The incidence of anthrax in humans has decreased during the past century, and it is now very rare in developed countries including the United States. However, anthrax remains a concern in the developed world because of its potential as an agent of bioterrorism. Anthrax meningitis and the fulminant phase of inhalation anthrax are associated with extremely high mortality rates.
The treatment of anthrax will be reviewed here. The microbiology, pathogenesis, epidemiology, clinical manifestations, diagnosis, and prevention of anthrax are discussed separately. (See "Microbiology, pathogenesis, and epidemiology of anthrax" and "Clinical manifestations and diagnosis of anthrax" and "Prevention of anthrax".)
The treatment recommendations presented here are in agreement with the recommendations of the United States Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) [1-3].
Important caveats — Treatment of patients suspected of having systemic anthrax should be started urgently and should include intravenous antimicrobial combination therapy, an antitoxin (raxibacumab or anthrax immunoglobulin), drainage of pleural effusions, supportive care, and consideration of adjunctive glucocorticoids . Each of these therapies is discussed in detail below. When selecting an antimicrobial regimen for anthrax, the production of toxin, the potential for antimicrobial drug resistance, the frequent occurrence of meningitis, and the presence of latent spores must be taken into account.
●Initial evaluation – Patients suspected of having systemic anthrax should undergo similar testing as is done in other patients with an acute febrile illness, including pretreatment blood cultures and other appropriate cultures . Unless it is contraindicated, all patients suspected of having systemic anthrax should undergo lumbar puncture to evaluate for meningitis. Other diagnostic testing is discussed separately. (See "Clinical manifestations and diagnosis of anthrax", section on 'Diagnosis'.)