From the Guidelines
Anthrax exposure requires immediate medical treatment with antibiotics, and the most effective treatment is ciprofloxacin 500 mg orally twice daily for 60 days, or doxycycline 100 mg orally twice daily for 60 days, as recommended by the highest quality and most recent study 1. The treatment of anthrax exposure is crucial to prevent morbidity, mortality, and improve quality of life.
Key Considerations
- The treatment duration for active infection is typically 60 days, as anthrax spores can remain dormant in the body before causing active infection 2.
- For confirmed anthrax infection, intravenous antibiotics are necessary, typically a combination of ciprofloxacin or doxycycline plus one or two additional antibiotics such as meropenem, linezolid, or clindamycin 3.
- Anthrax vaccine may also be administered along with antibiotics following exposure, as it can provide additional protection against the disease 4.
Treatment Options
- Ciprofloxacin 500 mg orally twice daily for 60 days, or doxycycline 100 mg orally twice daily for 60 days, are the recommended treatments for post-exposure prophylaxis in adults 1.
- For children, the recommended dosage is ciprofloxacin 15 mg/kg (not exceeding 500 mg/dose) twice daily, or doxycycline (if >8 years old) 2.2 mg/kg twice daily 2.
Important Notes
- Prompt treatment significantly improves outcomes, and anthrax bacteria produce toxins that cause severe tissue damage and can be fatal if untreated 3.
- The extended antibiotic course is necessary because anthrax spores can remain dormant in the body before causing active infection 4.
From the FDA Drug Label
To reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis. Inhalational anthrax (post-exposure): Doxycycline is indicated for the treatment of infections caused by the following gram-positive microorganisms when bacteriologic testing indicates appropriate susceptibility to the drug: Upper respiratory infections caused by Streptococcus pneumoniae (formerly Diplococcus pneumoniae) Anthrax due to Bacillus anthracis, including inhalational anthrax (post-exposure):
The treatment for anthrax exposure is doxycycline.
- The dosage for doxycycline is not specified in the provided text for anthrax exposure.
- Ciprofloxacin is also an option for treating anthrax exposure, with a dosage of 500 mg q 12 h for 60 days for adults, and 10 mg/kg (maximum 400 mg per dose) every 12 hours for 60 days for pediatric patients, or 15 mg/kg (maximum 500 mg per dose) every 12 hours for 60 days for pediatric patients orally 5, 6.
From the Research
Treatment Options for Anthrax Exposure
- Antibiotic treatment is the primary approach for treating anthrax exposure, with options including ciprofloxacin, doxycycline, levofloxacin, and moxifloxacin 7, 8, 9, 10
- Combination therapy using antibiotics and immunoglobulins has shown promise in treating anthrax, with a study demonstrating 90-100% survival in a rodent model when using a combination of ciprofloxacin and anti-protective antigen antibodies 7
- The choice of antibiotic may depend on the specific form of anthrax, with doxycycline, levofloxacin, and moxifloxacin showing superior efficacy to ciprofloxacin in treating anthrax meningitis in rabbits and non-human primates 10
Post-Exposure Prophylaxis
- Post-exposure prophylaxis is critical in preventing anthrax infection, with antibiotics such as ciprofloxacin and doxycycline commonly used for this purpose 8, 9, 11
- The use of vaccines, such as spore vaccines in veterinary settings and acellular vaccines in humans, can also play a role in preventing anthrax infection 8, 11
Treatment of Symptomatic Disease
- Treatment of symptomatic anthrax disease typically involves the use of antibiotics, with the specific choice of antibiotic depending on the form and severity of the disease 8, 9, 11, 10
- Hyperimmune or monoclonal antibody-based antitoxin therapies may also be used in conjunction with antibiotics to treat symptomatic disease 11