Table 1 – Factors Contributing to the Emergence of Infectious Disease

Genetic, Biological Microbial adaptation and change; infection susceptibility
Environmental Climate, weather; changing ecosystems
Social, Political, Economic Human demographics, behavior; economic development; international travel, commerce; technology, industry; poverty; war, famine; intent to harm

Narayanan N, et al. Pharmacotherapy. 2018 Feb;38(2):217-234.

Table 2 – Category A Biological Threats

• Anthrax
• Botulism
• Plague
• Tularemia
• Smallpox
• Ebola

Narayanan N, et al. Pharmacotherapy. 2018 Feb;38(2):217-234.

Table 3 – Anthrax Treatment (Antibiotics)*

Anthrax Form Recommended Treatment
Systemic anthrax (confirmed or possible meningitis) • Consists of 3 agents with good CNS penetration, with ≥1 bactericidal agent and 1 protein-synthesis inhibitor
Preferred regimen: Ciprofloxacin + meropenem + linezolid (all given IV)
• Duration of treatment: at least 2–3 weeks until clinically stable
• Adjunctive corticosteroids recommended at start of antibiotic therapy (based on data from nonanthrax bacterial meningitis)
Systemic anthrax (without meningitis) • Therapy should include at least 2 antibiotics
Preferred agents: Ciprofloxacin + linezolid or clindamycin (all given IV)
• Duration of initial IV therapy: at least 2 weeks or until clinically stable
• Transition to oral therapy to complete total treatment course of 60 days after completing initial IV therapy
Bioterrorism-related cutaneous anthrax  • Treated the same as postexposure prophylaxis
Preferred treatment: Oral ciprofloxacin or doxycycline
• Treatment duration: 60 days due to presumed inhalation of spores
Naturally-acquired uncomplicated cutaneous anthrax without systemic disease Preferred treatment: fluoroquinolone (oral ciprofloxacin, levofloxacin or moxifloxacin) or oral doxycycline
• Ciprofloxacin recommended as 1st-line agent by IDSA guidelines
• Treatment duration: 7–10 days

CNS=central nervous system; IV=intravenous; IDSA=Infectious Diseases Society of America 
*Dosages, alternative antimicrobials, and further details available in original article
Narayanan N, et al. Pharmacotherapy. 2018 Feb;38(2):217-234.

Table 4 – Anthrax Antitoxins

Antitoxin Type of Agent
Anthrax immune globulin intravenous (AIGIV) Human polyclonal antibody
Raxibacumab Fully humanized monoclonal antibody
Obiltoxaximab Human immunoglobulin G1 monoclonal antibody

Narayanan N, et al. Pharmacotherapy. 2018 Feb;38(2):217-234.

Table 5 – Treatments for Patients With Plague

Agent Comments
Streptocmycin • Drug of choice
• Not a practical agent for treatment due to limited availability in the U.S.
Gentamicin • Preferred alternative agent
• Dosage must be adjusted in patients with impaired renal function to assure therapeutically adequate, but not excessive blood levels
Ciprofloxacin • FDA approved based on the FDA Animal Rule
• Extremely limited human clinical efficacy data
• Still considered first-line treatment in the U.S.
Levofloxacin • FDA approved based on the FDA Animal Rule
• Extremely limited human clinical efficacy data
• Still considered first-line treatment in the U.S.
Doxycycline • FDA approved
• Clinical data in humans indicates comparable efficacy to gentamicin for patients with bubonic plague
Chloramphenicol • Not readily available for use in the U.S.
• May be useful for rare complications (ie, plague meningitis)
• Dosage should be adjusted in patients with hepatic or renal impairment

Narayanan N, et al. Pharmacotherapy. 2018 Feb;38(2):217-234.

Table 6 – Agents for Treating Tularemia

• Streptomycin (preferred)
• Gentamicin (preferred alternative if streptomycin is unavailable)
• Ciprofloxacin (oral preferred if other IV agents unavailable)
• Doxycycline (oral preferred if other IV agents unavailable)
• Chloramphenicol 

Narayanan N, et al. Pharmacotherapy. 2018 Feb;38(2):217-234.

Table 7 – Investigational Agents for the Treatment of Smallpox

• Cidofovir (IV)
• Brincidofovir
• Tecovirimat

Narayanan N, et al. Pharmacotherapy. 2018 Feb;38(2):217-234.