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
› or = 8 yrs: 2.2 mg/kg every 12 hrs
60 days§
Pregnant
Women*,**
Ciprofloxacin
500 mg BID
or
Doxycycline 100 mg BID
60
days§
Immunocompromised
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.