Rationale:

• Early treatment is essential to saving lives in inhalational anthrax, gastrointestinal anthrax, anthrax meningitis, and severe cutaneous disease.
• Two to three intravenous antibiotics are required for optimal treatment of inhalational anthrax, gastrointestinal anthrax, anthrax meningitis, and severe cutaneous anthrax.
• Blood culture and chest x-ray results are very useful in the diagnosis of inhalational anthrax, even early in the disease.
• Severe cutaneous anthrax is life-threatening, and the significant edema associated with lesions can result in airway obstruction for lesions on the face and neck.
• Anthrax is not transmissible, and standard precautions are adequate.

Evidence:

• All patients treated within 3 days of symptoms for inhalational anthrax survived during the 2001 anthrax outbreak (28; 37).
• The use of two to three iv antibiotics improved survival in the 2001 anthrax outbreak (28) compared to the 1979 Sverdlovsk, Russia, outbreak (18).
• In the 2001 anthrax outbreak, all patients had an abnormal chest x-ray result, and blood cultures showed gram-positive rods within 18 to 24 hours in all patients not previously treated with antibiotics (28).
• All 11 inhalational anthrax patients in the 2001 anthrax outbreak initially presented with nonspecific flu-like illnesses (28; 37).
• A 7-month-old infant with a primary cutaneous lesion progressed rapidly to systemic disease (27).
• The Working Group for Civilian Biodefense recommends treating severe cutaneous disease and cutaneous disease with head or neck involvement with two to three iv antibiotics (24).

Comments:

• None.