Based on US Navy Combat Medicine
Anthrax
Nuclear
Event
Chemical
Event
Biological
Event
Shelter in
Place
Evacuation
Plans
General
Antibiotic
Guidelines
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Emergency Preparedness:
Anthrax
Anthrax Drugs of Choice
Drugs-of-choice are chosen by the following criteria:
Proven Effectiveness
Availability and cost to the general public
Side effects
Doxycycline
a) According to the study
published in the JID 1993;167:1239-42, Doxycycline was successfully used as a
post exposure prophylaxis against Inhalation Anthrax. While taking Doxycycline, 9 out of 10 test subjects survived
a lethal challenge of Inhalation Anthrax and displayed no symptoms.
b) Doxycycline is
available to the general public as a prescription drug or as an
over-the-counter animal antibiotic.
At approximately $65.00 per 500ct of 100mg tablets (wholesale),
Doxycycline's cost is well within the reach of most households.
c) Doxycycline is less of a calcium binder than the other
Tetracyclines and produces fewer side effects including less discoloration of
the teeth in children. Unlike
the other Tetracyclines, it can be taken with milk.
Ciprofloxacin
a) According to the study
published in the JID 1993;167:1239-42, Ciprofloxacin was successfully used as
a post exposure prophylaxis against Inhalation Anthrax. Of the test subjects, 8 out of 9 survived a lethal challenge
of Inhalation Anthrax while taking Ciprofloxacin. One subject died of unknown causes and was excluded
from the statistical analysis.
b) Ciprofloxacin is
available only by prescription and not in the over-the-counter animal
antibiotic market. As a
prescription drug, Cirpofloxacin costs (wholesale) about $400.00 per 100ct of
500mg tabs.
c) Because of side
effects, humans under the age of 19 years are usually not given Ciprofloxacin.
Tetracycline and Oxytetracycline
a)
Tetracycline and Oxytetracycline were not used in the 1993 Anthrax
study. However, the Tetracyclines
have been successfully used and are recommended as a Prophylaxis against
numerous diseases as well as treatment for cutaneous Anthrax.
Considering that all Tetracyclines--including Doxycycline--act upon the 30s ribosome then extrapolation would indicate their usage if
Doxy and Cipro were not available.
b) Both Tetracycline and
Oxytetracycline are available as a prescription drug and an over-the-counter
animal antibiotic.
c) Tetracycline and
Oxytetracycline are calcium binders and will damage the teeth of children.
They will also affect the bones of the unborn and cause discoloration
of the first and second buds (teeth) after the birth.
The bone deformities will return to normal after the drug is stopped.
Penicillin
a) Penicillin was used in
the Anthrax study, but only had a 70% success rate as a prophylaxis.
b) Penicillin is
available as a prescription drug and an over-the-counter animal antibiotic.
c) Other than
Anaphylactic Shock, Penicillin has few side effects.
Dose and Doseage
Sec I
Dose is a unit
(example--500mg)
Sec II
Dosage is the Dose X the
Frequency X the Duration (example--500mg
every 12 hours for 60 days - or more days if directed by authorities.)
Sec I Dose: Military
guidelines for the daily dose total for Doxycycline (against Anthrax) is 200mg
(100mg twice a day). However,
you will note that our Charts recommend the Daily Dose Total for Doxycycline
against Anthrax is 300mg. We
chose this schedule for the following reasons.
1) The general population does not
have access to the Anthrax vaccine or the Plague vaccine.
2) Unlike the military, the general
population is not as healthy and does not have as strong an immune system.
3) We also feel that until otherwise
confirmed, an Anthrax event could be State sponsored and quite possibly be
both Anthrax and Plague or other combinations of Biologicals.
4) Also, unlike the military, secondary infections may also be present in the civilian population such as venereal diseases. Prophylaxis against Inhalation Anthrax may fail if the antibiotic is also fighting a disease like gonorrhea.
II Dosage: Different
antibiotics sometimes require different frequency of dose.
For instance Doxycycline should be taken at least BID (twice a day).
