Posted on 10/08/2001 5:06:14 PM PDT by Brian Kopp DPM
Simplified Antibiotic recommendations for prevention of Anthrax/ Biological Warfare bugs
This data was taken directly from the Virtual Naval Hospital: Treatment of Biological Warfare Agent Casualties site. Anthrax, plague, (and tularemia, in theory) have protocols for prophylaxis (taking antibiotics prior to exposure to prevent getting the infection.)
I have simply listed the recommended antibiotic prevention and treatment regimens listed on the Naval Hospital site. Of course, if any bioterror bugs have been manipulated to be antibiotic resistant, all bets are off. So far the strains in Florida are susceptible to good old penicillin, a good sign.
Bottom line? For those bugs for which antibiotics can prevent infection, Cipro appears to be the drug of choice. However, Doxycycline costs only 10% as much, is better tolerated, can be used in pediatric patients, and can be taken long term with few side effects. (Cipro causes premature growth plate closure and therefore should be avoided in pediatric patients unless absolutely necessary to save the life of the child.)
*Please refer to the Virtual Naval Hospital web site for in depth information on diagnosis, full treatment regimen, etc.
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Anthrax
Prophylaxis
Ciprofloxacin hydrochloride tablets (500 milligrams [mg]) are given orally every 12 hours beginning prior to imminent anthrax attack. When Ciprofloxacin hydrochloride tablets are not available, doxycycline hyclate tablets (100 mg) are given orally every 12 hours beginning prior to imminent anthrax attack. The chemoprophylaxis should be discontinued after attack if the use of anthrax has been excluded.
Post-exposure Prophylaxis. Use immunization with chemoprophylaxis to prevent the clinical manifestation of the disease. Chemoprophylaxis is recommended as an adjunct to immunization for post-exposure prophylaxis. Ciprofloxacin hydrochloride tablets (500 mg) should be taken orally every 12 hours for at least 4 weeks. When Ciprofloxacin hydrochloride tablets are not available, doxycycline hyclate tablets (100 mg) should be taken orally every 12 hours for at least 4 weeks. The duration of chemoprophylaxis administration for individuals without receipt of any vaccine should be extended until they receive at least three doses of vaccine. Chemoprophylaxis should be withdrawn under careful observation and with access to an MTF with intensive care and consultative assets. If fever develops following the withdrawal of chemoprophylaxis, empiric therapy for anthrax is indicated pending etiologic diagnosis.
Treatment: Once you know you are sick, treatment may be too late. If you have not had prophylactic antibiotics and you suspect you have been exposed, seek medical treatment immediately.
Plague
Prevention
Pre-exposure Prophylaxis. Administer ciprofloxacin 500 mg orally every 12 hours or doxycycline 100 mg orally every 12 hours beginning when a BW attack is imminent or suspected; discontinue if the employment of plague BW can be excluded. Post-exposure Prophylaxis. Administer doxycycline 100 mg orally every 12 hours for one week or ciprofloxacin 500 mg orally every 12 hours for one week.
Treatment
Streptomycin, 15 mg/kg lean body mass IM every 12 hours for 10 to 14 days.
Gentamicin, 5 mg/kg lean body mass IV every 24 hours for 10 to 14 days.
Gentamicin, 1.75 mg/kg lean body mass IV every 8 hours for 10 to 14 days.
Ciprofloxacin, 400 mg IV every 12 hours. Oral therapy may be given (750 mg orally every 12 hours) after the patient is clinically improved, for completion of a 10- to 14-day course of therapy.
Doxycycline, 200 mg IV loading dose followed by 100 mg IV every 12 hours. Oral therapy may be given (100 mg orally every 12 hours) after the patient is clinically improved, for completion of a 10- to 14-day course of therapy.
Tularemia
Prevention
Pre-exposure Chemoprophylaxis given for anthrax or plague (ciprofloxacin, doxycycline) may confer protection against tularemia, based on in vitro susceptibilities.
Post-exposure Prophylaxis. Post-exposure prophylaxis following a BW attack include - doxycycline 100 mg orally every 12 hours for 2 weeks; or tetracycline 500 mg orally every 6 hours for 2 weeks; or ciprofloxacin 500 mg orally every 12 hours for 2 weeks.
Treatment
Administer streptomycin 7.5 to 10 mg/kg IM every 12 hours for 10 to 14 days.
Administer gentamicin 3 to 5 mg/kg IV daily for 10 to 14 days.
Administer ciprofloxacin 400 mg IV every 12 hours, switch to oral ciprofloxacin (500 mg every 12 hours) after the patient is clinically improved; continue for completion of a 10- to 14-day course of therapy.
Administer ciprofloxacin 750 mg orally every 12 hours for 10 to 14 days.
Melioidosis
Prophylaxis
No antibiotic prophylaxis available
Treatment :
For localized disease, administer one of the following for a duration of 60 to 150 days:
Amoxicillin/clavulanate (Augmentin), 60 mg/kilograms (kg)/day in 3 divided oral doses.
Tetracycline, 40 mg/kg/day in 3 divided oral doses.
