Treatment of Anthrax: the Killer Disease

Anthrax can be easily and successfully treated if diagnosed promptly and treatment instituted early and immediately after diagnosis. Anthrax is in the news because of the recent microbial bioterrorist attacks in the United States. Modern science has revealed methods and unleashed a devil of deliberately spreading anthrax and other diseases in ways not appreciated by our ancestors. The combination of basic scientific research, good medical practice, and constant vigil will be required by the public and the Govt. to defend against such attacks.

Clinical features of anthrax: the clinical feature depends on the route of entry of the organism mainly gastrointestinal, cutaneous, and inhalational. Symptoms include cutaneous lesions of papule to eschar (begins as a papule following the introduction of spores through an opening in the skin. This papule then evolves to a painless vesicle followed by the development of a coal-black, necrotic eschar). If the anthrax is due to inhalation the symptoms are fever, malaise, chest pain, abdominal discomfort etc. On chest x-ray there is pleural effusion and widened mediastinum.

Diagnosis of anthrax: Anthrax is diagnosed with laboratory tests like PCR (polymerase chain reaction) test, Wright stain of blood peripheral smear, Gram staining and blood culture of the organism causing anthrax (Bacillus anthracis a gram-positive, nonmotile, spore-forming rod that is found in soil and predominantly causes disease in herbivores like cattle, goats, and sheep).

Treatment of anthrax: penicillin (amoxicillin), ciprofloxacin, and doxycycline are the currently licensed antibiotics for treatment of anthrax. But clindamycin and rifampin can also used as part of treatment regimens and they are also being used to treat anthrax. Treatment is started with penicillin (amoxicillin), ciprofloxacin, and doxycycline till sensitivity results are known and once sensitivity results are known treatment is changed if required.

Post exposure treatment: It is done with Ciprofloxacin, 500 mg, orally twice a day for 60 days or doxycycline 100 mg orally twice a day for 60 days or amoxicillin (likely to be effective if strain penicillin sensitive) 500 mg, orally thrice a day for 60 days.

Treatment of active anthrax: Ciprofloxacin, 500 mg intravenously 12 hourly or doxycycline 100 mg intravenously 12 hourly plus Clindamycin, 900 mg IV 8 hourly and/or rifampin, 300 mg IV 12 hourly. Switch to oral route when stable for60 days total treatment including intravenous route.