Sandbox JA

Medical Therapy

The treatment of anthrax infection includes antimicrobial and antitoxin agents. This treatment and postexposure prophylaxis differs from other bacterial infections because:

• Production of toxin
• Potential antibiotic resistance
• Frequent occurrence of meningitis
• Presence of latent spores must be taken into account when selecting postexposure prophylaxis or a combination of antibiotics for treatment of anthrax

Hospitalized patients for systemic anthrax should be immediately treated with a combination of broad-spectrum intravenous antimicrobial drug treatment pending confirmatory test results because any delay may prove fatal.

Because meningitis and hemorrhagic brain parenchymal infection was observed in ≤50% of cases, meningitis must be considered in all cases of systemic anthrax. Therefore antibiotics to treat possible meningitis must have good penetration of the central nervous system (CNS).

Empiric therapy for anthrax in which anthrax meningitis is suspected or cannot be ruled out should include ≥3 antibiotics with activity against Bacillus anthracis, in which:

• ≥1 drug should have bactericidal activity

• ≥1 should be a protein synthesis inhibitor

• All should have good CNS penetration

Given the high mortality rate associated with meningitis, 3 weeks of treatment for patients in whom meningitis could not be ruled out, is preferred. Because of the presence of a spore form of Bacillus anthracis, antibiotic therapy should be continued for 60 days to clear germinating organisms.

Antimicrobial Treatment

Follow-up Oral Treatment for Systemic Disease

Once patients with systemic illness who were exposed to aerosolized spores have completed initial combination treatment, they should be transitioned to single-agent oral treatment to prevent relapse from surviving Bacillus anthracis spores.