [[Doripenem]] 20 mg/kg/day  IV divided q12h for 2–3 weeks
+:::::::::* For 1–4 wk of Age :
+::::::::::* Preferred regimen (1): '''[[Meropenem]]''' 90 mg/kg/day  IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (2): [[Imipenem]] 75 mg/kg/day  IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (3): [[Doripenem]] 30 mg/kg/day  IV divided q8h for 2–3 weeks
+::::::::* 3.2.5.1.2.1.2 '''For 34–37 week gestational age'''
+:::::::::* For 0–1 week of Age :
+::::::::::* Preferred regimen (1): '''[[Meropenem]]''' 60 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (2): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Preferred regimen (3): [[Doripenem]]  20 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* For 1–4 week of Age :
+::::::::::* Preferred regimen (1): '''[[Meropenem]]''' 90 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (2): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (3): [[Doripenem]] 30 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::* 3.2.5.1.2.1.3 '''Term newborn infant'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Preferred regimen (1):'''[[Meropenem]]''' 60 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (2): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Preferred regimen (3): [[Doripenem]] 20 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Preferred regimen (1):'''[[Meropenem]]''' 90 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (2): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::::* Preferred regimen (3): [[Doripenem]] 30 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::* 3.2.5.1.2.2 ''' Alternatives for penicillin-susceptible strains'''
+::::::::* 3.2.5.1.2.2.1 '''For 32–34 weeks gestational age'''
+:::::::::* '''For 0–1 week of age'''
+::::::::::* Alternative regimen (1):'''[[Penicillin G]]''' 200000 Units/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 100 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* '''For 1–4 week of age''' :
+::::::::::* Alternative regimen (1): '''[[Penicillin G]]''' 300000 Units/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day divided IV q12h for 2–3 weeks
+::::::::* 3.2.5.1.2.2.2 '''For 34–37 week gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Alternative regimen (1): '''[[Penicillin G]]''' 300000 Units/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Alternative regimen (1): '''[[Penicillin G]]''' 400000 Units/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q12h for 2–3 weeks
+::::::::* 3.2.5.1.2.2.3 '''Term newborn infant'''
+:::::::::* '''For 0–1 week of age'''
+::::::::::* Alternative regimen (1): '''[[Penicillin G]]''' 300000 Units/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Alternative regimen (1): '''[[Penicillin G]]''' 400000 Units/kg/day IV divided q12h for 2–3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q12h for 2–3 weeks {{and}}
+::::::* 3.2.5.1.3 '''A protein synthesis inhibitor'''
+:::::::* 3.2.5.1.3.1 '''For 32–34 weeks gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Linezolid]]''' 20 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Clindamycin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 25 mg/kg/day IV q24h for 2–3 weeks
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): '''[[Linezolid]]''' 30 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 50 mg/kg/day IV q12h for 2–3 weeks
+:::::::* 3.2.5.1.3.2 '''For 34–37 week gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Linezolid]]''' 30 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 25 mg/kg/day IV q24h for 2–3 weeks
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1):'''[[Linezolid]]''' 30 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 weeks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 50 mg/kg/day IV q12h for 2–3 weeks
+:::::::* 3.2.5.1.3.3 '''Term newborn infant'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1):'''[[Linezolid]]''' 30 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 25 mg/kg/day IV q24h for 2–3 weeks
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): '''[[Linezolid]]''' 30 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 weeks
+:::::::::* Preferred regimen (3): [[Rifampin]] 20 mg/kg/day IV divided q12h for 2–3 weeks
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 50 mg/kg/day IV q12h for 2–3 weeks
+:::::::::* Note :Duration of therapy for 2–3 weeks, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.
+:::::* 3.2.5.2 '''Therapy for severe anthrax when meningitis can be ruled out'''
+::::::* 3.2.5.2.1 '''A bactericidal antimicrobial'''
+:::::::* 3.2.5.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::::::* 3.2.5.2.1.1.1 '''For 32–34 weeks gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2-3 weeks
+::::::::::* Preferred regimen (2): [[Meropenem]] 40 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Preferred regimen (3): [[Imipenem]] 40 mg/kg/day IV divided q12h for 2-3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2-3 weeks
