Table 3.

Biological Weapons: Recommended Diagnostic Procedures, Isolation, and Treatment in Children16 ,43

Diagnostic Sample(s)Isolation Precautions*Treatment OptionsProphylaxisComments
Anthrax1–60 dBlood culture, blood smear; skin lesions or tissue, culture or fluorescent antibody (FA) stainingStandard, contact for skin lesionsCiprofloxacin§or doxycycline or (penicillin G and streptomycin), vaccine, if available (see text)Ciprofloxacin§ or doxycycline Alternate agents: gentamicin, erythromycin, chloramphenicol
Brucellosis5–60 dBlood or bone marrow, culture, acute/convalescent seraStandard, contact if lesions are drainingDoxycycline and rifampin; if <8 y, trimethoprim-sulfamethoxazoleDoxycycline and rifampinTrimethoprim-sulfamethoxazole may substitute for rifampin with doxycycline
Plague2–3 dBlood, sputum, lymph node aspiration, culture or FA stainingDropletStreptomycin or gentamicin, doxycycline or chloramphenicolDoxycycline, tetracyclineTrimethoprim-sulfamethoxazole is alternative; chloramphenicol for meningitis
Q fever10–40 dAcute/convalescent seraStandardDoxycycline or tetracyclineDoxycycline, tetracycline
Tularemia2–10 dSputum or tissue, culture#, FA available, acute/convalescent seraStandardStreptomycin or gentamicinDoxycycline, tetracycline
Smallpox7–17 dPharyngeal swab or lesions, cultureAirborne, contactCidofovir** NA (vaccine effective but not available)
Botulism1–5 dSerum for toxin if <3 d; stool or gastric secretions, culture for organism and look for toxin; nerve conductionStandardAntitoxin (CDC3-164)If ingested, induced vomiting, gastric lavage, purgation and high enemas may benefitAminoglycosides potentiate paralysis; antitoxin after exposure for asymptomatic not usually given
enterotoxin B
1–6 hNasal swab, culture serum and urine for organism and look for toxinStandardSupportive careNA
  • * For decontamination guidelines, see text.

  • See the Report of the Committee on Infectious Diseases (Red Book) 24th ed, 1997 (or the most current edition) for drug doses. Intravenous therapy for severely ill patients is usually indicated, but oral therapy can be effective and may be the only practical alternative when large numbers of people are exposed.

  • Prophylaxis should only be initiated after consultation with public health officials in situations where exposure is highly likely. The duration of prophylaxis has not been determined for most agents.

  • § If susceptibility unknown. Ciprofloxacin is not FDA approved for persons <18 years of age, but is indicated for potentially serious or life-threatening infections (see Red Book).

  • If susceptibility unknown. Tetracyclines, including doxycycline, are not FDA approved and usually contraindicated in children less than 8 years, but treatment is warranted for selected serious infections (see 2000 Red Book).

  • Penicillin should be used only if the organism is known to be susceptible.

  • # Special media required for culture, laboratory hazard: only immunized technicians should ordinarily process cultures.

  • ** Pediatric dose not established.

  • F3-164 Centers for Disease Control and Prevention Drug Service. 404/639-3670 (weekdays, 8–4:30 ET) or 404/639-2888 (weekends, evenings, holidays).