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 Chemoprophylaxis should be withdrawn under careful observation and with access to an MTF with intensive care and consultative assets.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.
Where you list Gentamicin above, Netilmicin has much less ototoxicity potential and covers a broader range of bugs. Are you aware of an easy doxycycline ordering source?
The good news: we here in Oklahoma see so much Rocky Mountain Spotted fever that we start with Doxycycline, which works for most of these thing.
Does this mean acne ridden teens taking tetracycline are partly treated? I'm joking but not quite: There's a famous story of a hiker who got sick up in a mountain, and the only antibiotic they had was their acne medication: and they were cured.
Oh it works for Lyme disease also.
Only if taken early enough.
To be bookmarked.
Not without a prescription or a doctor's license, unfortunately.
My advice: Most docs have samples of Cipro on their shelves, and they are not going to give it away at this point. It is the drug of choice as prophylaxis, they know that, and they will keep it for themselves and family and friends.
If you are concerned and want a prescription for Doxycycline, just ask your doctor for one. If they resist...play on their guilt:
"Oh c'mon, doc, I know you have cipro samples for yourself. The least you can do is write me an Rx to put my mind at ease. You know that Doxycycline is harmless, cheap, and a good prophylaxis for anthrax and plague. How about writing an Rx for me. I'll probably never take it, but it will at least let me sleep at night."
Any kind of doc can write for this, i.e., MD's, dentists (they prescribe it for gum disease all the time, they should have no problem Rx'ing this), podiatrists. Ask for a two month supply per person. That's equal to 120 Doxycycline 100 mg tablets per person. Don't take it unless you have good reason to believe there has been a release. But get the prescription filled so you have it on the shelf.
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