Table 4.

Survival for Adults Reported to be Hospitalized for Systemic Anthrax by Specified Treatment During First 2 Days of Hospitalization and Illness Severity Through Admission, 1940–2018^a

Treatment Comparison	Survived n (%), N	Died n (%), N	Univariate Analysis		Multivariable Analysis		Variables Included in Multivariable Analysis
			OR (95% CI)	P Value	OR (95% CI)	P Value	Hypoxiab	Shockc	AMS
Bactericidal(s) alone vs no antimicrobial treatment	60 (94%), 64	27 (61%), 44	9.44 (2.90–30.74)	<.01	6.12 (1.49–25.14)	.01	…	Y	Y
Protein synthesis inhibitor(s) alone vs no antimicrobial treatment	6 (60%), 10	6 (26%), 23	4.25 (.88–20.44)	.07	…	…	…	…	…
Bactericidal(s) alone vs protein synthesis inhibitor(s) alone	60 (91%), 66	27 (82%), 33	2.22 (.66–7.52)	.20	4.57 (1.02–20.47)	.047	…	Y	Y
Bactericidal(s) and protein synthesis Inhibitor(s) vs bactericidal(s) alone	26 (30%), 86	14 (34%), 41	0.84 (.38–1.85)	.66	1.54 (.52–4.50)	.43	Y	Y	Y
Bactericidal(s) and protein synthesis inhibitor(s) vs protein synthesis inhibitor(s) alone	26 (81%), 32	14 (70%), 20	1.86 (.50–6.85)	.35	3.60 (.73–17.64)	.11	Y	…	…
Bactericidal(s) and protein synthesis inhibitor(s) vs bactericidal(s) alone or protein synthesis inhibitor(s) alone	26 (28%), 92	14 (30%), 47	0.93 (.43–2.01)	.85	1.89 (.67–5.31)	.23	Y	Y	Y
Antimicrobial combination therapy vs monotherapyd	31 (36%), 87	25 (53%), 47	0.49 (.24–1.00)	.051	0.88 (.33–2.35)	.80	Y	Y	Y
Antimicrobial(s) and antitoxin/antiserum vs antimicrobial(s) alone	7 (7%), 100	5 (9%), 55	0.75 (.23–2.49)	.64	1.31 (.24–7.07)	.75	Y	Y	Y

Abbreviations: AMS, altered mental status; CI, confidence interval; OR, odds ratio; Y, yes.

^aPatients are only included in each row if they received the specified treatment. Patients are considered to have the specified treatment if given in the first 2 days of hospitalization. Patients are classified as having no antimicrobial treatment if they did not receive any antimicrobials throughout hospitalization. Patients were excluded from analysis if they were dead on arrival, died on day 1 of hospitalization, or lacked survival status. Additional exclusions included patients who were given anthrax-appropriate antimicrobial treatment before 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 were given antitoxin/antiserum at any time in the course of their treatment were excluded except when comparing antimicrobial(s) and antitoxin/antiserum to antimicrobial(s) alone. Patients described by the author Meselson were excluded because they lacked sign, symptom, and treatment data [2].

^bVentilated or intubated or respiratory rate > 30.

^cVasopressors or systolic blood pressure < 90 mmHg.

^dIncluded 1 anthrax meningitis patient who did not meet our definition of systemic.