Anthrax

Treatment Overview

Antibiotics are used to treat all types of anthrax infection. But early treatment after exposure is essential for inhalational and gastrointestinal anthrax. After severe infection is under way, treatment is usually not effective.

Anthrax generally can be destroyed with antibiotics, mainly ciprofloxacin, doxycycline, and penicillins. These antibiotics are taken for about 60 days.

Experts recommend two or more antibiotics to treat inhalational anthrax because this is the most lethal type.

The following are recommendations for the treatment of inhalational and cutaneous anthrax infection:¹

Cutaneous anthrax

Adults (including pregnant women) and children: Ciprofloxacin or doxycycline by mouth

Inhalational and gastrointestinal anthrax

Adults (including pregnant women) and children: Ciprofloxacin or doxycycline and one or two additional antibiotics, which might include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin. Initial treatment is by vein (intravenous, or IV), followed by medicine by mouth. The dosage of these medicines is reduced in children.

Considerations about medicine

• The treatment for inhalational anthrax also may be used for gastrointestinal and oropharyngeal infections.
• Although doxycycline and ciprofloxacin are usually not recommended for children or during pregnancy, experts say the need to treat a life-threatening illness outweighs the risks of taking these medicines.¹ Potentially severe side effects to doxycycline in growing children include damage to dental enamel or possibly damage to formation of ligaments and cartilage. These medicines can cause staining and deformity of the teeth in newborns when given to women who are more than 4 months pregnant.
• Intravenous multidrug therapy is recommended to treat cutaneous anthrax infection if you have signs of wider infection, such as extensive fluids in tissues (edema) or lesions on the head and neck.
• Tests may be done to see if the anthrax bacteria can be killed by certain antibiotics. This is called sensitivity testing.
• Treatment of inhalational or gastrointestinal infection with penicillin alone is not recommended because the bacteria sometimes become resistant to penicillin.
• If the strain of bacteria is found to be susceptible to penicillin, children who might have been exposed to anthrax spores should be switched from doxycycline or ciprofloxacin to amoxicillin to prevent infection.¹ Amoxicillin is a member of the penicillin (beta-lactam) family of medicines.

Treatment for inhalational anthrax often is ineffective if the infection is under way. Supportive care in a hospital is essential. This care may include corticosteroids if fluid buildup (edema), respiratory trouble, or meningitis develops. Tubes may be used to drain fluid in the chest.

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Author:	Maria G. Essig, MS, ELS	Last Updated: June 20, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Christine Hahn, MD - Epidemiology
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