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Management of anthrax meningitis
James J Sejvar1, Fred C Tenover, David S Stephens
1Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. zea3@cdc.gov
The Lancet. Infectious Diseases
|April 28, 2005
Summary
Anthrax meningitis, a rare but deadly infection, requires improved treatment strategies. A combination therapy, including a fluoroquinolone plus other agents, is recommended for suspected cases.
Area of Science:
- Infectious Diseases
- Neuroscience
- Pharmacology
Background:
- Bacillus anthracis meningitis is a rare but highly fatal manifestation of anthrax.
- The 2001 bioterrorism event highlighted the need for better understanding and management of anthrax meningitis.
- Limited human clinical trials and animal studies necessitate evidence-based treatment approaches.
Purpose of the Study:
- To present a rational approach to the treatment of anthrax meningitis.
- To guide antimicrobial therapy based on pathogen characteristics and available data.
- To address the challenges posed by limited treatment options and potential antimicrobial resistance.
Main Methods:
- Review of B. anthracis pathogenicity, antimicrobial pharmacokinetics/pharmacodynamics.
- Analysis of anthrax post-exposure prophylaxis in non-human primates.
- Evaluation of susceptibility patterns from the 2001 outbreak strain and clinical experience.
Main Results:
- Previous single-drug regimens have shown limited success.
- Concerns regarding antimicrobial resistance necessitate broader coverage.
- Data suggest a multi-drug approach is crucial for effective treatment.
Conclusions:
- Initial treatment for suspected anthrax meningitis should involve an intravenous fluoroquinolone.
- Combination therapy with one or two additional agents active against B. anthracis and with good central nervous system penetration is recommended.
- Potential adjunctive agents include penicillin, ampicillin, meropenem, vancomycin, and rifampicin.