Sandbox JA

Primary Prevention

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.

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. 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.

Antibiotic Drugs

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 levofloxacin and moxifloxacin; amoxicillin and penicillin VK if the isolate is penicillin susceptible; and clindamycin. The antibiotic drug linezolid cannot be used for extended periods. Also, the risk for development of resistance must be kept in mind if using β-lactam drugs.

Vaccine

Clinical trials in humans have demonstrated evidence of seroconversion after 3 doses of AVA. The vaccine should be administered subcutaneously at diagnosis and 2 and 4 weeks later (37). 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.