From the Guidelines
The treatment of cutaneous anthrax requires prompt antibiotic therapy with oral penicillin V 500 mg four times daily for 7-10 days as the recommended treatment for naturally acquired cutaneous anthrax, as stated in the 2014 update by the Infectious Diseases Society of America 1. This approach prioritizes the most recent and highest quality evidence available, focusing on minimizing morbidity, mortality, and improving quality of life for patients with cutaneous anthrax. Key considerations in the treatment of cutaneous anthrax include:
- The use of antibiotics such as ciprofloxacin or doxycycline for 7-10 days in uncomplicated cases, which may be extended to 60 days if there is a risk of inhalational exposure 1.
- For severe cases or those with systemic symptoms, intravenous antibiotics are recommended, typically ciprofloxacin or doxycycline, with the option to switch to oral therapy when clinically appropriate 1.
- Penicillin G may be used for penicillin-susceptible strains, emphasizing the importance of susceptibility testing to guide treatment decisions 1.
- Supportive care, including pain management and monitoring for complications such as edema, is crucial, especially for lesions on the face or neck that may compromise airways.
- The characteristic black eschar of cutaneous anthrax will typically remain during treatment and eventually separate naturally, with antibiotics effective against the bacterial toxins causing tissue damage 1. Healthcare providers should report cases to public health authorities immediately due to the potential for anthrax to be used as a bioterrorism agent, and close contacts may require post-exposure prophylaxis with the same antibiotics used for treatment 1.
From the FDA Drug Label
Anthrax due to Bacillus anthracis, including inhalational anthrax (post-exposure): to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis. Doxycycline is indicated for the treatment of Anthrax due to Bacillus anthracis.
- The treatment includes inhalational anthrax (post-exposure) to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis 2.
From the Research
Treatment Options for Cutaneous Anthrax
- The treatment of choice for cutaneous anthrax is medical, with ciprofloxacin or doxycycline being the preferred antibiotics 3.
- A study comparing the clinical outcomes of patients receiving antibiotic treatment for either 3-5 days or 7-10 days in uncomplicated cutaneous anthrax found that short-course antibiotic therapy is as effective as standard-duration therapy 4.
- The Centers for Disease Control and Prevention (CDC) recommends the use of doxycycline or ciprofloxacin for prophylaxis and treatment in children, despite the potential risks associated with these antibiotics 5.
Antibiotic Therapy
- Ciprofloxacin and doxycycline are recommended for the treatment of cutaneous anthrax in adults and children 6, 5.
- Other agents with in vitro activity against Bacillus anthracis, such as rifampicin, vancomycin, imipenem, chloramphenicol, penicillin, and ampicillin, may be used in conjunction with ciprofloxacin or doxycycline 6.
- Steroid therapy may not be effective in the treatment of cutaneous anthrax, and its use is not recommended unless there are specific indications 4.