CDC Update, OCTOBER 17, 2001

Clinical laboratorians should be alert to the presence of Bacillus species in patient specimens. In particular, laboratorians should suspect B. anthracis when the specimen is from a previously healthy patient with a rapidly progressive respiratory illness or a cutaneous ulcer. If B. anthracis is suspected, laboratories should immediately notify the health-care provider and local and state public health staff. For rapid identification of B. anthracis, state and local health departments should access the Laboratory Response Network for Bioterrorism (LRN). LRN links state and local public health laboratories with advanced capacity laboratories --- including clinical, military, veterinary, agricultural, water, and food-testing laboratories. Laboratorians should contact their state public health laboratory to identify their local LRN representative.

Postexposure prophylaxis is indicated to prevent inhalational anthrax after a confirmed or suspected aerosol exposure. When no information is available about the antimicrobial susceptibility of the implicated strain of B. anthracis, initial therapy with ciprofloxacin or doxycycline is recommended for adults and children (Table 1).

Use of tetracyclines and fluoroquinolones in children has adverse effects. The risks for these adverse effects must be weighed carefully against the risk for developing life-threatening disease. As soon as penicillin susceptibility of the organism has been confirmed, prophylactic therapy for children should be changed to oral amoxicillin 80 mg/kg of body mass per day divided every 8 hours (not to exceed 500 mg three times daily). B. anthracis is not susceptible to cephalosporins or to trimethoprim/sulfamethoxazole, and these agents should not be used for prophylaxis.

 

Source: MMWR 50(41), 889-893, October 19, 2001.