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.
| 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.
