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(1000 mg initially, followed by 750 mg bid) or doxycycline (200
mg initially, followed by 100 mg q 12 hrs). Supportive therapy
for shock, fluid volume deficit, and adequacy of airway may all
be needed.
.
PROPHYLAXIS

	Vaccine. A licensed, alum-precipitated, preparation of
purified Bacillus anthracis protective antigen (PA) has been
shown to be effective in preventing or significantly reducing
the incidence of inhalation anthrax. Limited human data
suggest that after completion of the first three doses of the
recommended six-dose primary series protection against both
cutaneous and inhalation anthrax is afforded. Studies in
rhesus monkeys indicate that good protection is afforded after
two doses (10-16 days apart) for up to 2 years. It is likely
that two doses in humans is protective as well, but there is
too little information to draw firm conclusions. As with all
vaccines, the degree of protection depends upon the magnitude
of the challenge dose; vaccine-induced protection is
undoubtedly overwhelmed by extremely high spore challenge.

	In the present setting, three doses of the vaccine is
recommended for prophylaxis against inhalation anthrax.
Contraindications for use are sensitivity to vaccine components
(formalin, alum, benzethonium chloride) and/or history of
clinical anthrax.. Reactogenicity is mild to moderate: up to
6% of recipients will experience mild discomfort at the
innoculation site for up to 72 hours (tenderness, erythema,
edema, pruritus), while a smaller proportion (1%) will
experience more severe local reactions (potentially limiting
use of the extremity for 1-2 days); modest systemic reactions
(myalgia, malaise, low-grade fever) are uncommon, and severe
systemic reactions (anaphylaxis, which precludes additional
vaccination) are rare. The vaccine should be stored at
refrigerator temperature (not frozen).

ANTIBIOTICS

Choice of antibiotics for prophyla:is is guided by the same.
principles as that for treatment; i.e., it is relatively easy .
to produce a penicillin-resistant organism in the laboratory,

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