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Author: Admin | 2025-04-28
Although IV ciprofloxacin or IV doxycycline also are recommended. Erythromycin is suggested as an alternative to penicillin G for the treatment of naturally occurring or endemic anthrax in patients hypersensitive to penicillins. For the treatment of inhalational anthrax that occurs as the result of exposure to B. anthracis spores in the context of biologic warfare or bioterrorism, the CDC and the US Working Group on Civilian Biodefense recommend that treatment be initiated with a multiple-drug parenteral regimen that includes ciprofloxacin or doxycycline and 1 or 2 other anti-infectives predicted to be effective. Based on in vitro data, drugs that have been suggested as possibilities to augment ciprofloxacin or doxycycline in such multiple-drug regimens include chloramphenicol, clindamycin, rifampin, vancomycin, clarithromycin, imipenem, penicillin, or ampicillin. If meningitis is established or suspected, some clinicians suggest a multiple-drug regimen that includes ciprofloxacin (rather than doxycycline) and chloramphenicol, rifampin, or penicillin. Although there is evidence that erythromycin has in vitro activity against B. anthracis, strains of the organism that were associated with cases of inhalational or cutaneous anthrax that occurred in the US (Florida, New York, District of Columbia) during September and October 2001 in the context of an intentional release of anthrax spores (biologic warfare, bioterrorism) had only intermediate susceptibility to erythromycin. Limited or no clinical data are available to date regarding in vivo activity of erythromycin against B. anthracis and the drug is not considered a drug of choice for the treatment or prophylaxis of anthrax that occurs as the result of exposure to anthrax spores in the context of biologic warfare or bioterrorism. IV anti-infective therapy is recommended for the initial treatment of clinically apparent GI, inhalational, or meningeal anthrax and anthrax septicemia and also is indicated for the treatment of cutaneous anthrax when there are signs of systemic involvement, extensive edema, or head and neck lesions; oral therapy may be adequate for mild, uncomplicated cutaneous anthrax. Bartonella InfectionsOral erythromycin or oral azithromycin has been used in conjunction with IM or IV ceftriaxone for the treatment of bacteremia caused by Bartonella quintana† [off-label] (formerly Rochalimaea quintana). B. quintana, a gram-negative bacilli, can
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