Seek expert microbiological advice.
Recommended treatment for inhalation and ingestion anthrax:
- adults(includingpregnant women) - for 60 days
- ciprofloxacin 400mg IV every 12hr (or when appropriate 500mg oral twice daily) or
- doxycycline 100mg oral twice daily (when appropriate)plus
- one or two additional antibiotics (agents with in vitro activity include rifampicin, vancomycin, gentamicin, chloramphenicol, penicillin, amoxicillin, imipenem, meropenem and clindamycin)
- children - for 60 days
- ciprofloxacin10mg/kg IV every 12hr, not to exceed adult dose of 1500mg per day (change to oral therapy, 15mg/kg PO not to exceed 1500mg per day, when appropriate)or
- doxycycline100mg oral twice daily (NB: only for children > 8yrs and >45kg)plus
- one or two additional antibiotics (agents with in vitro activity include rifampicin, vancomycin, gentamicin, chloramphenicol, penicillin, amoxicillin, imipenem, meropenem and clindamycin)
Recommended treatment for cutaneous anthrax:
- ciprofloxacin or doxycycline should be considered first-line therapy
- treatment should be initiated with oral ciprofloxacin 500mg or doxycycline 100mg twice daily for 7 days
- this can be changed to oral amoxicillin if the organism is found to be susceptible or if the patient cannot take a fluoroquinolone or tetracycline class drug
- for adults recommended dose is 500mg amoxicillin 3 times a day
- for children, 80mg/kg amoxicillin divided into 3 doses given 8 hourly is an option for completion of therapy after clinical improvement
- presence of signs of systemic involvement, extensive oedema, or lesions on the head or neck requires intravenous therapy and a multi-drug approach is recommended
- treatment may need to be continued for up to 60 days if there is suspicion of deliberate release in order to provide cover for inhalation anthrax, which may have been acquired concurrently (1)
Note 1: ciprofloxacin is not licensed for children under 8 years of age or pregnant women.
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