This protocol covers empiric management of systemic anthrax — inhalation/pulmonary — in preterm and full-term newborns whose postmenstrual age (gestational age plus chronologic age) is between 32 and 44 weeks, including presentations where concurrent meningitis is present or cannot be excluded.

Therapeutic approach: When the preferred combination cannot be used, structured alternative regimens are available — involving combinations of bactericidal agents with protein synthesis inhibitors or RNA inhibitors, dual bactericidal combinations, or, where necessary, single-agent options — applied in descending order of preference according to clinical circumstances, with antitoxin continuing as an adjunct throughout. The complete sequencing, regimen selection criteria, and clinical decision points are in the full protocol.

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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, With or Without Meningitis

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