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

Treatment of Pulmonary Anthrax in Adults Aged 18 and Older: Systemic Anthrax (Not Pregnant, Not Lactating)

Systemic anthrax arising from inhalation exposure — pulmonary anthrax — requires prompt, protocol-driven antimicrobial management. The appropriate regimen in non-pregnant, non-lactating adults depends critically on suspected meningeal involvement and which drug classes are tolerated and available.

Clinical scenario Adults aged 18 years or older who are neither pregnant nor lactating, with systemic (inhalation/pulmonary) anthrax — with or without concurrent meningitis. In this population, bactericidal antimicrobial agents have been found to confer a survival benefit and are therefore preferred over other agent classes.
Treatment approach — partial overview When the first-choice drug combination cannot be used, a defined hierarchy of alternative regimens is available — each involving specific pairings or single agents from bactericidal and other antimicrobial classes, with adjunctive antitoxin therapy continuing throughout. The complete regimen sequence, decision rules for meningitis, and drug selection criteria are available in the full protocol.
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).

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: One bactericidal drug plus a PSI (start with this regimen if meningitis is not suspected and susceptibilities are known); One bactericidal drug plus a second bactericidal drug from a different antimicrobial drug class; One bactericidal drug plus an RNAI; A PSI plus an RNAI; Two PSIs from different antimicrobial drug classes; A single bactericidal drug; A single PSI.

View source ↗