Treating Anthrax in 2014

It's been almost 13 years since the anthrax attacks of 2001 and, not suprisingly, medical care has advanced during that time. Accordingly, the CDC has released new guidelines for the treatment of anthrax. 

Several important highlights include:

  • Attention to the coagulation defects that occur with anthrax with the goal of keeping fibrinogen levels above 100 and avoiding pharmacological thromboprophylaxis
  • Emphasis on the drainage of pleural effusions--a procedure linked to improved outcome
  • Carryover of the recommendation for 60 days of post-exposure prophylaxis
  • Delineation of anthrax with possible meningitis from anthrax without possible meningitis
    • In cases where meningitis is a possibility the recommendation to use 3 drugs with high CNS penetration, 1 of which should be a protein synthesis inhibitor (ciprofloxacin, meropenem, and linezolid)
    • In cases where meningitis has been ruled out the recommendation to use 2 drugs, 1 of which should be a protein synthesis inhibitor (ciprofloxacin + linezolid)
  • Use of an anti-toxin therapy such as raxibacumab (or anthrax immune globulin--not FDA approved)

Overall, the guidelines are highly evidence-based and consistent with standard infectious disease and critical care practice. Hopefully, when followed the 45% mortality rate experienced in 2001 would be significantly diminished (in the cases that have occurred in the US since 2001, no patient has died).