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Dosing Regimens

Nearly all of the regimens detailed below lack FDA approval as there is too little in the way clinical data to justify such approval. These regimens below are a composite of the recommendations by civilian, military and government experts based on extrapolation, previous results, and clinical information.

Anthrax

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CDC-Recommendations for Postexposure Prophylaxis for Prevention of Inhalational Anthrax after Intentional Exposure to Bacillus Anthracis
CategoryInitial TherapyDuration
Adults (including pregnant women and immunocompromised persons)Ciprofloxacin 500 mg po BID60 days
or
Doxycycline 100 mg po BID
ChildrenCiprofloxacin 10–15 mg/kg po every 12 hrs*60 days
or
Doxycycline:
>8 yrs and >45 kg: 100 mg po BID
>8 yrs and ≤45 kg: 2.2 mg/kg po BID
≤8 yrs: 2.2 mg/kg po BID

*Ciprofloxacin dose should not exceed 1 gram per day in children.

Courtesy of the CDC.

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CDC Recommendations for Management of Inhalational and Gastrointestinal Anthrax
Category Initial Therapy (Intravenous)b,cDuration
Adults
  • Ciprofloxacin 400 mg every 12 hrs
  • or
  • Doxycycline 100 mg every 12 hrse
  • and
  • One or two additional antimicrobialsc
  • IV treatment initially.d Switch to oral antimicrobial therapywhen clinically appropriate:
    • Ciprofloxacin 500 mg po BID
    • or
    • Doxycycline 100 mg po BID
  • Continue for 60 days (IV and po combined)f
Children
  • Ciprofloxacin 10–15 mg/kg every 12 hrsg,h
  • or
  • Doxycycline:e,i
    • >8 yrs and >45 kg: 100 mg every 12 hrs
    • >8 yrs and ≤45 kg: 2.2 mg/kg every 12 hrs
    • ≤8 yrs: 2.2 mg/kg every 12 hrs
  • and
  • One two additional antimicrobialsc
  • IV treatment initially.d Switch tooral antimicrobial therapywhen clinically appropriate:
    • Ciprofloxacin 10–15 mg/kg po every 12 hrsh
  • or
  • Doxycycline:i
    • >8 yrs and >45 kg: 100 mg po BID
    • >8 yrs and ≤45 kg: 2.2 mg/kg po BID
    • ≤8 yrs: 2.2 mg/kg po BID
  • Continue for 60 days (IV and po combined)f
Pregnant womenjSame for nonpregnant adults (the high death rate from the infection outweighs the risk posed by the antimicrobial agent)IV treatment initially. Switch to oral antimicrobial therapy when clinically appropriate.a Oral therapy regimens same for nonpregnant adults
Immunocompromised persons Same for nonimmunocompromised persons and childrenSame for nonimmunocompromised persons and children

a Ciprofloxacin or doxycycline should be considered an essential part of first-line therapy for inhalational anthrax.

b Steroids may be considered as an adjunct therapy for patients with severe edema and for meningitis based on experience with bacterial meningitis of other etiologies.

c Other agents with in vitro activity include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin. Because of concerns of constitutive and inducible beta-lactamases in Bacillus anthracis, penicillin and ampicillin should not be used alone. Consultation with an infectious disease specialist is advised.

d Initial therapy may be altered based on clinical course of the patient; one or two antimicrobial agents ...

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