Antimicrobial Prophylaxis to Prevent Anthrax Among Decontamination/Cleanup Workers Responding to an Intentional Distribution of Bacillus anthracis
Decontamination/cleanup workers working in environments known to be contaminated with Bacillus anthracis spores may be at risk for inhalation anthrax. These workers should wear appropriate personal protective equipment (PPE) and follow appropriate procedures, as outlined in other CDC guidance documents.
Despite appropriate PPE and procedures, however, there will remain a potential for breaches of protection and contamination of the workers. Furthermore, there is potential that such a breach or contamination will not be recognized at the time of occurrence. Finally, while it may be appropriate to conduct medical surveillance of cleanup workers for epidemiologic monitoring of the effectiveness of the protective measures, monitoring may not be reliable enough or timely enough to rely on for clinical decisions regarding the need for antimicrobial prophylaxis on an individual basis.
Recommendations:
CDC recommends that decontamination/cleanup workers receive antimicrobial prophylaxis, using standard regimens starting in conjunction with or prior to the time of first entry into a contaminated location and continuing for 60 days after final opportunity for exposure.
The current recommended regimens (for adults) are as follows:
ciprofloxacin,
500 mg by mouth every 12 hours
or
doxycycline, 100 mg by mouth every 12 hours
These recommendations may be modified as additional information becomes available.
A medical protocol should be developed to implement prophylaxis, and this program should be under the supervision of an experienced physician. At a minimum, the protocol should include the following components: there should be a pre-deployment assessment, including ascertainment of history of drug allergies, current medication that might interact adversely with the selected prophylactic antimicrobial, presence of any medical conditions that might contraindicate use of the selected antimicrobial, and education regarding potential side effects and how to report symptoms or problems. There should also be education regarding recognition of potential breaches in protection and regarding anthrax and it’s symptoms, emphasizing the need for prompt reporting of both breaches and symptoms. Provision should also be made for periodic re-assessment of workers receiving prophylaxis; this assessment should include both monitoring for evidence of side effects of medications and epidemiologic surveillance for evidence of exposures. There are no available data to guide selection of an appropriate interval for re-assessments, so as an interim guidance, this should be left to the professional judgment of the supervising physician. If workers develop adverse side effects during prophylaxis, alternative prophylactic antimicrobial therapies may be available and warranted.
It is important to emphasize that this is an interim guidance and that a number of important issues remain unresolved. This guidance is subject to revision as these issues become better clarified.
- Page last updated 2002
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