Bacillus anthracis: Difference between revisions

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{{main|Anthrax}}
{{main|Anthrax}}
Infections with ''B. anthracis'' can be treated with [[Beta-lactam|β-lactam]] [[antibiotic]]s such as [[penicillin]], and others which are active against Gram-positive bacteria.<ref>{{cite journal |author = Barnes JM |title=Penicillin and ''B. anthracis''. |journal= J Path Bacteriol |volume=194|year=1947|pages=113}}</ref>
Infections with ''B. anthracis'' can be treated with [[Beta-lactam|β-lactam]] [[antibiotic]]s such as [[penicillin]], and others which are active against Gram-positive bacteria.<ref>{{cite journal |author = Barnes JM |title=Penicillin and ''B. anthracis''. |journal= J Path Bacteriol |volume=194|year=1947|pages=113}}</ref>
==Treatment==
===Antimicrobial therapy===
:*  '''Bacillus anthracis treatment'''
::* 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>
:::* 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'''<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>
:::* 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 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
:::::::* 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'''<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
:::::* 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==
==References==

Revision as of 15:14, 5 August 2015

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
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

Main article: Anthrax

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

References

  1. ↑ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. ISBN 0-8385-8529-9.
  2. ↑ Madigan M, Martinko J (editors). (2005). Brock Biology of Microorganisms (11th ed. ed.). Prentice Hall. ISBN 0-13-144329-1.
  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.
  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.

Gallery

References

  1. ↑ 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)".


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