This protocol covers empiric treatment of systemic anthrax following pulmonary exposure in adults aged 18 years or older who are pregnant or lactating. The clinical picture may include cases with or without concurrent meningitis, and the approach differs meaningfully from standard adult recommendations.
Systemic (inhalation/pulmonary) anthrax in a pregnant or lactating adult, with or without meningitis. Recommendations for this population are similar to those for nonpregnant adults, with specific exclusions that apply because of pregnancy and lactation status.
Preferred empiric therapy involves combination treatment: two bactericidal agents drawn from different antimicrobial drug classes, combined with a protein synthesis inhibitor (PSI) or an RNA inhibitor (RNAI), plus a single antitoxin as adjunctive therapy. Certain antimicrobial agents otherwise used in adult systemic anthrax are specifically excluded for pregnant and lactating persons. The complete regimen, agent selection criteria, and sequencing are in the full protocol.
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:
Antimicrobial drugs: Choose two bactericidal drugs from different antimicrobial drug classes plus a PSI or an RNAI.
Antitoxin: Choose a single antitoxin as adjunctive therapy.
Recommendations for pregnant and lactating persons aged ≥18 years are similar to those for nonpregnant adults except that neither tetracycline nor minocycline are included.
Duration of antimicrobial drug treatment should be for 2 weeks or longer; however, duration can be shortened and IV administration transitioned to oral medication based on patient improvement and clinical judgment.
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