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Preferred regimen (3): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2-3 weeks
+::::::::* 3.2.5.2.1.1.2 '''For 34–37 week gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2-3 weeks
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Preferred regimen (3): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2-3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 20 mg/kg/day IV divided q12h''' for 2-3 weeks
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Preferred regimen (3): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::* 3.2.5.2.1.1.3 '''Term newborn infant'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Preferred regimen (1): '''[[Ciprofloxacin]] 30 mg/kg/day IV divided q12h''' for 2-3 weeks
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Preferred regimen (3): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2-3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Preferred regimen (1):'''[[Ciprofloxacin]] 30 mg/kg/day IV divided q12h''' for 2-3 weeks
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Preferred regimen (3): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2-3 weeks
+:::::::::::* [[Vancomycin]] IV (dosing based on serum creatinine for infants of 32 wk gestational age). Follow vancomycin serum concentrations to modify dose.
+::::::::::::* If  Serum creatinine < 0.7 then [[Vancomycin]] 15 mg/kg/dose IV q12h for 2-3 weeks
+::::::::::::* If Serum creatinine 0.7 -0.9 then [[Vancomycin]] 20 mg/kg/dose IV q24h for 2-3 weeks
+::::::::::::* If Serum creatinine 1–1.2 then [[Vancomycin]] 15 mg/kg/dose IV q24h for 2-3 weeks
+::::::::::::* If Serum creatinine 1.3–1.6 then [[Vancomycin]] 10 mg/kg/dose IV q24h for 2-3 weeks
+::::::::::::* If Serum creatinine > 1.6 then [[Vancomycin]] mg/kg/dose IV q48h for 2-3 weeks
+::::::::::* Note: Begin treatment with a 20 mg/kg loading dose {{or}}
+:::::::* 3.2.5.2.1.2 '''Alternatives for penicillin-susceptible strains'''
+::::::::* 3.2.5.2.1.2.1 '''For 32–34 weeks gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 200000 U/kg/day IV divided q12h for 2-3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 100 mg/kg/day IV divided q12h for 2-3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 U/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::* 3.2.5.2.1.2.2 '''For 34–37 week gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 U/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q8h for 2-3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 400000 U/kg/day IV divided q6h for 2-3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q6h for 2-3 weeks
+::::::::* 3.2.5.2.1.2.3 '''Term newborn infant'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 U/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q8h for 2-3 weeks
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 400000 U/kg/day IV divided q6h for 2-3 weeks
+::::::::::* Alternative regimen (2):[[Ampicillin]] 200 mg/kg/day IV divided q6h for 2-3 weeks
+::::::* 3.2.5.2.2 '''A protein synthesis inhibitor'''
+:::::::* 3.2.5.2.2.1 '''For 32–34 weeks gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 10 mg/kg/day IV divided q12h for 2–3 wks
+:::::::::* Preferred regimen (2): [[Linezolid]] 20 mg/kg/day IV divided q12h for 2–3 wks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
+:::::::* 3.2.5.2.2.2 '''For 34–37 week gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): [[Clindamycin]]  15 mg/kg/day IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 wks
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
+:::::::* 3.2.5.2.2.3 '''Term newborn infant'''
+::::::::* For 0–1 week of age :
+:::::::::* Preferred regimen (1): [[Clindamycin]] 15 mg/kg/day  IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (3): [[Doxycycline]] 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks
+:::::::::* Preferred regimen (4): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
+::::::::* For 1–4 week of age :
+:::::::::* Preferred regimen (1): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 wks
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
+:::::::::* Preferred regimen (3): [[Doxycycline]] 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks
+:::::::::* Preferred regimen (4): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
+:::::::::* Note: Duration of therapy for 2–3 wks, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness
+:::::* 3.2.5.3 '''Oral follow-up combination therapy for severe anthrax'''
+::::::* 3.2.5.3.1 '''A bactericidal antimicrobial'''
+:::::::* 3.2.5.3.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::::::* 3.2.5.3.1.1.1 '''For 32–34 weeks gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Preferred regimen: '''[[Ciprofloxacin]] 20 mg/kg/day PO bid'''
+::::::::::* '''For 1–4 week of age'''
