Bioterrorism antibiotics

Anthrax

Postexposure Prophylaxis

Patient should be vaccinated at day #0, #14, #28

• Ciprofloxacin 500mg PO q12hrs x 60 days OR
• Doxycycline 100mg PO q12hrs x 60 days

Cutaneous Anthrax (not systemically ill)

• Ciprofloxacin 500mg PO q12hrs x 60 days
• Doxycycline 100mg PO q12hrs x 60 days

Inhalation or Cutaneous with systemic illness

• Ciprofloxacin 400mg IV q12hrs x 60 days OR
• Doxycycline 100mg IV q12hrs x 60 days PLUS
  • Clindamycin 900mg IV q8hrs

Pediatric Postexposure Prophylaxis

• Ciprofloxacin 15mg/kg PO q12hrs x 60 days
• Doxycycline 2.2mg/kg PO q12hrs x 60 days

Pediatric Cutaneous Anthrax (not ill)

• Same as pediatric postexposure dosing and duration

Pediatric Inhalational or Cutaneous (systemically ill)

• Ciprofloxacin 15mg/kg IV q12hrs OR
• Doxycycline 2.2mg/kg IV q12hrs PLUS
  • Clindamycin 7.5mg/kg q6hrs
• Imipenem/Cilastatin 1g IV q6h for at least 2wk
• Imipenem/Cilastatin Neonates >32 wk gestation; 40-75 mg/kg/day IV divided q8-12h for at least 2wk; 1 month and older; 100 mg/kg/day IV divided q6h for at least 2wk
• Rifampin 600 mg IV q12h for at least 2 wk as part of a multi-drug regimen; Switch to PO abx x60 days total if inhalational exposure
• Rifampin Neonates >32 wk gestation; 10-20 mg/kg/day IV divided q12-24h for at least 2 wk as part of multi-drug regimen; 1+ mo; 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen; Max: 300 mg/dose
• Imipenem/Cilastatin 1g IV q6h for at least 2wk
• Imipenem/Cilastatin Neonates >32 wk gestation; 40-75 mg/kg/day IV divided q8-12h for at least 2wk; 1 month and older; 100 mg/kg/day IV divided q6h for at least 2wk
• Rifampin 600 mg IV q12h for at least 2 wk as part of a multi-drug regimen; Switch to PO abx x60 days total if inhalational exposure
• Rifampin Neonates >32 wk gestation; 10-20 mg/kg/day IV divided q12-24h for at least 2 wk as part of multi-drug regimen; 1+ mo; 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen; Max: 300 mg/dose

Botulism

Supportive Care

• Early ventilatory support
  • Consider intubation when vital capacity <30% predicted or <12cc/kg
• Wound Managment
  • Early wound debreedment with surgical consult.
  • Also exclude Necrotizing fasciitis and coverage with same broad antibiotic coverage

Foodborne Botulism

• Equine Serum Botulism Antitoxin
  • only for patients > 1yo
• Antitoxin obtained through CDC or local Department of Health.

Infant Botulism (<1yo)

• Human-based Botulism IG 100mg/kg IV x 1 dose (BabyBIG)
  • infusion divided into 25mg/kg/hr IV x 15 min followed by 50mg/kg/hr if no allergic reactions
  • Stop infusion after total of 100mg/kg infused
• BabyBIG obtained through CDC or local Department of Health

Inhalational Botulism

• Equine Serum Botulism Antitoxin
  • only for patients > 1yo
• Antitoxin obtained through CDC or local Department of Health

Wound Botulism

• Individualize therapy with ID consultant
• Broad antibiotic coverage same as for Necrotizing fasciitis while awaiting wound cultures

Smallpox

• IMMEDIATE NOTIFICATION OF PUBLIC HEALTH AUTHORITIES
• Vaccine administered up to 3 days post-exposure was effective in preventing infection as well as lessening the severity of the disease if infection occurred

Post-Exposure Prophylaxis

• Vaccinia Vaccine (administer within 72hrs of exposure)

Active Disease

• Supportive care and wound care for open lesions
• Vaccinia Vaccine within the first 72hrs can decrease total disease severity and within 7 days may decrease symptoms
  • Vaccination is not efficacious once the patient has developed rash

Tularemia

Postexposure Prophylaxis

• Doxycycline 100mg PO q12hrs x 14 days OR
• Ciprofloxacin 500mg PO q12hrs x 10 days

Active Disease

• Streptomycin 1g (15mg/kg) IM q12hrs daily x 10 days (First line) OR
• Gentamicin 5mg/kg/day IV/IM once daily x 10 days OR
• Ciprofloxacin 400mg (15mg/kg) IV q12hrs x 10 days OR
• Doxycycline 100mg (2.2mg/kg) IV q12hrs x 14 days OR
• Chloramphenicol 15mg/kg IV q6hrs x 14 days
• Streptomycin 1g IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)
• Streptomycin 15mg/kg IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)

Pediatric

• Gentamicin 2.5mg/kg IV/IM q8hrs x 10 days
• Doxycycline 2.2mg/kg PO/IV q12hrs x 14 days (max 100mg/dose)
• Ciprofloxacin 15mg/kg PO/IV q12hrs x 10 days (max 500mg PO / 400mg IV)

Yersinia

Postexposure Prophylaxis

• Doxycycline 100mg (2.2mg/kg) PO q12hrs OR
• Ciprofloxacin 500mg (20mg/kg) PO q12hrs OR
• Chloramphenicol 25mg/kg PO q6hrs
  • only if age > 2

Active Disease

• Gentamicin 5mg/kg IV/IM once daily x 10 days OR
• Ciprofloxacin 500mg (20mg/kg) PO q12hrs x 10 days OR
• Doxycycline 200mg (2.2mg/kg) PO/IV daily
• Streptomycin 1g IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)
• Streptomycin 15mg/kg IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)

Pediatric

• Gentamicin 2.5mg/kg IV/IM q8hrs x 10 days
• Doxycycline 2.2mg/kg PO/IV q12hrs (max 100mg/dose)
• Ciprofloxacin 15mg/kg PO q12hrs (max 500mg/dose)
• Chloramphenicol 25mg/kg PO/IV q6hrs (max 4g/day); age >2 only

See Also

Antibiotics by diagnosis

• Bone and joint antibiotics
• Cardiovascular antibiotics
• ENT antibiotics
• Eye antibiotics
• GI antibiotics
• GU antibiotics
• Neuro antibiotics
• OB/GYN antibiotics
• Pulmonary antibiotics
• Skin and soft tissue antibiotics
• Bioterrorism antibiotics
• Environmental exposure antibiotics
• Immunocompromised antibiotics
• Post exposure prophylaxis antibiotics
• Pediatric antibiotics
• Sepsis antibiotics
• Arthropod and parasitic antibiotics

For antibiotics by organism see Microbiology (Main)

External Links

• CDC Emergency Preparedness and Response