Other Tetracyclines call for a 4 times a day schedule. This is because it is important to keep a steady blood-level
of the antibiotic in the patient.
If
the peak and trough levels vary too greatly then the blood level is not
constant enough for a particular antibiotic to be efficient. When dosing, it is important to consider the daily dose total
as well as the frequency.
Example:
Doxycycline 3 times a day or 2 times a day is acceptable as long as the daily
dose total is accurate. However,
Oxytetracycline 2 times a day is not acceptable. Oxytetracycline must have a frequency of at least 4 times a
day.
Duration:
As borne out by the military studies, duration for Anthrax prophylaxis
must be for 60 days (or more days if directed by authorities)IF the vaccine is not available.
***END***
Source: This is an official CDC Health Update [edited]
Distributed via Health Alert Network
Recommendations for Post-Exposure Prophylaxis for _B. anthracis_ in Florida
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These recommendations are based on the susceptibility pattern of the _B.
anthracis_ isolate from the Florida inhalation anthrax case.
Adults
--------
Adult males & non-pregnant females (ages 18-65 yrs)
Ciprofloxacin 500 mg orally twice a day for 60 days (or more days if directed by authorities).
OR
Doxycycline 100 mg orally twice a day for 60 days (or more days if directed by authorities).
OR
Amoxicillin 500 mg orally 3 times a day for 60 days (or more days if directed by authorities).
*Drug-drug interactions and individual patient allergies should be considered
when selecting an antibiotic for prophylaxis.
Pregnant adult females
Amoxicillin 500 mg orally 3 times a day for 60 days (or more days if directed by authorities).
* If allergic to amoxicillin or penicillin, consultation with a physician is
required as ciprofloxacin or doxycycline may be indicated.
Adults age 65 yrs & over
Doxycycline 100 mg orally twice a day for 60 days (or more days if directed by authorities).
OR
Ciprofloxacin 500 mg orally twice a day for 60 days (or more days if directed by authorities).
OR
Amoxicillin 500 mg orally 3 times a day for 60 days (or more days if directed by authorities).
*Drug-drug interactions and individual patient allergies should be considered
when selecting an antibiotic for prophylaxis.
** In older adults, the potential CNS side effects of ciprofloxacin should
also be considered when selecting an antibiotic for prophylaxis.
Children
-----------
Antibiotics for children are listed in order of preference:
Children 9 yrs & over Amoxicillin 500 mg orally 3 times a day for 60 days (or more days if directed by authorities).
OR
Ciprofloxacin 500 mg orally twice a day for 60 days (or more days if directed by authorities).
OR
Doxycycline 100 mg orally twice a day for 60 days (or more days if directed by authorities).
*Drug-drug interactions and individual patient allergies should be considered
when selecting an antibiotic for prophylaxis. Amoxicillin is preferred for
children. If allergic to amoxicillin or penicillin, consultation with a
physician is required, as ciprofloxacin or doxycycline may be indicated.
Children less than 9 yrs
Amoxicillin 80 mg/kg/day orally, divided into 3 doses a day for 60 days (or more days if directed by authorities).
OR
Ciprofloxacin 10-15 mg/kg/day orally, divided into 2 doses a day for 60 days (or more days if directed by authorities).
OR
Doxycycline 5 mg/kg/day orally, divided into 2 doses a day for 60 days (or more days if directed by authorities).
* Drug-drug interactions and individual patient allergies should be considered
when selecting an antibiotic for prophylaxis. Amoxicillin is preferred for
children. If allergic to amoxicillin or penicillin, consultation with a
physician is required, as ciprofloxacin or doxycycline may be indicated.
* Reminder: symptoms of inhalational anthrax include fever, muscle aches, and
fatigue that rapidly progress to severe systemic illness. Workers and visitors
associate with the AMI work site in Florida who develop such symptoms should be
thoroughly evaluated to exclude anthrax and be reported
to the state health department.
FOR ADDITIONAL INFORMATION
CALL CDC ATLANTA, USA
(404) 639-2807
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