Bioterrorism antibiotics

Anthrax

Postexposure Prophylaxis

Patient should be vaccinated at day #0, #14, #28

• Ciprofloxacin 500mg PO q12hrs daily x 60 days OR
• Doxycycline 100mg PO q12hrs x 60 days

Cutaneous Anthrax (not systemically ill)

• Ciprofloxacin 500mg PO q12hrs x 60 days
• Doxycycline 100mg PO q12hrs x 60 days

Inhalation or Cutaneous with systemic illness

• Ciprofloxacin 400mg IV q12hrs x 60 days (1st line) OR
• Doxycycline 100mg IV q12hrs x 60days (only if allergic to ciprofloxacin) PLUS
  • Clindamycin 90mg IV q8hrs

Pediatric Postexpsoure Prophylaxis

• Ciprofloxacin 15mg/kg PO q12hrs x 60 days
• Doxycycline 2.2mg/kg PO q12hrs x 60 days

Pediatric Cutaneous Anthrax (not ill)

• Same as post exposure dosing and duration

Pediatric Inhalational or Cutaneous (systemically ill

• Ciprofloxacin 15mg/kg IV q12hrs (1st line) OR
• Doxycycline 2.2mg/kg IV q12hrs (only if allergic to cipro) PLUS
  • Clindamycin 7.5mg/kg q6hrs daily

Botulism

Supportive Care

• Early ventilatory support
  • Consider intubation when vital capacity <30% predicted or <12cc/kg
• Wound Managment
  • Early wound debreedment with surgical consult.
  • Also exclude Necrotizing fasciitis and coverage with same broad antibiotic coverage

Foodborne Botulism

• Equine Serum Botulism Antitoxin
  • only for patients > 1yo
• Antitoxin obtained through CDC or local Department of Health.

Infant Botulism (<1yo)

• Human-based Botulism IG 100mg/kg IV x 1 dose (BabyBIG)
  • infusion divided into 25mg/kg/hr IV x 15 min followed by 50mg/kg/hr if no allergic reactions
  • Stop infusion after total of 100mg/kg infused
• BabyBIG obtained through CDC or local Department of Health

Inhalational Botulism

• Equine Serum Botulism Antitoxin
  • only for patients > 1yo
• Antitoxin obtained through CDC or local Department of Health

Wound Botulism

• Individualize therapy with ID consultant
• Broad antibiotic coverage same as for Necrotizing fasciitis while awaiting wound cultures

Smallpox

• IMMEDIATE NOTIFICATION OF PUBLIC HEALTH AUTHORITIES
• Vaccine administered up to 3 days post-exposure was effective in preventing infection as well as lessening the severity of the disease if infection occurred

Postexposure Prophylaxis

• Vaccinia Vaccine (administer within 72hrs of exposure)

Active Disease

• Vaccinia Vaccine within the first 72hrs can decrease total disease severity and within 7 days may decrease symptoms
• Supportive care and wound care for open lesions

Tularemia

Postexposure Prophylaxis

• Doxycycline 100mg PO q12hrs x 14 days OR
• Ciprofloxacin 500mg PO q12hrs q12hrs x 10 days

Active Disease

• Streptomycin 1g (15mg/kg) IM q12hrs daily x 10 days (First line) OR
• Gentamicin 5mg/kg/day IV/IM once daily x 10 days OR
• Ciprofloxacin 400mg (15mg/kg) q12hrs daily x 10 days OR
• Doxycycline 100mg (2.2mg/kg) IV q12hrs daily x 14 days OR
• Chloramphenicol 15mg/kg IV q6hrs daily x 14 days

Yersinia

Postexposure Prophylaxis

• Doxycycline 100mg (2.2mg/kg) PO q12hrs daily OR
• Ciprofloxacin 500mg (20mg/kg) PO q12hrs daily OR
• Chloramphenicol 1mg (25mg/kg) PO q6hrs
  • only if age > 2

Active Disease

• Gentamicin 5mg/kg IV/IM once daily x 10 days OR
• Ciprofloxacin 500mg (20mg/kg) PO q12hrs x 10 days OR
• Doxycycline 200mg (2.2mg/kg) PO/IV daily

See Also

Antibiotics by diagnosis

• Bone and joint antibiotics
• Cardiovascular antibiotics
• ENT antibiotics
• Eye antibiotics
• GI antibiotics
• GU antibiotics
• Neuro antibiotics
• OB/GYN antibiotics
• Pulmonary antibiotics
• Skin and soft tissue antibiotics
• Bioterrorism antibiotics
• Environmental exposure antibiotics
• Immunocompromised antibiotics
• Post exposure prophylaxis antibiotics
• Pediatric antibiotics
• Sepsis antibiotics
• Arthropod and parasitic antibiotics

For antibiotics by organism see Microbiology (Main)

External Links

• CDC Emergency Preparedness and Response

References

Authors

Ross Donaldson, Michael Holtz, Daniel Ostermayer