The recommendations were based on the limited studies available and are subject to revision. Here is a list of major points relating to patient therapy, prophylaxis, and decontamination extracted and summarized from the recommendations:

1. Anyone with a fever or systemic (general) disease in an area where bioterrorist release of anthrax has occurred should receive therapy for anthrax until the disease is ruled out in that patient.

2. Guidelines to who needs postexposure prophylaxis would have to be developed quickly by "state and local health departments in consultation with national experts," based on timing and location of exposure, weather (if applicable), and monitoring cases of anthrax.

3. Penicillin and doxycycline have been approved by the FDA for treatment of anthrax. Animal studies suggested that ciprofloxacin would also be a highly effective therapy. Ciprofloxacin should be used until the sensitivity of the bacteria is established, then the "most widely available, efficacious, and least toxic" antibiotic should be given to patients with suspected anthrax and to anyone needing postexposure protection. Patients should receive the antibiotic intravenously if possible until their condition improves enough to receive oral antibiotics. Therapy should continue for 60 days unless patients can be vaccinated. If vaccination begins immediately, antibiotic therapy can be reduced to 30 to 45 days (with three doses of anthrax vaccine given at 0, 2, and 4 weeks). Patients with cutaneous anthrax should receive the full 60-day therapy when the disease is acquired from bioterrorism because of possible inhalation exposure.

4. Children should receive ciprofloxacin only until the antibiotic sensitivity of the antibiotic is discovered, then they should receive penicillin if the organism is not resistant. Doxycycline should only be used if other medication is unavailable or allergy exists to the other antibiotics.

5. Pregnant women should receive the same therapy as above. If doxycycline must be used, pregnant women should have periodic liver function testing since this therapy has been associated with liver damage in pregnant women.

6. Since no study has observed person-to-person transmission of anthrax, only standard isolation procedures are needed in hospitals. Patient contacts need not receive prophylaxis unless they were exposed to the aerosol.

7. The risk of acquiring inhalation anthrax is probably limited to the time of "primary" aerosolization (the first few hours up through the first day following release) while particles are still in the air. Although the group does not rule out any risk from reaerosolization, risk does not seem apparent from studies of the Sverdlovsk, Russia, outbreak. Decontamination was only recommended for heavily contaminated areas where the aerosolization occurred. The group did note that "although the risk of disease caused by secondary aerosolization would be extremely low, it would be difficult to offer absolute assurance that there was no risk whatsoever."

8. Any exposed individuals should wash the skin and clothing with soap and water. They should also receive antibiotic prophylaxis.

Reference

Working Group on Civilian Biodefense. Anthrax as a biological weapon: medical and public health management, JAMA.1999;281:1735-1745.