Infectious Diseases in Critical Care Medicine

Table 10

Treatment for Adults

Pathogen

Initial treatment prior to availability of susceptibility

Category A pathogens

Anthrax (

B. anthracis

)

Adults, including pregnant patients, with cutaneous disease

(also including pregnant patients).

Ciprofloxacin (400 mg PO b.i.d.) or Levofloxacin (500 mg PO

daily) for 60 days.

Adults including pregnant patients with inhalation,

gastrointestinal, oropharyngeal, fulminant bacteremia, orsevere systemic or life-threatening disease.

Ciprofloxacin (500 mg IV q12h) is preferred as meningeal is

likely, with systemic disease plus one or two other agents(rifampin, vancomycin, penicillin, ampicillin,chloramphenicol, imipenem, clindamycin, clarithromycin).The addition of clindamycin (900 mg IV q8h) and rifampin(300 mg IV q12h) is recommended. Treat for 60 days. Adjusttherapy according to clinical condition.

Adults including pregnant women with anthrax meningitis.

Same as above. Treat for 60 days. Use of steroids may be of

benefit, but there are no studies supporting thisrecommendation.

Botulism (

C. botulinum

toxin)

In case of ingestion, if no contraindication, clear gastrointestinal tract. Trivalent or pentavalent antitoxin.

Plague (

Y. pestis

)

First choice: Streptomycin 30 mg/kg/day (max dose 1 g q12h IM);Alternative agents:Gentamicin 5 mg/kg IM or IV daily or 2 mg/kg loading dose followed by 1.7 mg/kg q8h IV or IM; Doxycycline has been added to

gentamicin therapy;

or

Doxycycline 100 mg IV q12h or 200 mg IV daily;

or

Chloramphenicol 25 mg/kg q6h IVonly;

or

Ciprofloxacin 400 mg IV daily or 500 mg PO daily.

For pregnant patients: Gentamicin 5 mg/kg IM or IV daily or 2 mg/kg loading dose followed by 1.7 mg/kg q8h IV or IM.

Smallpox (

V. major

)

Cidofovir has been used to treat other poxviridae. Other promising therapy: imatinib mesylate (Gleevec) and other acyclic

nucleoside phosphonates analogues.

Tularemia (

F. tularensis

)

In order of preference:Streptomycin 15 mg/kg IV q12h for 10 days;Gentamicin 5 mg/kg IV daily for 10 days;Doxycycline 100 mg IV or PO q12h for 14–21 days (relapse rate higher);Ciprofloxicin 400 mg IV q12h or 500 mg PO q12h for 14–21 days. Third-generation cephalosporins, clindamycin, cotrimoxazole, and

chloramphenicol

not

recommended.

(Continued )

Bioterrorism Infections in Critical Care 469