Rationale:

• Treatment of cutaneous anthrax does not alter the course of the skin disease but it does decrease the likelihood of systemic disease.
• Cutaneous anthrax of the face and neck may compromise the airway and should be treated more aggressively with iv antibiotics.
• Cutaneous anthrax with systemic signs indicates more serious disease and should be treated as inhalational anthrax.
• Cutaneous anthrax associated with a bioterrorist attack should be treated for 60 days and with vaccination because of the concern for concomitant inhalation of spores at the time of exposure to an aerosol.

Evidence:

• Cutaneous anthrax treated appropriately has a <1% mortality rate; the mortality rate for untreated cutaneous anthrax is 20% (48).
• Cutaneous anthrax on the face or neck may compromise breathing, given the edematous response elicited by B. anthracis edema toxin (24).
• Concurrent vaccination with anthrax vaccine after exposure to a biological attack may help prevent disease once antibiotics are stopped and may help shorten the course of antibiotics (24).

Comments:

• None.