Table 13.
Agent | Vaccination | First-Line Therapy | Second-Line Therapy | Postexposure Chemoprophylaxis |
---|---|---|---|---|
Anthrax Bacillus anthracis |
Anthrax vaccine adsorbed (AVA) |
Thoracic/GI
|
Thoracic/GI
|
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.
Refer 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.