+::::::::::* Preferred regimen: '''[[Ciprofloxacin]] 20 mg/kg/day PO bid'''
+::::::::* 3.2.5.3.1.1.2 '''For 34–37 week gestational age'''
+:::::::::*  '''For < 1 week of age'''
+::::::::::* Preferred regimen: '''[[Ciprofloxacin]] 20 mg/kg/day PO bid'''
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Preferred regimen: '''[[Ciprofloxacin]] 20 mg/kg/day PO bid'''
+::::::::* 3.2.5.3.1.1.3 '''Term newborn infant'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Preferred regimen: '''[[Ciprofloxacin]] 30 mg/kg/day PO bid'''
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Preferred regimen: '''[[Ciprofloxacin]] 30 mg/kg/day PO bid''' {{or}}
+:::::::* 3.2.5.3.1.2 '''Alternatives for penicillin-susceptible strains'''
+::::::::* 3.2.5.3.1.2.1 '''For 32–34 weeks gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 50 mg/kg/day PO bid
+::::::::::* Alternative regimen (2): Penicillin VK  50 mg/kg/day PO bid
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 75 mg/kg/day PO bid
+::::::::::* Alternative  regimen (2): Penicillin VK 75 mg/kg/day PO bid
+::::::::* 3.2.5.3.1.2.2 '''For 34–37 week gestational age'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 50 mg/kg/day PO bid
+::::::::::* Alternative regimen (2): Penicillin VK 50 mg/kg/day PO bid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Alternative regimen (1):'''[[Amoxicillin]]''' 75 mg/kg/day PO bid
+:::::::::* Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid
+::::::::* 3.2.5.3.1.2.3 '''Term newborn infant'''
+:::::::::* '''For < 1 week of age'''
+::::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 75 mg/kg/day PO tid
+::::::::::* Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid
+:::::::::* '''For 1–4 week of age'''
+::::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 75 mg/kg/day PO tid
+::::::::::* Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid or qid
+::::::* 3.2.5.3.2 '''A protein synthesis inhibitor'''
+:::::::* 3.2.5.3.2.1 '''For 32–34 weeks gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Clindamycin]] 10 mg/kg/day PO bid'''
+:::::::::* Preferred regimen (2): [[Linezolid]] 20 mg/kg/day PO bid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1):'''[[Clindamycin]] 15 mg/kg/day PO bid'''
+:::::::::* Preferred regimen (2):[[Linezolid]] 30 mg/kg/day PO bid
+:::::::* 3.2.5.3.2.2 '''For 34–37 week gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Clindamycin]] 15 mg/kg/day PO tid'''
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day PO tid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): '''[[Clindamycin]] 20 mg/kg/day PO qid'''
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day PO tid
+:::::::* 3.2.5.3.2.3 '''Term newborn infant'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Clindamycin]] 15 mg/kg/day PO tid'''
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
+:::::::::* Preferred regimen (3): [[Linezolid]] 30 mg/kg/day PO tid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): '''[[Clindamycin]] 20 mg/kg/day PO qid'''
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
+:::::::::* Preferred regimen (3): [[Linezolid]] 30 mg/kg/day PO tid
+:::::::::* Note: Duration of therapy to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.
+:::::* 3.2.5.4 '''Treatment of cutaneous anthrax without systemic involvement'''
+::::::* 3.2.5.4.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::::::* 3.2.5.4.1.1 '''For 32–34 weeks gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+:::::::::* Preferred regimen (2): [[Clindamycin]] 10 mg/kg/day PO bid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1):'''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+:::::::::* Preferred regimen (2):[[Clindamycin]] 15 mg/kg/day PO tid
+:::::::* 3.2.5.4.1.2 '''For 34–37 week gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day PO tid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+:::::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day PO qid
+:::::::* 3.2.5.4.1.3 '''Term newborn infant'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 30 mg/kg/day PO bid
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)
+:::::::::* Preferred regimen (3): [[Clindamycin]] 15 mg/kg/day PO tid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1):'''[[Ciprofloxacin]]''' 30 mg/kg/day PO bid
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)
+:::::::::* Preferred regimen (3): [[Clindamycin]] 20 mg/kg/day PO qid
+::::::* 3.2.5.4.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* 3.2.5.4.2.1 '''For 32–34 weeks gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 50 mg/kg/day PO bid
+:::::::::* Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 75 mg/kg/day PO tid
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid
+:::::::* 3.2.5.4.2.2 '''For 34–37 week gestational age'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 50 mg/kg/day PO bid
