Category

Initial Therapy (Intravenous)

Duration

Adults

Ciprofloxacin 400 mg every 12 hours*
or
Doxycycline 100 mg every 12 hrs.††††
and
One or two additional antimicrobials¶

IV treatment initially**.
Switch to oral antimicrobial therapy
when clinically appropriate:

Ciprofloxacin 500 mg po BID
or
Doxycycline 100 mg po BID

Continued for 60 days (IV and po combined)§§

Children

Ciprofloxacin 10 - 15 mg/kg every 12 hrs¶¶***
or
Doxycycline.†††,††

› 8 yrs and › 45kg: 100 mg every 12 hrs
› 8yrs and ‹ or = 45kg: 2.2 mg/kg every 12 hrs
‹ or = 8 yrs: 2.2 mg/kg every 12 hrs
and
One or two additional antimicrobials¶

IV treatment initially**. Switch to oral antimicrobial therapy when clinically appropriate:

Ciprofloxacin 10 - 15 mg/kg po every 12 hrs***
or
Doxycycline:†††††

› 8 yrs and › 45 kg: 100 mg po BID
› 8 yrs and ‹ or = 45 kg: 22mg/kg po BID
‹ or = 8 yrs: 2.2 mg/kg po BID

Continue for 60 days (IV and po combined)§§

Pregant Women§§§

Same for nonpregnant adults (the high death rate from infection outweighs the risk posed by the antimicrobial agent)

IV treatment intially.
Switch to oral antimicrobial therapy when clinically appropriate.†† Oral therapy regimens same for nonpregnant adults.

Immunocompromised Persons

Same for nonimmunocompromised
persons and children.

Same for nonimmunocomprised
persons and children.

*	For gastrointestinal and oropharyngeal anthrax, use regimens recommended for inhalational anthrax.
†	Ciprofloxacin or doxycycline should be considered an essential part of first-line therapy for inhalational anthrax.
§	Steroids may be considered as an adjunct therapy for patients with severe edema and for meningitis based on experience with bacterial meningitis of other etiologies.
¶	Other agents with in vitro activity include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenern, clindamycin, and clarithromycin. Because of concerns of constitutive and inducible beta-lactamasses in Bacillus Anthracis, penicillin and ampicillin should not be used alone. Consultation with an infectious disease specialist is advised.
**	Initial therapy may be altered based on clinical course of the patient; one or two antimicrobial agents (e.g., ciprofloxacin or doxycycline) may be adequate as the patient improves.
††	If meningitis is suspected, doxycyline may be less optimal because of poor central nervous system penetration.
§§	Because of the potential persistence of spores after an aerosol exposure, antimicrobial therapy should be continued for 60 days.
¶¶	If intravenous ciprovloxacin is not available, oral ciprofloxacin may be acceptable because it is rapidly and well absorbed from the gastrointestinal tract with no substantial loss by first-pass metabolism. Maximum serum concentration are attained 1-2 hours after oral dosing but may not be achieved if vomiting or ileus are present.
***	In children, ciprofloxacin dosage should not exceed 1 g/day
†††	The American Academy of Pediatrics recommends treatment of young children with tetracyclines for serious infections. (e.g., Rocky Mountain spotted fever).
§§§	Although tetracyclines are not recommended during pregnancy, their use may be indicated for life-threatening illness. Adverse effects on developing teeth and bones are dos related; therefore, doxycycline might be used for a short time (7-14 days, before 6 months of gestation.