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. 2020 May 12;9(5):370. doi: 10.3390/pathogens9050370

Table 4.

Suggested antibiotic therapy for anthrax.

Category Antibiotic Duration
Naturally occurring anthrax First choice *:
• Procaine penicillin G, 0.6–1.2 M units IM q 12–24 h
Penicillin G, sodium or potassium 4 M units IV q 4–6 h
• Amoxicillin 500 mg PO q 6–8 h
Alternative *:
• Doxycycline 100 mg IV/PO q 12 h
Ciprofloxacin 200–400 mg IV q12 h, followed by 500–750 mg PO q12 h
3–5 days (up to 3–7 days) for cutaneous anthrax without complications; 10–14 days for systemic anthrax
Intravenous/injectional anthrax Combination of antibiotics, plus surgical debridement, followed by reconstructive surgery if required 10–14 days, with up to 60 days for intranasal drug users
Biological weapon or bio-terrorism-related anthrax • Ciprofloxacin 200–400 mg IV q 12 h, followed by 500–750 mg PO q12 h
• Doxycycline 100 mg IV/PO q12 h
42–60 days

* For mild cutaneous anthrax, antibiotics may be administered orally. For severe cutaneous or systemic anthrax, intravenous antibiotics must be administered initially; therapy may be changed to oral once body temperature has returned to normal. In cases of disseminated infection, the antibiotic selected initially must be combined with one or two of the following; penicillin, ampicillin, ciprofloxacin, imipenem, meropenem, vancomycin, rifampicin, clindamycin, linezolid, streptomycin, or another aminoglycoside. If the patient presents with meningitis, a combination of at least two antibiotics with the ability to penetrate cerebrospinal fluid must be administered. In addition to antibiotics, an antitoxin may also be administered given, if available. Source: Doganay, 2017 [2], and Bower, 2015 [34].