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Volume 14, Number 4—April 2008

Conference Summary

Peer Reviewed Report Available Online Only

Conference Report on Public Health and Clinical Guidelines for Anthrax

Eric Jacob Stern*, Kristin Broome Uhde*, Sean Vincent Shadomy*Comments to Author , and Nancy E. Messonnier*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

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Summary of recommended modifications to Centers for Disease Control and Prevention guidelines for postexposure prophylaxis and treatment of anthrax

1. Ciprofloxacin and doxycycline are equally recommended as first-line oral antimicrobials for postexposure prophylaxis (PEP) in adult and pediatric patients.
2. Ciprofloxacin is recommended as the first-line oral antimicrobial for PEP and treatment in pregnant women; doxycycline should not be used during pregnancy for PEP or treatment until the third trimester.
3. Ciprofloxacin is favored over doxycycline for treatment of anthrax cases with serious systemic illness such as: inhalation anthrax; gastrointestinal anthrax; cutaneous anthrax with systemic involvement; cases with suspected meningeal involvement; and fulminant cases with bacteremia.
4. Meningeal involvement should be suspected in inhalation anthrax or in any case of systemic anthrax, therefore treatment should consist of intravenous therapy with ciprofloxacin plus one or two additional antimicrobial agents with adequate CNS penetration and proven efficacy against B. anthracis.
5. The use of early, aggressive serial or continuous drainage of pleural effusions is recommended for all inhalation anthrax cases.

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