Table 13.

Adult treatment of prevention for potential bioterrorism agents^a

Agent	Vaccination	First-Line Therapy	Second-Line Therapy	Postexposure Chemoprophylaxis
Anthrax Bacillus anthracis	Anthrax vaccine adsorbed (AVA)	Thoracic/GI Ciprofloxacin 400 mg IV every 8 h + clindamycin 600 mg IV every 8 h + rifampin 300 mg every 12 h) Cutaneous Ciprofloxacin 500 mg by mouth twice a day	Thoracic/GI Levofloxacin or doxycycline + clindamycin or penicillin or meropenem Cutaneous Levofloxacin or doxycycline	Ciprofloxicin 500 mg by mouth twice a day or doxycycline 100 mg by mouth twice a day
Brucellosis Brucella sp	None	Doxycycline 100 mg by mouth every 12 h + gentamicin 5 mg/kg/IV every 24 h or rifampin 600 mg by mouth every 24 h	Ciprofloxacin + rifampin	Doxycycline 100 mg by mouth every 12 h + rifampin 600 mg by mouth every 24 h63
Botulism Clostridium botulinum toxin	Pentavalent toxoid for toxin types A, B, C, D, and E available19	Equine serum heptavalent botulism antitoxin	—	None
Glanders Burkholderia mallei	None	TMP-SMX	Tetracyclines or ciprofloxacin or gentamicin or imipenem	Ciprofloxacin + doxycycline (animal data only)64
Melioidosis Burkholderia pseudomallei	None	Ceftazidime 2 g IV every 6 h × 14 d then TMP-SMX 5 mg/kg every 12 h + doxycycline 2 mg/kg every 12 h	Imipenem or meropenem then TMP-SMX + doxycycline	Unknown
Plague Yersinia pestis	None	Gentamicin 5 mg/kg every 24 h	Doxycycline or ciprofloxacin or chloramphenicol	Doxycycline 100 mg every 12 h by mouth or ciprofloxacin 500 mg every 12 h by mouth
Q fever Coxiella burnetii	Q-Vax	Doxycycline 100 mg by mouth every 12 h	Levofloxacin	Doxycycline 100 mg by mouth every 12 h
Ricin toxin Ricinus communis	None	Supportive	—	None
Smallpox Variola major	Vaccinia	?Cidofovir	—	None
SEB Staphylococcus aureus	None	Supportive	—	None
Tularemia Francisella tularensis	Live attenuated vaccine (investigational)	Gentamicin, 5 mg/kg IM or IV once daily	Doxycycline, or chloramphenicol, or ciprofloxacin	Doxycycline, 100 mg every 12 h by mouth or ciprofloxacin, 500 mg every 12 h by mouth
VHF viruses Ebola, Marburg, Lassa, Machupo, and so forth	None	Supportive	—	None

Abbreviations: IM, intramuscular; IV, intravenous; TMP-SMX, trimethoprim sulfamethoxazole.

^aRefer to your local Public Health guidelines before making clinical management decisions.

Data from Centers for Disease Control and Prevention. Emergency preparedness and response. Available at: http://emergency.cdc.gov/. Accessed February 4, 2013.