Chloramphenicol and terramycin in the treatment of pneumonic plague

Pneumonic Plague Cluster, Uganda, 2004

“…pestis as a bioterrorism agent notes, "in the absence of early therapy (i.e., within the first 24 h), death occurs from overwhelming sepsis" ( 14 ). This follows Butler's widely cited reviews, which state that pneumonic plague is "invariably fatal" if treated >20–24 h after illness onset ( 11 , 12 ) and cite the 1956 report of McCrumb et al ( 24 ). More recent reviews ( 25 ) and other literature ( 26 , 27 ) indicate that survival is possible even when treatment is initiated after 24 h, consistent with caregiver B2's survival.…”

“…The chest radiographs of surviving caregiver B2 were consistent with but not uniquely diagnostic for primary pneumonic plague. As with the few other published radiographs of primary pneumonic plague patients ( 1 , 24 , 27 , 31 – 33 ), these radiographic findings alone would not prompt clinicians to consider pneumonic plague without a preexisting clinical suspicion.…”

Impact of Resistance Selection and Mutant Growth Fitness on the Relative Efficacies of Streptomycin and Levofloxacin for Plague Therapy

“…Case studies in the United States report that the fatality rates for antibiotic-treated bubonic, septicemic, and pneumonic plague are 14%, 22%, and 57%, respectively (12). Mortality rates approaching 100% are seen for people with plague pneumonia in whom therapy is delayed by as little as 18 to 24 h after the onset of disease symptoms (27). Mortality from plague is due to overwhelming infection, leading to septic shock and organ failure.…”

“…Mortality from plague is due to overwhelming infection, leading to septic shock and organ failure. However, the extent to which selection of resistance during therapy contributes to treatment failure is unknown, since susceptibility studies have been reported only for Y. pestis isolates that were cultured from patients either prior to or shortly after therapy was initiated (27). We are unaware of studies in which susceptibility studies were conducted on Y. pestis isolates that were collected from people after they had failed antibiotic therapy.…”

“…When therapy is delayed by as little as 18 h after the onset of symptoms, mortality from pneumonic plague approaches 100% (27,32). Previously developed vaccines were found to be ineffective for the prevention of pneumonic plague (10,12).…”