Table 4.
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].