APPENDIX 1

Postexposure Prophylaxis for B anthracis (for Children 1 Month of Age and Older)

1. For penicillin-resistant strains or prior to susceptibility testing
Ciprofloxacin, 30 mg/kg/day, by mouth (PO), divided every 12 h (not to exceed 500 mg/dose)
OR
Doxycycline,a <45 kg: 4.4 mg/kg/day, PO, divided every 12 h (not to exceed 100 mg/dose) >45 kg: 100 mg/dose, PO, given every 12 h
OR
Clindamycin,b 30 mg/kg/day, PO, divided every 8 h (not to exceed 900 mg/dose)
OR
Levofloxacin,c <50 kg: 16 mg/kg/day, PO, divided every 12 h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given every 24 h
OR
2. For penicillin-susceptible strainsb,d
Amoxicillin, 75 mg/kg/day, PO, divided every 8 h (not to exceed 1 g/dose)
OR
Penicillin VK, 50–75 mg/kg/day, PO, divided every 6 to 8 h
Duration of Therapy: 60 days after exposure
  • Bold font: preferred antimicrobial agent (when 2 bolded antimicrobial agents are present, both are considered equivalent in overall safety and efficacy).

  • Normal font: alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.

  • Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.

  • Italicized font: indicates FDA approval for the indication in the pediatric population.

  • a A single 14-day course of doxycycline is not routinely associated with tooth staining, but some degree of staining is likely for a prolonged treatment course of up to 60 days.

  • b On the basis of in vitro susceptibility data.

  • c Safety data for levofloxacin in the pediatric population are limited to 14 days for duration therapy.

  • d Be aware of the possibility of emergence of penicillin-resistance during monotherapy with amoxicillin or penicillin.