E-drug: Literature review on anthrax (cont'd)
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There are two recent reviews on anthrax, one from JAMA and one
from WHO. For those interested, I recommend the following:
Inglesby TV et al. Anthrax as a biological weapon. Medical and
public health management. JAMA 1999; 281: 1735-45
(http://bt.cdc.gov/Agent/Anthrax/Consensus.pdf)
WHO (Turnbull PCB, principal author). Guidelines for the
surveillance and control of anthrax in humans and animals. 3rd ed.
WHO/EMC/ZDI/98.6
(http://www.who.int/emc-documents/zoonoses/whoemczdi986c.ht
ml)
Jefferson T et al. Vaccines for preventing Anthrax (Cochrane
Review). The Cochrane Library, Issue 2, 2001. Oxford: Update
Software.
If you are interested but not able to download one or more of the
documents, I can mail copies.
The JAMA consensus document that Offerhaus referred to is in my
opinion not quite as positive to ciprofloxacin only as he stated. It
says ciprofloxacin is first choice for treatment of a person with
signs of the disease until the resistance pattern is known. As
prophylaxis it recommends cipro or doxycycline, and for children
cipro or amoxicillin.
The WHO document recommends Penicillin V or G, and mentions all
the other antibiotics that are alternatives including chloramphenicol,
aminoglycosides (will act synergistic to penicillin), erythromycin.
(Regarding norfloxacin, my guess would be that this is not so
widely used in the US, being a drug developed in Europe. And from
all the discussion on Ip-Health, I get the impression that cipro had
anthrax as an approved indication).
With the quick, dramatic and very serious progression of the
disease in an infected person, it is understandable that you want to
use an antibiotic you trust until you know the antibiotic
susceptibility of the strain. One often does the same in septicaemia
of unknown causes. However for prophylaxis or mild cutaneous
forms there is no scientific evidence for resistance to penicillin or
any of the other antibiotics mentioned above that I have seen.
It is recommended to vaccinate with a killed vaccine during
treatment. The Cochrane review should be read by anyone
interested in the issue. Only two articles qualified for inclusion, one
using a Georgian/Russian live vaccine, the other a UK/USA killed
vaccine.
Kirsten
Kirsten Myhr
Head of Eastern Health Region Drug Information Centre
RELIS Ost
Ulleval University Hospital
0407 Oslo, Norway
Tel.: +47 23 01 64 11(o) Fax: +47 23 01 64 10
+47 22 56 05 85 (h) mobile: +47 416 38 747
myhr@online.no (h)
kirsten.myhr@relis.ulleval.no (w)
www.relis.no
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