Trimethoprim/sulfa (Bactrim, Septrim) (TMP, 4 mg per kg per day/sulfa, 20 mg per kg per day in divided oral doses).
For localized disease with mild toxicity, administer antibiotics as follows: Combine two of the above oral regimens for a duration of 30 days, followed by monotherapy with either amoxicillin / clavulanate or TMP / sulfa for 60 to 150 days. For extrapulmonary suppurative disease, the antibiotic therapy should be administered for 6 to 12 months. Surgical drainage of abscesses is indicated.
(3) For severe and / or septicemic disease, administer antibiotics as follows: Ceftazidime, 120 mg / kg / day in three divided doses, combined with TMP / sulfa (TMP, 8 mg per kg per day / sulfa, 40 mg per kg per day in four divided doses). Initially, administer parenteral therapy for 2 weeks, followed by oral therapy for 6 months.
(4) The addition of streptomycin is indicated if presentation (acute pneumonia) and sputum studies suggests plague
Brucellosis
Prophylaxis
No antibiotic prophylaxis available
Treatment
Undifferentiated febrile illness. Antibiotic therapy requires a combination of two medications. Administer - Doxycycline, 200 mg, daily for 6 weeks and rifampin, 600 mg, daily for 6 weeks or Doxycycline, 200 mg, daily for 6 weeks and streptomycin, 1 gm intramuscularly (IM), daily for 2 weeks.
Osteoarticular disease. Treat as indicated in (1) above, but extend therapy to 12 weeks.
Endocarditis. Administer antibiotic therapy as indicated in (1) above. Optimal duration of therapy is undefined; however, treatment is often continued for 6 to 9 months. Surgical heart valve replacement is usually necessary for total cure and should be strongly considered.
(4) Central nervous system (CNS) disease. Administer antibiotic therapy as indicated in (1) above, but extend therapy for 6 to 9 months.
(5) Abscesses. In addition to treatment in (1) above, drainage of abscesses should be done as surgically indicated.
Glanders
Prophylaxis
No antibiotic prophylaxis available
Treatment
For localized disease, administer one of the following for a duration of 60 to 150 days:
Amoxicillin/clavulanate, 60 mg/kg/day in 3 divided oral doses.
Tetracycline, 40 mg/kg/day in 3 divided oral doses.
Trimethoprim/sulfa (TMP, 4 mg per kg per day/sulfa, 20 mg per kg per day in divided oral doses).
For localized disease with mild toxicity, administer antibiotics as follows: Combine two of the above oral regimens for a duration of 30 days, followed by monotherapy with either amoxicillin / clavulanate or TMP / sulfa for 60 to 150 days.
For extrapulmonary suppurative disease, the antibiotic therapy should be administered for 6 to 12 months. Surgical drainage of abscesses is indicated.
For severe and / or septicemic disease, administer antibiotics as follows: Ceftazidime, 120 mg / kg / day in three divided doses, combined with TMP / sulfa (TMP, 8 mg per kg per day / sulfa, 40 mg per kg per day in four divided doses). Initially, administer parenteral therapy for 2 weeks, followed by oral therapy for 6 months.
The addition of streptomycin is indicated if presentation (acute pneumonia) and sputum studies suggests plague.
Q Fever
Prophylaxis
No antibiotic prophylaxis available
Post-exposure Chemoprophylaxis. Chemoprophylaxis (tetracycline 500 mg orally every 6 hours for 5 days, or doxycycline 100 mg orally every 12 hours for 5 days) is effective if begun 8 to 12 days post-exposure. Chemoprophylaxis is not effective if given immediately (1 to 7 days) post-exposure; it merely delays the onset of disease.
Treatment
Administer doxycycline 100 mg orally every 12 hours for at least 2 days after the patient is afebrile.
Administer tetracycline 500 mg every 6 hours for at least 2 days after the patient is afebrile.
Consider treating patients unable to take tetracycline with ciprofloxacin and other quinolones, which are active in vitro. The duration of therapy is usually 5 to 7 days, at least 2 days after the patient is afebrile. Quinolones are not recommended for the treatment of children.
Chemical Neutralizes Anthrax Toxin
Nathan Seppa
Scientists have created a synthetic compound that disables the toxin that makes the bacterial disease anthrax so lethal. Meanwhile, another research team has discovered a gene that protects some mice against anthrax. These findings could lead to an antidote to the anthrax toxin and help clarify the mechanism by which it kills.
Whether the new compound can serve as an antitoxin in people remains unclear since the scientists have tested it only in rats, says R. John Collier of Harvard Medical School in Boston. Nevertheless, the concept of neutralizing anthrax toxin has appeal because the current treatments, which target the bacterium, and the vaccine now in use have drawbacks.
When a person inhales spores of Bacillus anthracis—the microbe that causes anthrax—they unleash three proteins that combine to form a toxin. This triad makes blood pressure plummet, causes hemorrhaging, and can lead to coma and death.
