First Line

• Cutaneous: Ciprofloxacin 500 mg PO b.i.d. or doxycycline 100 mg PO b.i.d. for 7–10 days for localized or uncomplicated cases of naturally acquired cutaneous anthrax. Treat for 7–10 days with IV instead for severe cases of naturally acquired cutaneous anthrax with signs of systemic involvement, extensive edema, or lesions of the head and neck.
  • If cutaneous case is localized or uncomplicated but is bioterrorism-related, the patient must be treated for 60 days with PO ciprofloxacin or doxycycline because they are at risk for inhalational anthrax.
  • Patients with bioterrorism-related cutaneous anthrax who show signs of systemic involvement, massive edema, or lesions on the head or neck should be treated per inhalational anthrax recommendation (below) (4,5)[C].
• Inhalational and GI: IV ciprofloxacin 400 mg q12h (1st line) or doxycycline 100 mg q12h (2nd line) and 1 or 2 additional antimicrobials such as rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin
  • May switch to PO when clinically appropriate.
  • Must complete 60-day course (combined PO and IV) (4)[C].
  • Early and aggressive pleural fluid drainage is recommended for all inhalational anthrax patients (5)[C].

Second Line Patients being treated for anthrax may also benefit from vaccination as part of their regimen.

General Measures

• Inhalational and GI anthrax are not known to spread from person to person, so communicability concerns are not an issue during management of the patient.
• Although cutaneous anthrax is also considered noncontagious, avoidance of contact with the wound or wound drainage seems prudent.