Clinical Scenario

This protocol covers systemic anthrax (inhalation/pulmonary), with or without meningitis, occurring in preterm and full-term neonates at 32–44 weeks' postmenstrual age — that is, gestational age plus chronologic age. This is a particularly vulnerable population in which regimen selection requires careful consideration.

Treatment Approach

When the preferred combination regimen cannot be used, structured alternative options are available in a defined order of preference. These range from a bactericidal drug combined with a protein synthesis inhibitor or an RNA-inhibitor agent, to two-drug combinations of agents from different antimicrobial classes, through to single-drug options when combinations are not feasible. Antitoxin continues as an adjunct throughout.

Full regimen sequencing, drug selection, and all related guidance are in the complete protocol — see below.

References

For preterm and full-term newborns 32–44 weeks' postmenstrual age (i.e., gestational age plus chronologic age), empiric treatment regimens for those with systemic anthrax with or without meningitis (Table 17) are summarized as follows:
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:
One bactericidal drug plus a PSI (start with this regimen if meningitis is not suspected)
One bactericidal drug plus a second bactericidal agent 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

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Treatment of Pulmonary Anthrax in Neonates at 32–44 Weeks Postmenstrual Age

Clinical Scenario

Treatment Approach

References