Pediatric Anthrax Clinical Management

Abstract

Anthrax is a zoonotic disease caused by Bacillus anthracis, which has multiple routes of infection in humans, manifesting in different initial presentations of disease. Because B anthracis has the potential to be used as a biological weapon and can rapidly progress to systemic anthrax with high mortality in those who are exposed and untreated, clinical guidance that can be quickly implemented must be in place before any intentional release of the agent. This document provides clinical guidance for the prophylaxis and treatment of neonates, infants, children, adolescents, and young adults up to the age of 21 (referred to as “children”) in the event of a deliberate B anthracis release and offers guidance in areas where the unique characteristics of children dictate a different clinical recommendation from adults.

Two cases of human cutaneous anthrax with massive tissue damage, severe edema, and slight injury to the liver

“…Naturally occurring Bacillus anthracis is particularly susceptible to penicillin but highly resistant to cephalosporins, particularly to the extended‐spectrum cephalosporins . Meanwhile the single penicillin treatment could induce β ‐lactam resistance, especially because high bacterial loads could induce systemic anthrax . Although antibiotic treatment does not affect the progress of the lesions or other toxin‐related systemic damage and does not alter the evolutionary stages, early treatment will limit the size of lesions .…”

“…7,8 Meanwhile the single penicillin treatment could induce b-lactam resistance, especially because high bacterial loads could induce systemic anthrax. 9 Although antibiotic treatment does not affect the progress of the lesions or other toxin-related systemic damage and does not alter the evolutionary stages, early treatment will limit the size of lesions. 10 Although no randomized trials demonstrate that steroid therapy is necessary for human anthrax, adjunctive steroids for cutaneous anthrax with serious edema or meningoencephalitis appear to favor their use in such situations.…”

Disaster Preparedness: Biological Threats and Treatment Options

“…However, considerations particular to the pediatric population may include higher weight‐based doses and more frequent dosing due to pharmacokinetic differences in children as compared with adults. A 2014 published review on the clinical management of anthrax in pediatrics addresses various clinical considerations, including antibiotic dosing for children ranging from neonates to young adults …”

Prioritization of Pediatric Chemical, Biological, Radiologic, Nuclear, and Explosive Disaster Preparedness Education and Training Needs

“…(21) This document provides a comprehensive understanding of the pathophysiology and clinical presentation of the disease as well as clinical guidelines for the prophylaxis and treatment of children in the event of a B. anthracis release. It offers guidance in areas where the unique characteristics of children dictate a different clinical recommendation from that for adults.…”