Treatment of Systemic Pulmonary Anthrax in Non-Pregnant Adults Aged 18 and Older
Systemic anthrax in adults aged 18 years or older who are not pregnant and not lactating — including the inhalation (pulmonary) form — represents a highly lethal infection that demands a structured, evidence-based combination approach. This protocol applies whether or not meningitis is present.
Clinical Scenario
Adult patient aged 18 years or older, not pregnant, not lactating, presenting with systemic anthrax (inhalation/pulmonary). Meningitis may or may not be present. In this population, bactericidal agents have been found to provide a survival benefit compared with other agents.
Treatment Approach
Management centres on a preferred combination regimen: bactericidal agents drawn from different antimicrobial drug classes, combined with an inhibitor targeting bacterial protein or RNA synthesis, plus antitoxin as adjunctive therapy.
The complete regimen — including drug selection, sequencing, alternatives, and duration guidance — is available in the full structured protocol.
References
- For nonpregnant adults aged ≥18 years with systemic anthrax with or without meningitis, bactericidal agents have been found to provide a survival benefit compared with other agents and are preferred over PSIs (Table 8).
- Because of the highly lethal nature of untreated systemic anthrax, particularly when complicated by anthrax meningoencephalitis, combination therapy should be used to address both the toxin-mediated pathogenesis of this infection and potential antibiotic-resistant B. anthracis.
- Antimicrobial drugs: Choose two bactericidal drugs from different antimicrobial drug classes plus a PSI or an RNA synthesis inhibitor (RNAI).
- Antitoxin: Choose a single antitoxin as adjunctive therapy. Anthrax antitoxin should be provided as adjunctive therapy to antimicrobial drug regimens for all patients with noncutaneous systemic anthrax.
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