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Published on: May 19, 2020

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
PubMed

Insights

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.

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