Pulmonary anthrax
ICD-10 A22.1 · ICD-11 1B97/CA40.0

Treatment of Pulmonary Anthrax in Nonpregnant Adults Aged 18 Years or Older — Systemic Anthrax With or Without Meningitis

Clinical scenario

This protocol addresses systemic anthrax (inhalation/pulmonary form) in nonpregnant, non-lactating adults aged 18 years or older, including cases complicated by meningitis. Because of the highly lethal nature of untreated systemic anthrax — particularly when complicated by meningoencephalitis — a structured combination approach is required to address both the toxin-mediated and antimicrobial dimensions of this infection.

Why age and pregnancy status matter

For nonpregnant adults aged 18 years or older with systemic anthrax with or without meningitis, bactericidal agents have been found to provide a survival benefit compared with other agents. This shapes the preferred regimen structure significantly for this specific population.

Treatment approach — partial overview

The preferred regimen combines two bactericidal drugs from different antimicrobial drug classes with an additional inhibitor, alongside a single anthrax antitoxin as adjunctive therapy. Multiple first-line and alternative agents are specified for each component. The complete regimen — including agent selection, sequencing, and transition criteria — is in the full protocol.

Drug choices, doses, and the full algorithm are not shown here.

Instant Access to Structured Evidence-Based Regimens

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.

View source ↗