Table 3.
Survival for Adults Reported to be Hospitalized for Anthrax by Meningitis Status, Route of Infection, Systemic Criteria, and Antimicrobial Treatment During First 2 Days of Hospitalization,a 1940–2018
| Monotherapy | Combination Therapy | |||||||
|---|---|---|---|---|---|---|---|---|
| Treatment | Without Meningitis | With Meningitis | Without Meningitis | With Meningitis | ||||
| Localized Cutaneous | Inhalation | Systemicb | Localized Cutaneous | Inhalation | Systemicb | |||
| Nonec | 3/6 (50%) | 0/2 (0%) | 4/9 (44%) | 0/9 (0%) | 3/6 (50%) | 0/2 (0%) | 4/9 (44%) | 0/9 (0%) |
| Any | 61/62 (98%) | 1/6 (17%) | 55/65 (85%) | 3/14 (21%) | 15/15 (100%) | 7/10 (70%) | 33/45 (73%) | 3/18 (17%) |
| Aminoglycosides | … | … | 1/1 (100%) | … | 1/1 (100%) | 2/3 (67%) | 8/12 (67%) | 0/6 (0%) |
| Amphenicols | 3/3 (100%) | … | 1/1 (100%) | … | … | … | … | 0/5 (0%) |
| Carbapenems | … | … | … | … | … | 1/1 (100%) | 2/4 (50%) | 0/1 (0%) |
| Fluoroquinolones | 1/1 (100%) | … | … | … | 12/12 (100%) | 5/8 (63%) | 24/32 (75%) | 3/7 (43%) |
| Glycopeptides | … | … | … | … | … | 0/1 (0%) | 4/7 (57%) | 0/3 (0%) |
| Lincosamides | … | … | 2/2 (100%) | 0/1 (0%) | 3/3 (100%) | 2/2 (100%) | 18/21 (86%) | 2/4 (50%) |
| Macrolides | … | 1/2 (50%) | 1/2 (50%) | … | … | 3/4 (75%) | 4/5 (80%) | 1/2 (50%) |
| Metronidazole | … | … | 0/2 (0%) | … | … | … | 2/4 (50%) | 0/1 (0%) |
| Oxazolidinone | … | … | … | … | … | … | … | 0/1 (0%) |
| Rifamycins | … | … | … | … | … | 2/4 (50%) | 2/4 (50%) | 2/2 (100%) |
| Streptogramins | … | … | … | … | 7/7 (100%) | … | … | … |
| Tetracyclines | 8/8 (100%) | 0/1 (0%) | 3/4 (75%) | 0/1 (0%) | 4/4 (100%) | 1/1 (100%) | 2/2 (100%) | 0/3 (0%) |
| Penicillins (all) | 49/50 (98%) | 0/3 (0%) | 47/53 (89%) | 3/12 (25%) | 13/13 (100%) | 3/6 (50%) | 22/31 (71%) | 2/15 (13%) |
| Beta-lactamase resistant or with a beta lactamase inhibitord | 4/4 (100%) | 0/1 (0%) | 3/4 (75%) | … | 3/3 (100%) | 1/3 (33%) | 17/21 (81%) | 1/2 (50%) |
| Otherd | 45/46 (98%) | 0/1 (0%) | 40/44 (91%) | 3/12 (25%) | 11/11 (100%) | 3/7 (43%) | 24/33 (73%) | 2/15 (13%) |
Each line is the number that survived divided by the total number that received that treatment. Patients described by author Meselson were excluded because they lacked treatment data [2]. Additional exclusions included patients who were dead on arrival, patients who died on their first day of hospitalization, patients who lacked survival status, and patients who received antitoxin/antiserum during the first 2 days of hospitalization. Sulfa drugs and cephalosporins are not considered anthrax-appropriate antimicrobial treatment and therefore did not contribute to the count of antimicrobials in this table. Patients who had at least 1 antimicrobial other than a sulfa or cephalosporin before hospitalization or had their first treatment (antimicrobial or antitoxin/antiserum) after day 2 of hospitalization were excluded from this table. A few patients had unclear treatment timing and could not be classified.
Systemic refers to our definition published in “Identifying Meningitis During an Anthrax Mass Casualty Incident: Systemic Review of Systemic Anthrax Since 1880” except that we removed the qualification of “death” [11].
“None” refers to no antimicrobials or antitoxin/antiserum given at all before or throughout hospitalization. This is the only category that is not restricted to the first 2 days of hospitalization.
In the last 2 lines of the table, when splitting out beta-lactamase resistant or with beta-lactamase inhibitor and other penicillins, monotherapy means that patients just had penicillins from that specific category. Combination therapy means they could have also had a penicillin from the other category or any other antimicrobial class. Beta-lactamase resistant or with beta-lactamase inhibitor penicillins include ampicillin/sulbactam, Tazocin, Augmentin, flucloxacillin, and other beta lactam penicillin. The “other” penicillin category includes amoxicillin, ampicillin, penicillin, and benzyl/benzathine penicillin.