The proteins attack human cells as a team. One protein—protective antigen (PA)—binds to a receptor on the cell surface and is cleaved by enzymes there. The part of PA that remains stuck, called PA63, provides a docking site for the other anthrax proteins—lethal factor and edema factor. Once assembled, the toxin enables lethal factor to enter the cell. There, it chops up proteins, setting into motion the chain of events that leads to anthrax's symptoms, says Nicholas C. Duesbery of the Van Andel Research Institute in Grand Rapids, Mich.
Since no drug in use at present disables the toxin, Collier and his colleagues set out to create such a compound. First, they identified a peptide, or partial protein, that bonds to PA63 in lab tests. Next, they linked together multiple copies of the peptide. In test tubes, this synthetic molecule, which they call polyvalent inhibitor (PVI), prevented the natural anthrax proteins from binding to PA63.
When injected into rats, PVI protected the animals against subsequent exposure to 10 times the normally lethal dose of anthrax toxin, the researchers report in the October Nature Biotechnology. Without PVI treatment, rats died within hours.
Antibiotics can kill B. anthracis but have no effect on the toxin already present in the body when symptoms appear, says Robert C. Liddington of the Burnham Institute in La Jolla, Calif. The vaccine poses problems, too. It can cause side effects, and "it's hard to justify vaccinating a whole country against one particular agent of biological terrorism," he says.
Ideally, a toxin antidote would be mass-produced and kept in storage around the country, Collier says.
Researchers are currently charting the anthrax proteins' course in the body. In the Oct. 2 Current Biology, William F. Dietrich of the Howard Hughes Medical Institute and Harvard Medical School in Boston and his colleagues report that certain variations of a gene called Kif1C, which encodes a protein that ushers other proteins around inside cells, protect mice from the effects of the anthrax toxin.
"We've got the PA63 molecular activity on one end and the disease on the other end. The Kif1C gene gives us some clues as to where to look in between," Duesbery says.
References:
Mourez, M., ... and R.J. Collier. 2001. Designing a polyvalent inhibitor of anthrax toxin. Nature Biotechnology 19(October):958.
Watters, J.W., ... and W.F. Dietrich. 2001. Kif1C, a kinesin-like motor protein, mediates mouse machophage resistance to anthrax lethal factor. Current Biology 11(Oct. 2):1503.
Further Readings:
Dixon, T.C., et al. 1999. Anthrax. New England Journal of Medicine 341:815.
Duesbery, N.S., et al. 1998. Proteolytic inactivation of MAP-kinase-kinase by anthrax lethal factor. Science 280:734.
Petosa, C., et al. 1997. Crystal structure of the anthrax toxin protective antigen. Nature 385:833.
Seppa, N. 2001. New anthrax treatment works in rats. Science News 159(May 12):296.
Travis, J. 2000. Viruses that slay bacteria draw new interest. Science News 157(June 3):358.
______. 1998. New clue hints at how anthrax kills. Science News 153(May 9):299.
Sources:
R. John Collier
Department of Microbiology and Molecular Genetics Harvard Medical School 200 Longwood Avenue Boston, MA 02115
William F. Dietrich
Department of Genetics Howard Hughes Medical Institute Harvard Medical School Boston, MA 02115
Nicholas S. Duesbury
Van Andel Research Institute 3333 Bostwick Avenue N.E. Grand Rapids, MI 49503
Robert C. Liddington
Burnham Institute 10910 North Torrey Pines Road La Jolla, CA 92037
From Science News, Vol. 160, No. 14, Oct. 6, 2001, p. 212.
Copyright ©2001 Science Service. All rights reserved. 1719 N St., NW, Washington, DC 20036 | 202-785-2255 | scinews@sciserv.org
I know I have a bad attitude, but things like this remind me of the cold war adage:
"In the event of nuclear attack, put your head between your knees, cover your ears, and kiss your $$$ goodbye."
Cipro can also cause bone problems in kids. And pregnant women can't take it, since the baby's bones are affected with all three.
Section II - Anthrax
Headquarters Departments of the Army, the Navy, and the Air Force, and Commandant, Marine Corps
Peer Review Status: Internally Peer Reviewed
2-9. Control of Patients, Contacts, and Treatment Areas
Report all cases to line and medical chains of command.
Employ Standard Precautions for handling, treating, and moving all active cases.
Use sporicidal agents, such as disinfectant strength iodophors, in MTFs for general area disinfection. Antiseptic strength iodophors are not sporicidal. Hypochlorite solutions may be attenuated by organic matter, but will provide a disinfectant capability when used in a 5-percent solution. The hypochlorite solution should be replaced frequently. Autoclaving, steam sterilizing, or burning is required for complete eradication of spores.
The real good news is that all the batch of Anthrax spores that were smuggled into the USA are all sensitive to PCN!
That's what's not being reported on the TV or here on FR.
Let's Roll,
DrMike
Shalom,
DrMike
Stay Safe !
I read recently that they don't know. But hey, they tried!
Not having taken the Doxycycline, I can't guarantee that it's good, but everything appears to be legit. Shipping has been ~3 weeks, and Credit Card billing has worked with no problems.
There's a $50 minimum, so maybe pick up some Amoxycillin too. That's safer for kids and pregnant women. No good for anthrax, but better for ear/nose/throat infections, and you never know what you'll need.
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