Treatment of Systemic Pulmonary Anthrax in Pregnant or Lactating Adults (≥18 Years)

This protocol covers the management of systemic anthrax — inhalation/pulmonary form, with or without meningitis — in adults aged 18 years or older who are pregnant or lactating.

Clinical scenario: Adult patient (≥18 years) who is pregnant or breastfeeding, presenting with systemic inhalation/pulmonary anthrax. Meningeal involvement may or may not be present. Recommendations for this population are similar to those for nonpregnant adults, with notable exclusions based on pregnancy and lactation status.

Treatment approach (partial overview): When the preferred antibiotic combination cannot be used, a structured set of alternative combination regimens is available — applied in descending order of preference — with antitoxin continuing as an adjunct throughout. The appropriate regimen is determined by contraindication profile, likelihood of meningeal involvement, and drug availability. The full ranked algorithm and regimen specifications are in the protocol.

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References

For pregnant or lactating persons aged ≥18 years, empiric treatment regimens for those with systemic anthrax with or without meningitis (Table 11) are summarized as follows:

Recommendations for pregnant and lactating persons aged ≥18 years are similar to those for nonpregnant adults except that neither tetracycline nor minocycline are included.

If an appropriate combination of bactericidal drugs 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:

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