+:::::::::* Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 75 mg/kg/day PO bid
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO bid
+:::::::* 3.2.5.4.2.3 '''Term newborn infant'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Alternative regimen (1): '''[[Amoxicillin]]''' 75 mg/kg/day PO tid
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid
+::::::::* '''For 1–4 week of age'''
+:::::::::* Alternative regimen (1): '''[[Amoxicillin]]'''  75 mg/kg/day PO tid
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid or qid
+:::::::::* Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.
+:* '''Bacillus anthracis, postexposure prophylaxis'''
+::* 1. '''For adults'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
+:::* 1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::* Preferred regimen (1): '''[[Ciprofloxacin]] 500 mg IV q12h'''
+::::* Preferred regimen (2): '''[[Doxycycline]] 100 mg IV q12h'''
+::::* Preferred regimen (3): [[Levofloxacin]] 750 mg IV q24h
+::::* Preferred regimen (4): [[Moxifloxacin]] 400 mg IV q24h
+::::* Preferred regimen (5): [[Clindamycin]] 600 mg IV q8h
+:::* 1.2 '''Alternatives for penicillin-susceptible strain'''
+::::* Preferred regimen (1): [[Amoxicillin]] 1 g IV q8h
+::::* Preferred regimen (2): Penicillin VK 500 mg IV q6h
+::* 2. '''For children = 1 month'''<ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
+:::* 2.1 '''For penicillin-resistant strains or prior to susceptibility testing'''
+::::* Preferred regimen (1): '''[[Ciprofloxacin]] 30 mg/kg/day PO bid (not to exceed 500 mg/dose)'''
+::::* Preferred regimen (2):
+:::::* If patients body weight < 45 kg: [[Doxycycline]] 4.4 mg/kg/day PO bid (not to exceed 100 mg/dose)
+:::::* If patients body weight > 45 kg: [[Doxycycline]] 100 mg/dose PO bid
+::::* Preferred regimen (3): [[Clindamycin]] 30 mg/kg/day PO tid (not to exceed 900 mg/dose)
+::::* Preferred regimen (4):
+:::::* If patients body weight < 50 kg: [[Levofloxacin]] 16 mg/kg/day PO bid (not to exceed 250 mg/dose)
+:::::* If patients body weight > 50 kg: [[Levofloxacin]] 500 mg PO qd
+:::* 2.2 '''For penicillin-susceptible strains'''
+::::* Preferred regimen (1): '''[[Amoxicillin]] 75 mg/kg/day PO tid (not to exceed 1 g/dose)'''
+::::* Preferred regimen (2): [[Penicillin VK]] 50-75 mg/kg/day PO bid or tid
+::::* Note: '''Duration of Therapy is 60 days after exposure'''
+::* 3. '''For children < 1 month'''
+:::* 3.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::* 3.1.1 '''For 32–34 weeks gestational age'''
+:::::* 3.1.1.1 '''For < 1 week of Age'''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+::::::* Preferred regimen (2): [[Clindamycin]] 10 mg/kg/day PO bid
+:::::* 3.1.1.2 '''For 1–4 week of age '''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day PO tid
+::::* 3.1.2 '''For 34–37 week gestational age'''
+:::::* 3.1.2.1 '''For < 1 week of age'''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day PO tid
+:::::* 3.1.2.2 '''For 1–4 week of age'''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 20 mg/kg/day PO bid
+::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day PO tid
+::::* 3.1.3 '''Term newborn infant'''
+:::::* 3.1.3.1 '''For < 1 week of age '''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 30 mg/kg/day PO bid
+::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)
+::::::* Preferred regimen (3): [[Clindamycin]] 15 mg/kg/day PO tid
+:::::* 3.1.3.2 '''For 1–4 week of Age'''
+::::::* Preferred regimen (1): '''[[Ciprofloxacin]]''' 30 mg/kg/day PO bid
+::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)
+::::::* Preferred regimen (3): [[Clindamycin]] 20 mg/kg/day PO qid
+:::* 3.2 '''Alternatives for penicillin-susceptible strains'''
+::::* 3.2.1 '''For 32–34 weeks gestational age'''
+:::::* 3.2.1.1 '''For < 1 week of age'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day PO bid
+::::::* Alternative regimen (2): Penicillin Vk  50 mg/kg/day PO bid
+:::::* 3.2.1.2 '''For 1–4 week of age'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
+::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid
+::::* 3.2.2 '''For 34–37 week gestational age'''
+:::::* 3.2.2.1 '''For < 1 week of age'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day PO bid
+::::::* Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid
-:::::* (B). A protein synthesis inhibitor: [[Clindamycin]] 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) {{or}} [[Doxycycline]] <45 kg: 4.4 mg/kg/day, PO, divided q12h (not exceed 100 mg/dose) ≥45 kg: 100 mg, PO, given q12h {{or}} [[Linezolid]] (non-CNS infection dose):
+:::::* 3.2.2.2 '''For 1–4 week of age'''
-:::::: <12 y old: 30 mg/kg/day, PO, divided q8h
-:::::: ≥12 years old: 30 mg/kg/day, PO, divided q12h (not to exceed 600 mg/dose)
-::::::: Note (1): Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-::::::: Note (2): Severe anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-::::::: Note (3): Bold font for  preferred antimicrobial agent.
