Dena M. Bravata, MD, MS

When untreated, inhalational anthrax typically resultsin a rapidly fatal illness. Evidence suggests that both theanthrax vaccine and prophylaxis with ciprofloxacin or doxycyclineare effective in preventing illness after inhalational anthraxexposure. The current anthrax vaccine appears to have anadverse-effect profile that is similar to that of other adult vaccines.For patients with active infection, the CDC recommendsa multi-antibiotic regimen that should include doxycycline ora fluoroquinolone and 2 additional antibiotics that have proteinor RNA synthesis inhibition, such as rifampin and clindamycin.Monoclonal antibodies directed against anthrax toxinsmay also play a role in treating active infection. (J Respir Dis.2008;29(6):249-254)

ABSTRACT: The 2001 anthrax attack demonstrated the UnitedStates' vulnerability to bioterrorism. Governmental and publichealth agencies are preparing for the enormous logistical challengesrequired for a response to a large-scale bioterrorist attack.These include the stockpiling and distribution of antibioticsand vaccines for prophylaxis and treatment of exposedpopulations. Given that untreated inhalational anthrax is rapidlyfatal, early identification and timely initiation of appropriatetherapy are essential. The prodromal phase of illness ischaracterized by flu-like symptoms, such as cough, fever, andfatigue, followed by respiratory distress and shock. Chest radiographicfindings include pleural effusions and widening ofthe mediastinum. (J Respir Dis. 2008;29(5):215-221)