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CDC Releases Anthrax Treatment Recommendations

Kate Traynor

The Centers for Disease Control and Prevention (CDC) today released recommendations for the treatment of inhalational, gastrointestinal, and cutaneous anthrax resulting from the recent bioterrorism attacks.

The recommendations appear in the Oct. 26 issue of Morbidity and Mortality Weekly Report (MMWR) (PDF). Tables describing the suggested dosage and administration protocols appear on pages 9 and 10 of the PDF document.

According to CDC, inhalational and gastrointestinal anthrax should be treated initially with intravenous (i.v.) ciprofloxacin or doxycycline. Patients can be switched to oral formulations of these drugs when "clinically appropriate."

In addition to initial i.v. therapy with ciprofloxacin or doxycycline, CDC advises concurrent use of one or two additional antimicrobial agents—rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, or clarithromycin—to treat patients who have inhalational or gastrointestinal anthrax.

For the treatment of cutaneous anthrax that shows no signs of systemic disease, CDC recommends an oral regimen of ciprofloxacin or doxycycline.

CDC established different dosage regimens for children and adults. According to CDC, therapy for anthrax should not be altered if the patient is pregnant or immunocompromised. But the agency did note that doxycycline therapy for pregnant women before six months of gestation might best be restricted to one or two weeks' duration to minimize adverse effects on fetal bones and teeth.

Treatment of all forms of anthrax should continue for 60 days, according to CDC.

Last week’s issue of MMWR (PDF) offered "interim guidelines" for prophylaxis to prevent inhalational anthrax after exposure to Bacillus anthracis spores. As CDC obtains additional data on the anthrax strains and patients' response to treatment, the agency’s recommendations may change. To obtain the most recent CDC information on anthrax prevention and treatment and other bioterrorism-related issues, visit