-::::::: Note (4): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
-::::::: Note (5): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-::::::: Note (6):  A single 14-day course of doxycycline is not routinely associated with tooth staining.
-::::::: Note (7): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it. [[Linezolid]] use for >14 days carries additional hematopoietic toxicity.
-::::* (5).''' Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
-:::::* (A). Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)
-::::::* (1). '''Bactericidal antimicrobial (fluoroquinolone) therapy'''
-:::::::* (a) For 32–34 weeks gestational age
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::: For 1–4 weeks of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::* (b) For 34–37 week gestational age
-:::::::: For 0–1 wk of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::: For 1–4 wk of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::* (c) Term Newborn Infant
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 weeks of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 10 mg/kg/day, q24h {{and}}
-::::::* (2). '''A bactericidal antimicrobial (β-lactam)'''
+::::::* Alternative regimen (2): Penicillin Vk  75 mg/kg/day PO tid
-:::::::* a. For all strains, regardless of penicillin susceptibility or if susceptibility is unknown :
-::::::::* (a) For 32–34 weeks gestational age
-::::::::: For 0–1 week of Age : '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
-::::::::: For 1–4 wk of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h
-::::::::* (b) For 34–37 week gestational age
-::::::::: For 0–1 week of Age : '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h
-::::::::* (c) Term Newborn Infant
-::::::::: For 0–1 week of Age: '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h {{or}}
-:::::::* b. Alternatives for penicillin-susceptible strains
-::::::::* (a) For 32–34 weeks gestational age
-::::::::: For 0–1 week of Age : '''[[Penicillin G]]''' 200000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 100 mg/kg/day divided q12h,
-::::::::: For 1–4 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
-::::::::* (b) For 34–37 week gestational age
-::::::::: For 0–1 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
-::::::::: For 1–4 week of Age : '''[[Penicillin G]]''' 400000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 200 mg/kg/day divided q12h,
-::::::::* (c) Term Newborn Infant
-::::::::: For 0–1 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
-::::::::: For 1–4 week of Age : '''[[Penicillin G]]''' 400000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 200 mg/kg/day divided q12h, {{and}}
-::::::* (3).'''A protein synthesis inhibitor'''
+::::* 3.2.3 '''Term newborn infant'''
-:::::::* (a) For 32–34 weeks gestational age
-:::::::: For 0–1 week of Age : '''[[Linezolid]]''' 20 mg/kg/day,divided q12h, {{or}} [[Clindamycin]] 10 mg/kg/day,divided q12h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h , {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
-:::::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
-:::::::* (b) For 34–37 week gestational age
-:::::::: For 0–1 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
-:::::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 20 mg/kg/day,divided q6h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
-:::::::* (c) Term Newborn Infant
-:::::::: For 0–1 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
-:::::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 20 mg/kg/day,divided q6h {{or}} {[Rifampin]] 20 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
-:::::::: Note :Duration of therapy For ≥2–3 week, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.
-:::::* (B). Therapy for severe anthrax when meningitis can be ruled out
+:::::* 3.2.3.1 '''For < 1 week of age'''
-::::::* (1).'''A bactericidal antimicrobial'''
-::::::: (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
-::::::::* (a) For 32–34 weeks gestational age
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}} [[Meropenem]] IV 40 mg/kg/day,divided q8h {{or}} [[Imipenem]] IV 40 mg/kg/day,divided q12h
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h'''  {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 50 mg/kg/day,divided q12h
-::::::::* (b) For 34–37 week gestational age
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 50 mg/kg/day,divided q12h
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}}  [[Imipenem]] 75 mg/kg/day,divided q8h
-::::::::* (c) Term Newborn Infant
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day,divided q12h''' {{or}}   [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}}  [[Imipenem]] 50 mg/kg/day,divided q12h
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 75 mg/kg/day,divided q8h {{or}}
