Antimicrobial Treatment for Systemic Anthrax: Analysis of Cases from 1945–2014 Identified through Systematic Literature Review

Details

• Alternative Title:
  Health Secur
• Personal Author:
  Pillai, Satish K. ; Huang, Eileen ; Guarnizo, Julie ; Hoyle, Jamechia ; Katharios-Lanwermeyer, Stefan ; Turski, Theresa ; Bower, William ; Hendricks, Katherine ; Meaney-Delman, Dana
• Description:
  Background ; Systemic anthrax is associated with high mortality. Current national guidelines, developed for the individualized treatment of systemic anthrax, outline the use of combination intravenous antimicrobials for a minimum of two weeks; bactericidal and protein synthesis inhibitor antimicrobials for all cases of systemic anthrax; and at least 3 antimicrobials with good blood-brain barrier penetration for anthrax meningitis. However, in an anthrax mass casualty incident, large numbers of anthrax cases may create challenges in meeting antimicrobial needs. ; Methods ; To further inform our understanding of the role of antimicrobials in treating systemic anthrax, a systematic review of the English language literature was conducted to identify cases of systemic anthrax treated with antimicrobials for which a clinical outcome was recorded. ; Results ; A total of 149 cases of systemic anthrax were identified (cutaneous n=59, gastrointestinal n=28, inhalation n=26, primary anthrax meningitis n=19, multiple routes n=9, and injection n=8). Among the identified 59 cases of cutaneous anthrax, 33 were complicated by meningitis (76% mortality), while 26 simply had evidence of the systemic inflammatory response syndrome (4% mortality); 21 of 26 (81%) of this latter group received monotherapy. Subsequent analysis regarding combination antimicrobial therapy was restricted to the remaining 123 cases of more severe anthrax (overall 67% mortality). Recipients of combination bactericidal and protein synthesis inhibitor therapy had a 45% survival versus 28% in the absence of combination therapy (p = 0.07). For meningitis cases (n=77), survival was greater for those receiving a total of ≥3 antimicrobials over the course of treatment (3 of 4; 75%), compared to receipt of 1 or 2 antimicrobials (12 of 73; 16%) (p = 0.02). Median parenteral antimicrobial duration was 14 days. ; Conclusion ; Combination bactericidal and protein synthesis inhibitor therapy may be appropriate in severe anthrax disease, particularly anthrax meningitis, in a mass casualty incident.
• Subjects:
  • Article
  • Administration, Intravenous
  • Anthrax
  • Anti-Bacterial Agents
  • Antitoxins
  • Drug Therapy, Combination
  • Global Health
  • Humans
• Source:
  Health Secur. 13(6):355-364.
• Pubmed ID:
  26623698
• Pubmed Central ID:
  PMC4710510
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  13
• Issue:
  6
• Download URL:
  https://stacks.cdc.gov/view/cdc/37533/cdc_37533_DS1.pdf
• File Type:
  [PDF - 801.89 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c7b753f564ad2ea658c853feb29b9753a5a46e02a86ebf50ec667c0827eaf141