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==Primary Prevention==
==Primary Prevention==
Well-timed and effective postexposure [[prophylaxis]] can potentially save thousands of lives. Postexposure [[prophylaxis]] of [[asymptomatic]] persons should start as soon as possible after exposure, because its effectiveness decreases with delay in implementation. Initial [[symptoms]] may resemble a common [[cold]], including [[sore throat]], mild [[fever]], [[myalgia]], and [[malaise]]. After a few days, the [[symptoms]] may progress to severe breathing problems [[shock]], and ultimately death.
Well-timed and effective postexposure [[prophylaxis]] can potentially save thousands of lives. Postexposure [[prophylaxis]] of [[asymptomatic]] persons should start as soon as possible after exposure because its effectiveness decreases with delay in implementation. Initial [[symptoms]] may resemble a common [[cold]], including [[sore throat]], mild [[fever]], [[myalgia]], and [[malaise]]. After a few days, the [[symptoms]] may progress to severe breathing problems [[shock]], and ultimately death.  
 
In order to prevent infection and transmission of the virus, several measures should be implemented, including:
 
* All possibly contaminated bedding or clothing of [[infected]] patients should be isolated in double plastic bags and treated as possible biohazard waste. 
 
* If a person is suspected of having died from [[anthrax]], every precaution should be taken to avoid [[skin]] contact with the potentially contaminated body. The body should be put in strict quarantine, sealed in an airtight body bag and then cremated. No embalming or autopsy should be attempted without a fully equipped biohazard laboratory and trained, knowledgeable personnel.
 
 
 
* Full isolation of the body is important to prevent possible contamination of others. Protective, impermeable clothing and equipment such as [[rubber glove]]s, rubber apron, and rubber boots with no perforations should be used when handling the body. No skin, especially if it has any wounds or scratches, should be exposed. Disposable personal protective equipment is preferable, but if not available, decontamination can be achieved by autoclaving. 
 
* Anyone working with anthrax in a suspected or confirmed victim should wear respiratory equipment capable of filtering this size of particle or smaller.<ref>National Personal Protective Technology Laboratory [http://www.cdc.gov/niosh/npptl/default.html Respirators]. National Institute for Occupational Safety and Health. 30 April 2009.</ref>
 
* Microscopic visualization of the encapsulated bacilli, usually in very large numbers, in a [[blood smear]] stained with polychrome methylene blue (McFadyean stain) is [[diagnostic]], although culture of the organism is still the gold standard for diagnosis.  


===Antibiotic Drugs===
===Antibiotic Drugs===
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>
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>


[[Ciprofloxacin]], [[levofloxacin]], and [[doxycycline]] are [[FDA]]-approved for the [[antibiotic]] drug portion of postexposure [[prophylaxis]] for inhalation anthrax in adults ≥18 years of age.  
[[Ciprofloxacin]], [[levofloxacin]], and [[doxycycline]] are [[FDA]]-approved for the [[antibiotic]] drug portion of postexposure [[prophylaxis]] for inhalation anthrax in adults ≥18 years of age.  

Revision as of 00:01, 18 July 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Primary Prevention

Well-timed and effective postexposure prophylaxis can potentially save thousands of lives. Postexposure prophylaxis of asymptomatic persons should start as soon as possible after exposure because its effectiveness decreases with delay in implementation. Initial symptoms may resemble a common cold, including sore throat, mild fever, myalgia, and malaise. After a few days, the symptoms may progress to severe breathing problems shock, and ultimately death.

Antibiotic Drugs

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.[1] 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.[2]

Ciprofloxacin, levofloxacin, and doxycycline are FDA-approved for the antibiotic drug portion of postexposure prophylaxis for inhalation anthrax in adults ≥18 years of age.

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:

Vaccine

There is evidence of seroconversion after 3 doses of AVA. The vaccine should be administered subcutaneously at diagnosis and 2 and 4 weeks later.[1] 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.

Prophylaxis Regimen

▸ Click on the following categories to expand treatment regimens.[3][4][5]

PEP for Infection with B. anthracis

  ▸  Adult Patients

  ▸  Pediatric Patients

  ▸  Pregnant Patients

Postexposure Prophylaxis, Adult Patients
Preferred Regimen
▸ Ciprofloxacin 500 mg PO q12h
OR
▸ Doxycycline 100 mg PO q12h
OR
▸ Levofloxacin 750 mg PO q24h
OR
▸ Moxifloxacin 400 mg PO q24h
OR
▸ Clindamycin 600 mg PO q8h
OR
Alternative Regimen
▸ Amoxicillin 1 g PO q8h
OR
▸ Penicillin VK 500 mg PO q6h
Postexposure Prophylaxis, Pediatric Patients
Preferred Regimen
▸ Ciprofloxacin 30 mg/kg/day PO q12h, max: 500 mg/dose
OR
▸ Doxycycline 4.4 mg/kg/day PO q12h, max: 100 mg/dose (<45 kg)
OR
▸ Doxycycline 100 mg/dose PO q12h (≥45 kg)
OR
▸ Clindamycin 30 mg/kg/day PO q8h, max: 900 mg/dose
OR
▸ Levofloxacin 16 mg/kg/day PO q12h, max: 250 mg/dose (<50 kg)
OR
▸ Levofloxacin 500 mg PO q24h (≥50 kg)
Alternative Regimen
▸ Amoxicillin 75 mg/kg/day PO q8h, max: 1 g/dose
OR
▸ Penicillin VK 50–75 mg/kg/day PO q6–8h
Postexposure Prophylaxis, Pregnant Patients
Preferred Regimen
▸ Ciprofloxacin 500 mg PO q12h


References

  1. ↑ 1.0 1.1 Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC) (2010). "Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009". MMWR Recomm Rep. 59 (RR-6): 1–30. PMID 20651644.
  2. ↑ "Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults".
  3. ↑ Hendricks, Katherine A. (2014-02). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerging Infectious Diseases. 20 (2). doi:10.3201/eid2002.130687. ISSN 1080-6059. PMC 3901462. PMID 24447897. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  4. ↑ Bradley, John S. (2014-04-28). "Pediatric Anthrax Clinical Management". Pediatrics. doi:10.1542/peds.2014-0563. ISSN 1098-4275. PMID 24777226. Unknown parameter |coauthors= ignored (help)
  5. ↑ Meaney-Delman, Dana (2014-02). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerging Infectious Diseases. 20 (2). doi:10.3201/eid2002.130611. ISSN 1080-6059. PMC 3901460. PMID 24457117. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)

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