-::::::::: [[Vancomycin]] IV (dosing based on serum creatinine for infants ≥32 wk gestational age). Follow vancomycin serum concentrations to modify dose.
-:::::::::: If  Serum creatinine <0.7 then [[Vancomycin]] IV 15 mg/kg/dose q12h
-:::::::::: If Serum creatinine 0.7 -0.9 then  [[Vancomycin]] IV 20 mg/kg/dose q24h
-:::::::::: If Serum creatinine 1–1.2 then [[Vancomycin]] IV 15 mg/kg/dose q24h
-:::::::::: If Serum creatinine 1.3–1.6 then  [[Vancomycin]] IV 10 mg/kg/dose q24h
-:::::::::: If Serum creatinine >1.6 15 then [[Vancomycin]] IV mg/kg/dose q48h
-::::::::::: Note : Begin treatment with a 20-mg/kg loading dose {{or}}
-:::::::: (b). Alternatives for penicillin-susceptible strains
-:::::::::* (a) For 32–34 weeks gestational age
-:::::::::: For 0–1 week of Age : [[Penicillin G]] IV 200000 U/kg/day,divided q12h, {{or}} [[Ampicillin]] IV 100 mg/kg/day,divided q12h
-:::::::::: For 1–4 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}} [[Ampicillin]] IV 150 mg/kg/day,divided q8h
-:::::::::* (b) For 34–37 week gestational age
-:::::::::: For 0–1 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}}  [[Ampicillin]] IV 150 mg/kg/day,divided q8h
-:::::::::: For 1–4 week of Age : [[Penicillin G]] IV 400000 U/kg/day,divided q6h, {{or}} [[Ampicillin]] IV 200 mg/kg/day,divided q6h
-:::::::::* (c) Term Newborn Infant
-:::::::::: For 0–1 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}} [[Ampicillin]] IV 150 mg/kg/day,divided q8h
-:::::::::: For 1–4 week of Age : [[Penicillin G]] IV 400000 U/kg/day,divided q6h, {{or}} [[Ampicillin]] IV 200 mg/kg/day,divided q6h {{and}}
-::::::*(2).'''A protein synthesis inhibitor'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
-:::::::* (a) For 32–34 weeks gestational age
-:::::::: For 0–1 week of Age : [[Clindamycin]] IV 10 mg/kg/day, divided q12h, {{or}} [[Linezolid]] IV 20 mg/kg/day, divided q12h, {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}}  [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::* (b) For 34–37 week gestational age
-:::::::: For 0–1 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 week of Age : [[Clindamycin]] IV 20 mg/kg/day, divided q6h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::* (c) Term Newborn Infant
-:::::::: For 0–1 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}}  [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}} [[Doxycycline]] IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg)  {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 week of Age : [[Clindamycin]] IV 20 mg/kg/day, divided q6h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}} [[Doxycycline]] IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg)  {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
-::::::::: Note: Duration of therapy: For ≥2–3 wk, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness
-:::::*(C). Oral follow-up combination therapy for severe anthrax
+::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid
-::::::(1).'''A bactericidal antimicrobial'''
-::::::: (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
-::::::::* (a) For 32–34 weeks gestational age
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::* (b) For 34–37 week gestational age
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::* (c) Term Newborn Infant
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 30 mg/kg/day, divided q12h'''
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 30 mg/kg/day, divided q12h''' {{or}}
-:::::::(b). Alternatives for penicillin-susceptible strains
-::::::::* (a) For 32–34 weeks gestational age
-::::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h, {{or}} Penicillin VK PO 50 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
-::::::::* (b) For 34–37 week gestational age
-::::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} Penicillin VK PO  50 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
-::::::::* (c) Term Newborn Infant
-::::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
-::::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q6–8h  {{and}}
-::::::(2).'''A protein synthesis inhibitor'''
-:::::::* (a) For 32–34 weeks gestational age
-:::::::: For 0–1 week of Age : '''[[Clindamycin]] PO 10 mg/kg/day, divided q12h''' {{or}} [[Linezolid]] PO 20 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::* (b) For 34–37 week gestational age
-:::::::: For 0–1 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Clindamycin]] PO 20 mg/kg/day, divided q6h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::* (c) Term Newborn Infant
-:::::::: For 0–1 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg)  {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age :'''[[Clindamycin]] PO 20 mg/kg/day, divided q6h''' {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg) {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h  {{or}}
