[djf]

Anybody know what the antibiotic of choice is here?

[mewzilla]

CDC Plague Home Page

Lots of info there :)

[Hoplite]

Anybody know what the antibiotic of choice is here?

Whiskey.

Been self medicating, and no bubonic plague yet, so it must be working.

[COEXERJ145]

Tetracycline and Cipro are usually the most common.

[4U2OUI]

Several. Drug Category: Antibiotics -- Drugs that cover Y pestis should be empirically given to any patient with predisposing risk factors and signs and symptoms of the plague. Antibiotic treatment duration should be 10 d. In severe cases, a 2-drug regimen should be used. Antibiotic regiments for postexposure prophylaxis should be considered for close contacts of infected patients. Dosages and antibiotics are covered below. Drug Name Gentamicin (Garamycin, Jenamicin) -- Aminoglycoside antibiotic for gram-negative coverage. DOC with consideration of use as secondary agent. Adult Dose 5 mg/kg IV/IM qd or 2 mg/kg loading dose followed by 1.7 mg/kg IV/IM tid Pediatric Dose 2.5 mg/kg IV/IM tid (Neonates and premature infants require varying dosages.) Contraindications Documented hypersensitivity to aminoglycosides; non–dialysis-dependent renal insufficiency; use of concomitant live bacterial vaccines Interactions Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; because aminoglycosides enhance effects of neuromuscular blocking agents, prolonged respiratory depression may occur; coadministration with loop diuretics may increase auditory toxicity of aminoglycosides; possible irreversible hearing loss of varying degrees may occur (monitor regularly) Pregnancy D - Unsafe in pregnancy Precautions Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment; caution in neutropenic or ICU patients; may cause vestibular, renal, and auditory damage Drug Name Streptomycin sulfate -- Alternative DOC in combination with consideration of use with a secondary agent. Drug often not commercially available. Treatment usually limited to 5 d due to toxicity concerns. Continuation of secondary agent for full 10 d recommended. Adult Dose 30 mg/kg/d IM divided bid/qid; not to exceed 2 g/d Pediatric Dose 20-30 mg/kg/d IM divided bid/qid Newborn infants with transplacental infection by plague should receive gentamicin instead Contraindications Documented hypersensitivity; those with non–dialysis-dependent renal insufficiency Interactions Nephrotoxicity may be increased with aminoglycosides, cephalosporins, penicillins, amphotericin B, and loop diuretics Pregnancy D - Unsafe in pregnancy Precautions Because of narrow therapeutic index and toxic hazards associated with extended administration, not intended for long-term therapy; adjust dose in patients with renal impairment; caution in myasthenia gravis, renal failure (not on dialysis), hypocalcemia, and conditions that depress neuromuscular transmission Drug Name Chloramphenicol (Chloromycetin) -- DOC to be used as secondary agent in plague meningitis (better CNS penetration), profound hypotension, and pleural and/or pericardial involvement. May be considered as secondary agent. DOC for pregnant patients. Binds to 50S bacterial ribosomal subunits and inhibits bacterial growth. Effective against gram-negative and gram-positive bacteria. Adult Dose 50-100 mg/kg/d IV divided q6h 30 mg/kg/d PO divided q6h may be substituted for IV in last 5 d of therapy Pediatric Dose 0-7 days: 25 mg/kg PO/IV qd >7 days: 50 mg/kg/d PO/IV divided q12h Contraindications Documented hypersensitivity Interactions Concurrently with barbiturates, chloramphenicol serum levels may decrease while barbiturate levels may increase, causing toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce serum chloramphenicol levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; chloramphenicol levels may be increased or decreased Pregnancy C - Safety for use during pregnancy has not been established. Precautions Use only for indicated infections or as prophylaxis for bacterial infections; serious and fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in therapy; discontinue upon appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia, or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in pregnancy at term or during labor because of potential toxic effects on fetus (gray syndrome) Drug Name Doxycycline (Doryx, Vibramycin, Bio-Tab) -- Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May be considered as secondary agent or for postexposure prophylaxis. Adult Dose Loading dose 200 mg IV; thereafter, 100 mg IV bid for 10 d Pediatric Dose <45 kg: 2.2 mg/kg IV bid (maximum daily dose of 200 mg) >45 kg: Administer as in adults Contraindications Documented