Vaccines, Therapeutics, and Prophylaxis for Selected Biological Warfare Agents. (RX).
The authors note that although most of the regimens are based on standard treatment guidelines some regimens may differ because the clinical presentation of certain diseased caused by biological weapons can vary from the endemic form. The regimens may be derived from in vitro data, animal models, and limited human data.
The authors also note that the investigational new drug (IND) products that are mentioned are often used in laboratory settings to protect health care workers, but these products are not available commercially and can be given only under a protocol with informed consent. They are mentioned for scientific completeness and are not necessarily to be construed as recommendations for therapy.
DISEASE VACCINE Anthrax BioPort vaccine (licensed): 0.5 mL given subcutaneously at 0, 2, and 4 wk and 6, 12, and 18 mo, then annual boosters Botulism Department of Defense pentavalent toxoid vaccine for serotypes A-E (IND): 0.5 mL by deep subcutaneous injection at 0, 2, and 12 wk, then annual boosters Brucellosis No human vaccine available Cholera Wyeth-Ayerst vaccine: two doses of 0.5 mL each, given IM or subcutaneously at 0 and 7-30 days, then boosters every 6 months Q fever Investigation new drug (IND) 610: inactivated whole-cell vaccine given as single 0.5-mL subcutaneous injection Smallpox Wyeth calf lymph vaccinia vaccine (licensed): single does by scarification Tularemia IND, live attenuated vaccine: single 0.1-mL does given by scarification Viral Venezuelan equine encephalitis TC- encephalitides 83 live attenuated vaccine (IND): single 0.5-mL subcutaneous dose; Venezuelan equine encephalitis C-84 vaccine (formalin-inactivated TC-83, IND): up to three 0.5-mL doses given subcutaneously; Eastern equine encephalitis inactivated vaccine (IND): 0.5 mL given subcutaneously at 0 and 28 days; Western equine encephalitis inactivated vaccine (IND): 0.5 mL given subcutaneosuly at 0, 7, and 28 days Viral Argentine hemorrhagic fever hemorrhagic Candid No. 1 vaccine (cross- fevers protection for Bolivian hemorrhagic fever) (IND); Rift Valley fever inactivated vaccine (IND) DISEASE CHEMOPROPHYLAXIS Anthrax Oral ciprofloxacin 500 mg b.i.d. for 4 wk; if unvaccinated, begin initial doses vaccine OR Oral doxycycline 100 mg b.i.d for 4 wk plus vaccination In the absence of vaccine, continue chemoprophylaxis for at least 60 days. Botulism NA Brucellosis Oral doxcycline 200 mg/day plus oral rifampin 600 mg/day for 6 wk Cholera NA Q fever Oral tetracycline 500 mg q.i.d. for 5 days (start 8-12 days after exposure) OR Oral doxycycline 100 mg b.i.d. for 5 days (start 8-12 days after exposure) Smallpox IM vaccinia immune globulin 0.6 mL/kg within 3 days of exposure; best within 24 hr Tularemia Oral doxycycline 100 mg b.i.d. for 14 days OR Oral tetracycline 500 mg q.i.d. for 14 days OR Oral ciprofloxacin 500 mg every 12 hr for 14 days Viral NA encephalitides Viral NA hemorrhagic fevers DISEASE CHEMOTHERAPY Anthrax IV ciprofloxacin 400 mg every 12 hr OR IV doxycycline 200 mg initially, then 100 mg every 12 hr OR IV penicillin 4 million units every 4 hr Botulism Department of Defense heptavalent equine despeciated antitoxin for serotypes A-G (IND): one vial (10 mL) IV; CDC trivalent equine antitoxin for serotypes A, B, E (licensed) Brucellosis Oral doxycycline 200 mg/day plus oral rifampin 600 mg/day for 6 wk OR Oral ofloxacin 400 mg/day plus oral rifampin 600 mg/day for 6 wk Cholera Oral rehydration therapy plus: Tetracycline 500 mg every 6 hr for 3 days OR Doxcycline 300 mg once or 100 mg every 12 hr for 3 day OR Ciprofloxacin 500 mg every 12 hr for 3 days OR Norfloxacin 400 mg every 12 hr for 3 days Q fever Oral tetracycline 500 mg every 6 hr for 5-7 days, continued for at least 2 days after patient is afebrile OR Oral doxycycline 100 mg every 12 hr for 5-7 days, continued for at least 2 days after patient is afebrile Smallpox No current treatment other than supportive care; cidofovir effective in vitro; animal studies ongoing Tularemia IM streptomycin 7.5-10 mg/kg b.i.d. for 10-14 days OR IV gentamicin 3-5 mg/kg per day for 10-14 days OR IV ciprofloxacin 400 mg every 12 hr until improved, then 500 mg orally every 12 hr for a total of 10-14 days OR Oral ciprofloxacin 750 mg every 12 hr for 10-14 days Viral Supportive therapy: analgesics and encephalitides anticonvulsants as needed Viral IV ribavirin (Crimean-Congo hemorrhagic hemorrhagic fever/Lassa fever) fevers (IND): 30 mg/kg initial dose, then 16 mg/kg every 6 hr for 4 days, then 8 mg/kg every 8 hr for 6 days; passive antibody for Argentine hemorrhagic fever, Bolivian hemorrhagic fever, Lassa fever, and Crimean-Congo hemorrhagic fever DISEASE COMMENTS Anthrax Potential drug alternatives: gentamicin, erythromycin, and chloramphenicol. Use penicillin for sensitive organisms only. Botulism Perform skin test for hypersensitivity before administering equine antitoxin. Brucellosis Trimethoprim-sulfamethoxazole may be substituted for rifampin; however, relapse may reach 30%. Cholera Vaccine not recommended for routine protection in endemic areas (50% efficacy, short-term protection). Drug alternatives: erythromycin, trimethoprim- sulfamethoxazole, and furazolidone. Use quinolones for tetracycline/doxcycline-resistant strains. Q fever Currently testing vaccine to determine the necessity of skin testing prior to use. Smallpox Preexposure and postexposure vaccination recommended if >3 years since last vaccine. Tularemia Viral TC-83 is reactogenic in 20%; encephalitides no seroconversion seen in 20%; only effective against subtypes 1A, 1B, and 1C. C-84 vaccine used in nonrespnders to TC-83 vaccine. Eastern equine encephalitis and Western equine encephalitis inactivated vaccines are poorly immunogenic. Multiple immunizations are required. Viral Aggressive supportive care and hemorrhagic management of hypotension are fevers very important.
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|Publication:||Internal Medicine News|
|Date:||Nov 1, 2001|
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