Bioterrorism antibiotics
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Contact CDC Emergency Hotline 1-707-488-7100 for all suspected bioterrorism cases
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 900mg 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 [1]
Post-Exposure Prophylaxis
- Vaccinia Vaccine (administer within 72hrs of exposure)
Active Disease
- Supportive care and wound care for open lesions
- Vaccinia Vaccine within the first 72hrs can decrease total disease severity and within 7 days may decrease symptoms
- Vaccination is not efficacious once the patient has developed rash[2]
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
References
- ↑ Kman NE, Nelson RN. Infectious agents of bioterrorism: a review for emergency physicians. Emerg Med Clin North Am. 2008 May;26(2):517-47
- ↑ Cdc.gov. 2020. Prevention and Treatment | Smallpox | CDC. [online] Available at: <https://www.cdc.gov/smallpox/prevention-treatment/index.html> [Accessed 11 September 2021].