This protocol addresses adults aged 18 years or older who are not pregnant and not lactating, presenting with systemic anthrax in its inhalation or pulmonary form, with or without concurrent meningitis.
In nonpregnant adults aged 18 or older with systemic anthrax — regardless of whether meningitis is present — bactericidal agents have been found to provide a survival benefit compared with other agents and are preferred as the foundation of therapy.
When the preferred combination regimen cannot be used, a structured set of alternative regimens is available — spanning combinations of different drug classes as well as, in selected circumstances, single-agent options. The choice among alternatives is guided by whether meningitis is suspected and by available susceptibility data. The complete ranked algorithm with all regimen details is in the full protocol.
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).
If an appropriate combination of bactericidal antimicrobial drug plus a PSI or an RNAI is contraindicated, not well tolerated, or not available or if meningitis is considered unlikely, consider the following regimens in descending order of preference: