TRANSMITTAL OF POLICY MEMORANDA

File: 120396_sep96_decls87_0003.txt
Page: 0003
Total Pages: 6

Subject: TRANSMITTAL OF POLICY MEMORANDA                                 

Unit: OTSG        

Parent Organization: HSC         

Box ID: BX003203

Folder Title: TRANSMITTAL OF POLICY MEMORANDA                                                                 

Document Number:          1

Folder SEQ  #:         39






                            DEPARTMENT OF THE ARMY
                           OFFICE OF THE SURGEON GENERAL
                                  5109 LEESBURG PIKE
                               FALLS CHURC


               REPLY TO
               ATTENTION OF
          SGPS-PSP



          MEMORANDUM FOR COL ROBERT P. BELIHAR, COMMAND SURGEON, USCENTCOM,
                           MACDILL AIR FORCE BASE, FL 33608-7001

          SUBJECT: Policy for Antibiotic Use in Anthrax


          1. Purpose: To present the recommended policy for antibiotic
          use in anthrax.

          2. Discussion: A biowarfare attack with anthrax spores
          delivered by aerosol would cause inhalation anthrax. Inhalation
          anthrax begins with non-specific symptoms followed in 2-3 days by
          the sudden onset of severe respiratory distress and toxemia
          leading rapidly to death. Treatment with penicillin, initiated
          at the toxemic stage of the disease, has been unsuccessful.
          Limited experiments in aerosol-infected monkeys showed that
          post-exposure prophylaxis with a short course of antibiotics was
          ineffective while combining a short course of antibiotics with
          vaccination on days 1 and 10 post-exposure was protective. The
          vast majority of anthrax strains are sensitive in vitro to
          penicillin, however, resistant strains exist. All strains tested
          to date have been sensitive to tetracycline, erythromycin,
          chloramphenicol, gentamicin, and ciprofloxacin.

          3. Recommendations:

              a. Prophylaxis. If a biowarfare attack is imminent, begin
          ciprofloxacin (500 mg p.o. bid) or doxycycline (100 mg p.o. bid).
          If unvaccinated, a single 0.5 ml dose of vaccine should be given
          subcutaneously. if the attack is confirmed, antibiotics should
          be continued for 4 weeks and 0.5 ml doses of vaccine given at 2

          should receive a single 0.5 ml booster. If vaccine is not avail-
          able, antibiotics should be continued until the patient can be
          closely observed upon discontinuation of therapy. If signs of
          anthrax occur after cessation, they should be treated as below.

              b. Suspected Inhalation Anthrax. Institute treatment at the
          earliest signs of disease with oral ciprofloxacin (1000 mg
          initially followed by 750 mg bid) or            - doxycycline (200
          mg initially followed by 100 mg q 12 hours).




                                          FREDERICK J. ERDTMANN
                                          Colonel, MC
                                          Chief, Preventive and Military
                                             Medical Consultants Division

Document 6 f:/Week-36/BX003203/TRANSMITTAL OF POLICY MEMORANDA/transmittal of policy memoranda:11259610133727
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = TRANSMITTAL OF POLICY MEMORANDA
Folder Seq # = 39
Subject = TRANSMITTAL OF POLICY MEMORANDA
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 25-NOV-1996