Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults

Katherine A. Hendricks, Mary E. Wright, Sean V. Shadomy, John S. Bradley, Meredith G. Morrow, Andy T. Pavia, Ethan Rubinstein, Jon-Erik C. Holty, Nancy E. Messonnier, Theresa L. Smith, Nicki Pesik, Tracee A. Treadwell, William A. Bower

, and the Workgroup on Anthrax Clinical Guidelines

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K.A. Hendricks, S.V. Shadomy, M.G. Morrow, N.E. Messonier, T.L. Smith, N. Pesik, T.A. Treadwell, W.A. Bower); National Institutes of Health, Bethesda, Maryland, USA (M.E. Wright); University of California, San Diego School of Medicine, San Diego, California, USA (J.S. Bradley); University of Utah, Salt Lake City, Utah, USA (A.T. Pavia); University of Manitoba, Winnipeg, Manitoba, Canada (E. Rubenstein); Stanford University, Stanford, California, USA (J.-E. Holty)

Abstract

The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis.

Anthrax has been recognized as an infectious disease of animals and humans for millennia. Within the United States, animal anthrax is reported in most years, but naturally occurring human anthrax is rare. Worldwide, however, the disease is common in wild and domestic animals and not uncommon among persons who interact with animals in agricultural regions of South and Central America, sub-Saharan Africa, central and southwestern Asia, and southern and eastern Europe (1). Biodefense experts often place Bacillus anthracis at or near the top of the list for potential threat agents. Inhalation anthrax is particularly deadly, as demonstrated by the 1979 accidental release of B. anthracis from a military microbiology facility in the Sverdlovsk region of Russia; 88% (66/75) of patients reported with inhalation anthrax died (2). More recently, humans have acquired disease from exposure to spores released purposefully as a bioterrorist weapon (3) and accidentally from naturally occurring sources (4,5).