- Administer preexposure vaccine to persons at high risk for exposure at work.
- Administer postexposure vaccine and 60 days of prophylaxis with doxycycline or ciprofloxacin to persons who have been exposed to anthrax during a biological attack.
Administer preexposure vaccine to persons at high risk for exposure at work.
- Administer preexposure vaccine to:
- Laboratory personnel who work with concentrated quantities of B. anthracis spores, handle anthrax-associated environmental samples, or are involved in activities with a high potential for spore aerosolization
- People working with imported hides, furs, bone meal, wool, or animal hair in settings where workplace standards and restrictions are inadequate to prevent exposure to anthrax spores
- People who handle potentially infected animals in areas with a high incidence of anthrax cases
- Military personnel deemed at risk for exposure by the Department of Defense
- Administer 0.5 mL of AVA, an inactivated cell-free product, intramuscularly at 0 and 4 weeks and at 6, 12, and 18 months, followed by annual boosters.
- Counsel vaccinated persons on safety, side effects, and contraindications to the use of the anthrax vaccine as discussed on the CDC anthrax Web site.
- Vaccinate pregnant women against anthrax if they are at high risk for contracting the disease and the potential benefits of vaccination outweigh potential risks to the fetus.
- Note that contraindication to the anthrax vaccine includes an anaphylactic reaction after a previous dose of AVA or any of the vaccine components. Use caution in administering the AVA to persons with a history of anthrax infection, as these individuals might be at an increased risk for severe local adverse reactions.
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Administer postexposure vaccine and 60 days of prophylaxis with doxycycline or ciprofloxacin to persons who have been exposed to anthrax during a biological attack.
- Administer postexposure antibiotic prophylaxis to persons with a known exposure to anthrax or who are in a high-risk group for exposure during a biological attack with B. anthracis.
- Administer oral ciprofloxacin, doxycycline, or levofloxacin for postexposure prophylaxis during a biological attack.
- Consider amoxicillin for postexposure prophylaxis once the B. anthracis strain has been shown to be susceptible to amoxicillin.
- Administer antibiotics for at least 60 days.
- If available, administer 0.5 mL of AVA subcutaneously at 0, 14, and 28 days to all patients receiving postexposure antibiotic prophylaxis.
- Monitor patients for side effects to antibiotics and vaccine.
- See table Drug Treatment for Anthrax.
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The American College of Physicians is accredited by the Accreditation Council for continuing Medical Education (ACCME) to provide continuing education for physicians. The American College of Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate with the extent of their participation in the activity. Purpose: This activity has been developed for internists to facilitate the highest quality professional work in clinical applications, teaching, consultation, or research. Upon completion of the CME activity, participants should be able to demonstrate an increase in the skills and knowledge required to maintain competence, strengthen their habits of critical inquiry and balanced judgement, and to contribute to better patient care. Disclosures: Nicholas John Vietri, MD, MS has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
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