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| ==Primary Prevention==
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| Well-timed and effective postexposure [[prophylaxis]] can potentially save thousands of lives. Postexposure [[prophylaxis]] of [[asymptomatic]] persons should ideally start as soon as possible after exposure because its effectiveness decreases with delay in implementation.
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| After exposure to anthrax, it is recommended 60 days of [[antibiotic]] drug [[prophylaxis]] for immediate protection and a 3-dose series of Anthrax Vaccine Adsorbed (AVA) for long-term protection.<ref name="pmid20651644">{{cite journal| author=Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC)| title=Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-6 | pages= 1-30 | pmid=20651644 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20651644 }} </ref> To ensure adequate and continued protection, everyone exposed to aerosolized [[Bacillus anthracis]] [[spores]] should receive a full 60 days of postexposure prophylaxis antibiotic drugs, whether they are unvaccinated, partially [[vaccinated]], or fully vaccinated.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref>
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| ===Antibiotic Drugs===
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| [[Ciprofloxacin]], [[levofloxacin]], and [[doxycycline]] are [[FDA]]-approved for the [[antibiotic]] drug portion of postexposure [[prophylaxis]] for inhalation anthrax in adults ≥18 years of age.
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| No safety data are available for [[levofloxacin]] use beyond 30 days; thus, oral [[ciprofloxacin]] and [[doxycycline]] are recommended as first-line [[antibiotic]] drugs for postexposure [[prophylaxis]]. Alternative [[antibiotic]] drugs that might be used for postexposure [[prophylaxis]], if first-line agents are not tolerated or are unavailable, include:
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| * [[Levofloxacin]] and [[moxifloxacin]]
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| * [[Amoxicillin]] and [[penicillin V Potassium]] if the isolate is [[penicillin]] susceptible
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| * [[Clindamycin]].
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| ===Vaccine===
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| There is evidence of [[seroconversion]] after 3 doses of AVA. The [[vaccine]] should be administered [[subcutaneous|subcutaneously]] at [[diagnosis]] and 2 and 4 weeks later.<ref name="pmid20651644">{{cite journal| author=Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC)| title=Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-6 | pages= 1-30 | pmid=20651644 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20651644 }} </ref> AVA is not FDA-approved for postexposure [[prophylaxis]] and could be made available under an Investigational New Drug protocol or an Emergency Use Authorization in a declared emergency.
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| ==Prophylaxis Regimen==
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| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL><ref>{{Cite journal | doi = 10.3201/eid2002.130687 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Hendricks | first = Katherine A. | coauthors = Mary E. Wright, Sean V. Shadomy, John S. Bradley, Meredith G. Morrow, Andy T. Pavia, Ethan Rubinstein, Jon-Erik C. Holty, Nancy E. Messonnier, Theresa L. Smith, Nicki Pesik, Tracee A. Treadwell, William A. Bower, Workgroup on Anthrax Clinical Guidelines | title = Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24447897 | pmc = PMC3901462 }}</ref><ref>{{Cite journal | doi = 10.1542/peds.2014-0563 | issn = 1098-4275 | last = Bradley | first = John S. | coauthors = Georgina Peacock, Steven E. Krug, William A. Bower, Amanda C. Cohn, Dana Meaney-Delman, Andrew T. Pavia, AAP COMMITTEE ON INFECTIOUS DISEASES and DISASTER PREPAREDNESS ADVISORY COUNCIL | title = Pediatric Anthrax Clinical Management | journal = Pediatrics | date = 2014-04-28 | pmid = 24777226 }}</ref><ref>{{Cite journal | doi = 10.3201/eid2002.130611 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Meaney-Delman | first = Dana | coauthors = Marianne E. Zotti, Andreea A. Creanga, Lara K. Misegades, Etobssie Wako, Tracee A. Treadwell, Nancy E. Messonnier, Denise J. Jamieson, Workgroup on Anthrax in Pregnant and Postpartum Women | title = Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24457117 | pmc = PMC3901460 }}</ref>
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| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''PEP for Infection with B. anthracis'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Adult Patients'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Pediatric Patients'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Pregnant Patients'''
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| </font>
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| </div>
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| <!--COLLECT ALL THE BOXES BELOW-->
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Postexposure Prophylaxis, Adult Patients}}
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg PO q12h'''''<br> OR <br> ▸ '''''[[Levofloxacin]] 750 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 600 mg PO q8h'''''<br> OR <br>
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin]] 1 g PO q8h'''''<BR> OR <BR>▸ '''''[[Penicillin VK]] 500 mg PO q6h'''''
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Postexposure Prophylaxis, Pediatric Patients}}
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day PO q12h, max: 500 mg/dose'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 4.4 mg/kg/day PO q12h, max: 100 mg/dose (<45 kg)''''' <BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg/dose PO q12h (≥45 kg)'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 900 mg/dose''''' <BR> OR <BR> ▸ '''''[[Levofloxacin]] 16 mg/kg/day PO q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg PO q24h (≥50 kg)'''''
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin]] 75 mg/kg/day PO q8h, max: 1 g/dose''''' <BR> OR <BR> ▸ '''''[[Penicillin VK]] 50–75 mg/kg/day PO q6–8h'''''
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Postexposure Prophylaxis, Pregnant Patients}}
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''
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| |}
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| |}
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| |}
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| ==References== | | ==References== |
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| {{reflist|2}} | | {{reflist|2}} |