-::::::::: Note: Duration of therapy: to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.
-:::::*(D).Treatment of cutaneous anthrax without systemic involvement
+:::::* 3.2.3.2 '''For 1–4 week of age'''
-::::::*(1).'''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-:::::::* (a) For 32–34 weeks gestational age
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 10 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-:::::::* (b) For 34–37 week gestational age
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
-:::::::* (c) Term Newborn Infant
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
-::::::*(2).'''Alternatives for penicillin-susceptible strains'''
-:::::::* (a) For 32–34 weeks gestational age
-:::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h  {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-:::::::* (b) For 34–37 week gestational age
-:::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-:::::::* (c) Term Newborn Infant
-:::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q6–8h
-::::::::: Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.
-:* [[Bacillus anthracis]], postexposure prophylaxis
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
-::* '''For adults'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-:::* (1) For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Ciprofloxacin]], 500 mg q12h''' {{or}} '''Doxycycline, 100 mg q12h''' {{or}} Levofloxacin, 750 mg q24h {{or}} Moxifloxacin, 400 mg q24h {{or}} Clindamycin, 600 mg q8h {{or}}
-:::* (2) Alternatives for penicillin-susceptible strain Amoxicillin, 1 g q8h {{or}} Penicillin VK, 500 mg q6h
-:::: Note (1): Preferred drugs are indicated in boldface.
-:::: Note (2): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment or if first-line treatment is unavailable.
-::* '''For children ≥ 1 month'''<ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
+::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO bid or tid
-:::* (1) For penicillin-resistant strains or prior to susceptibility testing: '''[[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose)''' {{or}} '''[[Doxycycline]], <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose)''' >45 kg: 100 mg/dose, PO, given q12h {{or}} [[Clindamycin]], 30 mg/kg/day, PO, divided q8h (not to exceed 900 mg/dose) {{or}} [[Levofloxacin]], <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h {{or}}
-:::* (2) For penicillin-susceptible strains: '''[[Amoxicillin]], 75 mg/kg/day, PO, divided every q8h (not to exceed 1 g/dose)''' {{or}} [[Penicillin VK]], 50-75 mg/kg/day, PO, divided q6h to q8h
-:::: Note (1) : '''Duration of Therapy is 60 days after exposure'''
-:::: Note (2) : Bold font are  preferred antimicrobial agent (when 2 bolded antimicrobial agents are present, both are considered equivalent in overall safety and efficacy).
-:::: Note (3) : Normal font are alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
-:::: Note (4) : Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-:::: Note (5) : Italicized font: indicates FDA approval for the indication in the pediatric population.
-:::: Note (6) : A single 14-day course of doxycycline is not routinely associated with tooth staining, but some degree of staining is likely for a prolonged treatment course of up to 60 days.
-:::: Note (7) : Safety data for [[Levofloxacin]] in the pediatric population are limited to 14 days for duration therapy.
-:::: Note (8) : Be aware of the possibility of emergence of penicillin-resistance during monotherapy with [[Amoxicillin]] or [[Penicillin]].
-::* '''For children < 1 month'''
+::::::* Note: Duration of therapy is  60 days from exposure
-:::* (1) '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::::* (a) For 32–34 weeks gestational age
-::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 10 mg/kg/day, divided q12h
-::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-::::* (b) For 34–37 week gestational age
-::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
-::::* (c) Term Newborn Infant
-::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h  {{or}}
-:::* (2) '''Alternatives for penicillin-susceptible strains'''
-::::* (a) For 32–34 weeks gestational age
-::::: For 0–1 week of Age : [[Amoxicillin]] PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-::::* (b) For 34–37 week gestational age
-:::::: For 0–1 week of Age : [[Amoxicillin]] PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-:::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-::::* (c) Term Newborn Infant
-::::: For 0–1 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q6–8h
-::::: Note: Duration of therapy is  60 days from exposure

Bacillus anthracis: Difference between revisions

Revision as of 18:05, 28 July 2015

Overview

Historical background

Pathogenicity

Treatment

Treatment

Antimicrobial therapy

References

Gallery

References

Navigation menu

Search