|
Anthrax |
Survival improves
when multiple antibiotics are used. Doxycycline and
ciprofloxacin do not enter the CSF well. Drain pleural
effusions. Do not use topicals on cutaneous lesions. Consider
rifampin, vancopmycin, chloramphenicol, clindmycin,
clarithromycin, penicillin, ampicillin, and imipenum (2001
anthrax was sensitive). Treatment is for 60 days.
Children should not get more than 1g of
ciprofloxacin a day. |
|
Antibiotic |
Adult |
Pediatric |
| Ciprofloxacin |
400mg IV q12h 500mg PO q12h |
15mg/kg IV or PO q12h |
| Doxycycline |
100mg IV q12h 100mg PO a12h |
>45kg:100mg IV or PO bid <45kg:
2.2mg/kg/d IV or PO bid |
| Erythromycin |
15-20mg/kg IV qd |
15-20mg/kg/d IV |
| Penicillin G |
20 million U/d IV |
400,000 U/k/d |
| Anthrax Vaccine Adsorbed |
MMWR Anthrax Vax Recom 2000.pdf |
FDA Anthrax Vax Emerg Use.pdf |
|
|
Botulism |
Do not delay giving
antitoxin pending lab confirmation. Antitoxin only from CDC
(404-639-2206/2888). Currently a bivalent (AB) antitoxin, but
military has a heptavalent product. Screen for hypersensitivity
before giving antitoxin. Aminoglycosides and clindamycin
are contraindicated because they increase neuromuscular block. |
| Antitoxin |
1 Vial diluted 1:10 with saline slow IV |
|
|
Plague |
Sulfamethoxazole/trimethoprim is effective but is second tier
because it is not FDA approved and is associated with prolonged
fever. *Gentamicin is not FDA approved. |
| Streptomysicin |
1 gm IM q12h |
| Gentamicin* |
5mg/kg IM/IV q8h |
| Doxycycline |
100mg IV q12h |
| Ciprofloxacin |
400mg IV q12h |
| Chloramphenicol |
25mg/kg IV q6h |
|
|
Smallpox |
No specific treatment. Use Dixon
Criteria to triage for hospital admission. Approach
supportive care similar to burns. Antibiotics may help with
secondary infection. No evidence that cidofovir is
effective once symptoms are present. |
No specific treatment. |
|
Tularemia |
*Not FDA approved.
Treat with aminoglycosides for 10 days. Treat with
chloramphenicol/tetracycline for 21 days. Beta-lactams/macrolides
associated with treatment failures. Do Not give more than
1g/d of ciprofloxacin to children. |
| Streptomycin |
1 gm IM/IV q12h |
| Gentamicin* |
5mg/kg IV/IM qd |
| Doxycycline |
100mg IV q12h |
| Chloramphenicol* |
25mg/kg IV q6h |
| Ciprofloxacin* |
400mg IV q12h |
|
|
Viral Hemorrhagic fevers |
No antiviral drugs are approved
by the FDA for any VHF. Ribavirin has in vitro activity for
Arenaviridiae and Bunyviridiae. Ribavirin is associated with
dose dependent reversible hemolytic anemia and is
contraindicated in pregnancy. Ribavirin given within 6
days of fever in Lassa Fever cases reduced mortality from 76% to
9%. |
| Ribavirin |
16mg/kg q6h for 6 days |
|
