Table 64.2.
Specific Therapies for the Class A Bioterrorist Agents
| Agent | Preferred Regimen | Alternate Regimen | Duration | Prophylactic Regimen |
|---|---|---|---|---|
| Anthrax | ||||
| Inhalational | Ciprofloxacin 400mg IV q12hr, or doxycycline 100mg IV q12hr, plus one or two of the following: clindamycin, rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, or clarithromycin | Same | 60 Days | Ciprofloxacin 500mg po q12hr for 60 days, or doxycycline 100mg po q12hr for 60 days |
| Cutaneous | Ciprofloxacin 400mg IV q12hr, or doxycycline 100mg IV q12hr | Same | 60 Days | Ciprofloxacin 500mg po q12hr for 60 days, or doxycycline 100mg po q12hr for 60 days |
| Plague | Streptomycin 1g IM q12hr, or gentamicin 5mg/kg IV q day | Doxycycline 100mg IV q12hr, or ciprofloxacin 400mg IV q12hr | 10 Days | Doxycycline 100mg po q12hr × 7 days, or ciprofloxacin 500mg po q12hr × 7 days |
| Tularemia | Streptomycin 1g IM q12hr, or gentamicin 5mg/kg IV q day | Doxycycline 100mg IV q12hr, or ciprofloxacin 400mg IV q12hr | Streptomycin, gentamicin, or ciprofloxacin, 10days; doxycycline, 14–21 days | Doxycycline 100mg po q12hr × 14 days, or ciprofloxacin 500mg po q12hr × 14 days |
| Botulism | Equine trivalent antitoxin | N/A | One dose | Equine antitoxin, if available |
| Smallpox | ? Cidofovir | Uncertain | Vaccinia vaccine, within 4 days of exposure | |
| Viral hemorrhagic fevers (unknown etiology or known to be caused by arenaviruses or bunyaviruses | Ribavirin 30mg/kg IV once, then 16mg/kg IV q6hr for 4 days; then 8mg/kg IV q8hr for 6 days | No therapy for filoviruses or flaviviruses | 10 Days | None |
Data from Inglesby TV, Dennis DT, Henderson DA, et al: Plague as a biological weapon. Medical and public health management. JAMA 2000;283:2281–2290; Inglesby TV, O'Toole T, Henderson DA, et al: Anthrax as a biological weapon, 2002. Updated recommendations for management. JAMA 2002;287:2236–2252; Dennis DT, Inglesby TV, Henderson DA, et al: Tularemia as a biological weapon. Medical and public health management. JAMA 2001;285:2763–2773; Arnon SS, Schechter R, Inglesby TV, et al: Botulinum toxin as a biological weapon: Medical and public health management. JAMA 2001;285:1059–1070; and Henderson DA, Inglesby TV, Bartlett JG, et al: Smallpox as a biological weapon: Medical and public health management. JAMA 1999;281:2127–2137.
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