Table 2.4.

Plague Prophylaxis Guidelines Using National Pharmaceutical Stockpile Components^a

	Therapy	Duration
ADULTS	Doxycycline 100 mg PO twice daily OR Ciprofloxacin 500 mg PO twice dailyb,c	7 days
CHILDREN	Doxycyclined >45 kg: 100 mg PO twice daily ≤45 kg: 2.2 mg/kg PO twice daily OR Ciprofloxacin 20 mg/kg PO twice dailybce	7 days
PREGNANCY	Same as for nonpregnant adultsf
IMMUNOCOMPROMISED	Same as for nonimmunosuppressed adults and children

PO, orally.

^aOne antibiotic regimen, appropriate for patient age, should be chosen from among alternatives. The duration of all recommended therapies is 7 days.

^bNot a US Food and Drug Administration-approved use.

^cRefer to package insert to adjust dose in the event of renal insufficiency.

^dIn 1991, the American Academy of Pediatrics amended its recommendation to allow treatment of young children with tetracyclines for serious infections, for which doxycycline may be indicated. Doxycycline is preferred for its twice-a-day dosing and low incidence of gastrointestinal side effects.

^eThe American Academy of Pediatrics states that the use of quinolones in children younger than 18 yr of age may be justified in special circumstances. For the treatment of plague, the assessment of the risks and benefits indicates that administration of ciprofloxacin to pediatric patients is appropriate. Ciprofloxacin dose should not exceed 1 g/day in children.

^fTetracyclines can cause damage to fetal teeth and bones when administered to pregnant women.