hypersensitivity; severe hepatic dysfunction; breastfeeding; children <8 y; live bacterial vaccines Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy Pregnancy D - Unsafe in pregnancy Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines Drug Name Ciprofloxacin (Cipro) -- Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Has no activity against anaerobes. Animal studies have shown effectiveness against the plague. Can be considered as a secondary agent or as an agent for postexposure prophylaxis. Adult Dose 400 mg IV bid or 500 mg PO bid Pediatric Dose 15 mg/kg IV bid or 20 mg/kg PO bid Contraindications Documented hypersensitivity; use of live vaccines Interactions Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT) Pregnancy C - Safety for use during pregnancy has not been established. Precautions Dosage adjustments (adult adjustments) CrCl (mL/min) <10: 50% of PO or IV dose q12h HD: 0.25-0.5 g PO or 0.2-0.4 g IV q12h During peritoneal dialysis: 0.25-0.5 g PO or 0.2-0.4 g IV q8h In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy Not drug of first choice in pediatrics because of increased incidence of adverse events compared to controls, including arthropathy; no data exist for dose for pediatric patients with renal impairment (ie, CrCl <50 mL/min) Drug Name Tetracycline (Sumycin, Tetracyn IV) -- Treats susceptible bacterial infections of both gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections; inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits of susceptible bacteria; use with either streptomycin or gentamicin. Consider as a secondary agent or for postexposure prophylaxis. Adult Dose Loading dose: 15 mg/kg PO; not to exceed 1 g Day 1: 40-50 mg/kg PO q4h Thereafter: 30 mg/kg PO q6h for 10-14 d Loading dose: 5 mg/kg IV Day 1: 15 mg/kg IV q4h Thereafter: 5 mg/kg IV q6h; may switch to PO at any time if patient can tolerate Prophylactic dosing: 25-50 mg/kg/d PO divided qid Pediatric Dose If suspicion of plague is high, some authors recommend similar dosages and regimens for all pediatric patients, even children <8 y Prophylactic dosing >8 years: 25-50 mg/kg/d PO divided qid Contraindications Documented hypersensitivity; those diagnosed with severe hepatic dysfunction Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; can increase hypoprothrombinemic effects of anticoagulants Pregnancy D - Unsafe in pregnancy Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines Drug Name Co-trimoxazole (Bactrim, Septra) -- DOC for prophylaxis of pregnant women and children <8 y; inhibits bacterial synthesis of dihydrofolic acid by competing with PABA, inhibiting folic acid synthesis and resulting in the inhibition of bacterial growth. Adult Dose 1 DS tab PO bid for 5-10 d Pediatric Dose <2 months: Do not administer >2 months: 8 mg/kg/d trimethoprim and 40 mg/kg/d sulfamethoxazole PO divided bid for 5-10 d Contraindications Documented hypersensitivity; those diagnosed with megaloblastic anemia due to folate deficiency Interactions May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine Pregnancy C - Safety for use during pregnancy has not been established. Precautions Discontinue at first appearance of rash or sign of adverse reaction; obtain CBCs frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholics, elderly patients, those receiving anticonvulsant therapy, or those with malabsorption syndrome); hemolysis may occur in individuals with G-6-PD deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation

[mewzilla]

From the CDC

Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. Streptomycin is the antibiotic of choice. Gentamicin is used when streptomycin is not available. Tetracyclines and chloramphenicol are also effective.

[Billthedrill]

Used to be tetracyclines. Dunno know. Yersinia pestis is a gram-negative critter that has an endotoxin associated with its cell wall to which the human body hardly reacts until the cell dies and lyses. Then massive doses of the endotoxin hit you all at once. That's why a sudden high dose of antibiotics can actually cause more harm than good. So you hit it with a measured dosage and provide supportive therapy for fever and dehydration and usually the patient does fine. Unless they die.

[bert]

.......Anybody know what the antibiotic of choice is here?.....

Back in 1994 we learned that a cure for Rats was Tongue of Newt.

Ahhh but we can only wish he he had a stronger influence today.

[Jaysun]

Anybody know what the antibiotic of choice is here?

colloidal silver

[Nuc1]

Anybody know what the antibiotic of choice is here?


Tetracycline as I recall. Not sure of the spelling but you get the idea.