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Volume 14, Number 4—April 2008
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;

Main Article


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.

Main Article

Page created: July 16, 2010
Page updated: July 16, 2010
Page reviewed: July 16, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.