Table 2

Recommended prophylaxis after exposure toBacillus anthracis

Antimicrobial agentAdultsChildren
Ciprofloxacin is not licensed for use in children or pregnant women. There have been no formal studies of the use of ciprofloxacin during pregnancy, but it is unlikely to be associated with a high risk of abnormalities of fetal development. There is some evidence that the use of fluoroquinolones in children (including use by breast feeding mothers) may be associated with tendinopathy and arthropathy. If B anthracis exposure is confirmed, the organism must be tested for penicillin susceptibility. If susceptible, exposed persons may be treated with oral amoxicillin as an alternative to ciprofloxacin or doxycycline (40 mg/kg of body mass/day in divided doses 8 hourly; not to exceeed 500 mg, three times daily). Pharmacokinetic studies have shown that ciprofloxacin achieves far higher concentrations in lung macrophages than penicillin, and is therefore a more effective prophylactic antibiotic. The risk of adverse effects must be weighed against the risk of developing a serious disease. Ciprofloxacin has the added advantage that it is also an effective prophylactic treatment for other potential agents that may be used in deliberate release scenarios, such as plague and tularaemia.
bd, twice daily.
Oral fluoroquinolones
Ciprofloxacin500 mg bd20–30 mg/kg of body mass daily, divided into doses—as a guide
10 kg: 125 mg bd
20 kg: 250 mg bd
30 kg: 375 mg bd
40 kg: as for adult
If fluoroquinolones are not available or are contraindicated
Doxycycline100 mg bd5 mg/kg body mass/day divided into two doses