Biological Warfare (cont.)

Medical Author:

Edmond Hooker, MD, DrPH

Edmond Hooker, MD, DrPH

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Treatment

• Inhalation anthrax: As previously stated because inhalation anthrax moves quickly throughout the body, doctors will begin antibiotic treatment right away even before a firm diagnosis is made through lab testing.
• Ciprofloxacin (Cipro), doxycycline (Vibramycin), and penicillin are FDA-approved antibiotics for treatment of anthrax. Experts currently recommend ciprofloxacin or other drugs in the same class for adults who are assumed to have inhalation anthrax infection. Penicillin and doxycycline may be used once organism culture sensitivities are known.
• Traditionally, ciprofloxacin and other antibiotics in that class are not recommended for use in children younger than 16-18 years of age because of a weak theoretical link to permanent joint disorders. Balancing these small risks against the risk of death and the possibility of infection with a resistant strain of anthrax, experts recommend that ciprofloxacin nonetheless be given to children in appropriate doses.
• Because there is a risk the infection will recur, victims are treated with antibiotics for at least 60 days.
• Skin anthrax: Treatment of skin anthrax with antibiotics generally prevents the disease from progressing to the entire body although the black tissue and scar continue to form. Although previous guidelines have suggested treating skin anthrax with seven to 10 days of therapy, recent recommendations suggest treatment for 60 days in the setting of bioterrorism, thus assuming the person may also have been exposed to inhalational anthrax.
• In pregnant women, experts recommend that ciprofloxacin be given after exposure as a preventive medication following exposure to an anthrax attack.

Prevention

A vaccination series to protect against anthrax consists of five IM doses administered at day 0, week 4, and months 6, 12, and 18, followed by annual boosters. The CDC does not recommend vaccination for the general public, health care workers, or even people working with animals. The only groups that are recommended to receive routine vaccination are military personnel and investigators and remediation workers who are likely to enter an area with B. anthracis spores.

Postexposure Prophylaxis

When unvaccinated people are exposed to anthrax, it is now recommended that they receive both antibiotics for 60 days and be vaccinated. The common antibiotics used for postexposure prophylaxis are ciprofloxacin and doxycycline. The vaccine is Anthrax Vaccine Adsorbed (AVA), and it is given as three subcutaneous doses (administered at 0, 2, and 4 weeks postexposure). These recommendations are for everyone and include pregnant women and children (although the recommendation for children will be reviewed on an event by event basis). The government has stockpiles of drugs and vaccines available and can deliver them to an affected area very quickly.

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