Table 2.

Treatment and prophylaxis of Y. pestis infection.24, 25, 37, 38, 39

Patient Group	Treatment Treatment course 10–14 days, can be switched to oral therapy when improving. Begin within 24 h of onset of symptoms.	Prophylaxis Indicated for asymptomatic individuals in close contact (<2m), exposure to bodily fluids, or aerosolized deliberate release.	Protection and supportive treatment For all patients
Adults	1st line; Streptomycin 1 g IM BD or Gentamicin 5 mg/kg IV/IM once daily and/or Doxycycline IV 200 mg once daily 2nd line; Ciprofloxacin, Levofloxacin, Moxifloxacin, Chloramphenicol	1st line; Doxycycline 100 mg oral BD or Ciprofloxacin 500 mg oral BD 2nd line; Chloramphenicol 25 mg/kg orally QDS For a minimum of 7 days Prevent flea bites with insect repellents such as N,N-diethyl-meta-toluamide (DEET)	Tissue perfusion and oxygenation in septic patients should be maintained by fluid resuscitation and vasopressors if required. With the possibility of ECLS if needed. Patients with pneumonic plague may require ventilatory support. Isolate patients with pneumonic plague (48 h minimum) and take precautions against droplet transmission in the form of surgical face masks. Report all cases of plague per local procedure. Procedures that may aerosolize plague should be avoided, such as bone sawing in amputation.
Children	1st line; Streptomycin 15 mg/kg IM BD (2 g max) or Gentamicin 2.5 mg/kg IV/IM TD 2nd line; Doxycycline, Ciprofloxacin, Chloramphenicol - (maintain concentration between 5–20 µg/ml)	1st line; Doxycycline if ≥ 45 kg give adult dose, if ≤ 45 kg give 2.2 mg/kg orally BD or Ciprofloxacin 20 mg/kg orally BD 2nd line; Chloramphenicol 25 mg/kg orally QDS (maintain concentration between 5–20 µg/ml) Prevent flea bites with insect repellents such as N,N-diethyl-meta-toluamide (DEET)
Pregnant women	1st line; Gentamicin 5 mg/kg IV/IM OD 2nd line; Doxycycline or Ciprofloxacin Avoid Streptomycin For breastfeeding women and their infants use Gentamicin	As for non-pregnant adults