Adults aged 18 and older who are pregnant or lactating and develop systemic anthrax via the pulmonary (inhalation) route represent a clinically distinct population. Meningitis may or may not be present. Empiric regimen selection must account for the constraints of pregnancy and lactation alongside the severity of systemic infection.
This protocol applies when the patient is pregnant or lactating, aged 18 or older, with confirmed or suspected systemic anthrax (inhalation/pulmonary), with or without concurrent meningitis. Recommendations for this population are similar to those for nonpregnant adults, but certain agents are excluded based on safety considerations specific to pregnancy and lactation.
When the preferred combination regimen cannot be used, structured alternative antibiotic combination regimens are available — each drawing from different classes of antimicrobial activity. The complete protocol specifies which options apply in the context of pregnancy and lactation.