TABLE 4. Cutaneous Anthrax Treatment Protocol* for Cases Associated With This Bioterrorism Attack

Category	Initial Therapy (oral)†	Duration
Adults	Ciprofloxacin 500 mg BID or Doxycycline 100 mg BID	60 days§
Children*	Ciprofloxacin 10-15 mg/kg every 12 hrs (not to exceed 1 g/day) or Doxycyline:¶ >8 yrs and > 45 kg: 100 mg every 12 hrs <8 yrs and ? 45 kg: 2.2 mg/kg every 12 hrs >/= 8 yrs: 2.2 mg/kg every 12 hrs	60 days§
Pregnant Women'*	Ciprofloxacin 500 mg BID or Doxycycline 100 mg BID	60 days§
Immunocomprimised Persons*	Same for nonimmunocompromised persons and children.	60 days§

*Cutaneous anthrax with signs of systemic involvement, extensive edema, or lesions on the head or neck require intravenous therapy, and a multidrug approach is recommended. (Table 4)

†Ciprofloxacin or Doxycycline should be considered first-line therapy. Amoxicillin 500 mg po TID for adults or 80 mg/kg/day divided every 8 hours for children is an option for completion of therapy after clinical improvement. Oral amoxicillin dose is based on the need to achieve appropriate minimum inhibitory concentration levels.

§Previous guidelines have suggested treating cutaneous anthrax for 7-10 days, but 60 days is recommended in the setting of this attack, given the likelihood of exposure to aerosolized B. Anthracis.

¶The American Academy of Pediatrics recommends treatment of young children with tetracyclines for serious infections. (e.g., Rocky Mountain Spotted Fever).

**Although tetracyclines or ciprofloxacin are not recommended during pregnancy, their use may be indicated for life-threatening illness. Adverse effects on developing teeth and bones are dose related; therefore, doxycycline might be used for a short time (7-14 days) before 6 months of gestation.