Anthrax: Preventive Therapy

by CDC

(Page 7 of 10)

In the event that persons are exposed to potentially aerosolized Bacillus anthracis spores, what will CDC recommend to prevent inhalation anthrax?

CDC will recommend 60 days of selected oral antibiotics in conjunction with a 3-dose regimen (0, 2 weeks, 4 weeks) of anthrax vaccine (BioThraxT, formerly known as AVA) as an emergency public health intervention. Two major U.S. national advisory bodies have considered strategies for post-exposure prophylaxis for prevention of inhalation anthrax among individuals exposed to potentially aerosolized B. anthracis spores. Both groups, the Advisory Committee on Immunization Practices (ACIP) and the John Hopkins Working Group on Civilian Biodefense, concluded that based on available data, the best means for prevention of inhalation anthrax is prolonged antibiotic therapy in conjunction with anthrax vaccination. In addition, a recent Institute of Medicine Report on anthrax vaccine safety and efficacy also concluded that based on limited animal studies, anthrax vaccine administered in combination with antibiotics following exposure to B. anthracis spores may help to prevent the development of inhalation anthrax. BioThraxT is not licensed for post-exposure prophylaxis for prevention of inhalation anthrax, or for use in a 3-dose regimen; therefore, this program would be conducted under an Investigational New Drug (IND) application.

Why does CDC recommend 60 days of antibiotics?

Anthrax spores grow like plant seeds. If you plant seeds and give them sun and water, they will grow into plants. If you give anthrax spores the right environment, such as the human body, they can grow into the harmful form of the bacteria that can cause anthrax disease. It takes anthrax spores an average of 7 days to grow into the harmful form of the bacteria, but it can take longer. For this reason, CDC recommends preventive antibiotics for the full 60 days.

Which antibiotics does CDC recommend for prevention of inhalation anthrax?

In selecting an antibiotic, we will be guided by the organism's culture and sensitivity results, history of allergic reactions, age and health status factors and antibiotic availability. When no information is available about the antimicrobial susceptibility of the implicated strain of B. anthracis, initial therapy with ciprofloxacin or doxycycline is recommended for adults and children, or levofloxacin for adults.

What drugs are FDA-approved for postexposure prophylaxis (PEP)?

Ciprofloxacin and doxycycline are FDA-approved for PEP in adults and children, and levofloxacin is FDA-approved for PEP in adults ages 18 and older.

Are there special instructions for taking ciprofloxacin or doxycycline?

As with all antibiotics, take the medication according to the schedule you were instructed, and even if you begin to feel better, continue taking it for the full number of days.

What is cipro (ciprofloxacin)?

Ciprofloxacin, or cipro as it is commonly known, is a broad-spectrum, synthetic antimicrobial agent active against several microorganisms. The use of ciprofloxacin is warranted only under the strict supervision of a physician.

Does ciprofloxacin have an expiration date? Yes. Antibiotics, just like all medicines, have expiration dates. If you received your ciprofloxacin through a pharmacist, the expiration date should be listed on the bottle. If you can't find it or have questions about the expiration date, contact your pharmacist directly.

What side effects could I get from taking cipro?

Common side effects of Cipro include an upset stomach, vomiting, diarrhea, fatigue, dizziness, or headache. If you have problems with any of these symptoms, tell your doctor. Less common side effects include pain in arms or legs, changes in vision, restlessness, ringing in the ears, or mental changes. If any of these symptoms occur, call your doctor right away.

Can other fluoroquinolones be used instead of ciprofloxacin for postexposure prophylaxis (PEP)/treatment?

Other fluoroquinolones, such as ofloxacin and levofloxacin, are not specifically recommended as alternatives to ciprofloxacin because of a lack of sufficient data on their efficacy. However, if first-line drugs were not available, these other fluoroquinolones may be effective.

Besides anthrax, what else is ciprofloxacin prescribed for? Has there been resistance to ciprofloxacin when used in other instances (historically)?

Ciprofloxacin is a broad-spectrum, highly effective antibiotic that has been part of the "international traveler's" kit at CDC for at least a year. It can be used against most bacterial infections. However, ciprofloxacin is frequently overused for many diseases that can be treated with less powerful, narrower-spectrum drugs. Right now, most bacteria are susceptible to ciprofloxacin, which is why we want to be cautious about its use. Overuse of ciprofloxacin could lead to the development of resistance.

Is there a generic form of ciprofloxacin?

No, there is currently no generic form of ciprofloxacin in the United States.

What side effects could I get from taking doxycycline?

Common side effects of doxycycline include an upset stomach, vomiting, or diarrhea. If you have problems with any of these symptoms, tell your doctor. Less common side effects include dark urine, yellowing of the eyes or skin, sore throat, fever, unusual bleeding or bruising, fatigue, white patches in the mouth. If any of these symptoms occur, call your doctor right away.

What side effects could I get from taking amoxicillin?

Common side effects of amoxicillin include an upset stomach, vomiting, and diarrhea. If you have problems with any of these symptoms, tell your doctor.

What side effects are serious enough that I should go to a doctor?

Any side effect that forces you not to take your medicine is serious enough that you should consult or see your doctor.

Serious side effects of ciprofloxacin include seizures, mental confusion, rash that does not go away, or excessive diarrhea.

If you have any of these effects, call your doctor.

Serious side effects of doxycycline include jaundice (yellow eyes or skin), rash that does not go away, or excessive diarrhea. If you have any of these effects, call your doctor.

Any reaction that causes a rapid swelling of the lips and face, shortness of breath, or hives is a medical emergency. You should call 911. These types of reactions are extremely rare.

About the Author

www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.