Vietri Nicholas J, Purcell Bret K, Tobery Steven A, Rasmussen Suzanne L, Leffel Elizabeth K, Twenhafel Nancy A, Ivins Bruce E, Kellogg Mark D, Webster Wendy M, Wright Mary E, Friedlander Arthur M
Division of Bacteriology, Center for Aerobiological Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland 21702, USA.
J Infect Dis. 2009 Feb 1;199(3):336-41. doi: 10.1086/596063.
Postexposure prophylaxis of inhalational anthrax requires prolonged antibiotic therapy or antibiotics and vaccination. The duration of treatment for established anthrax is controversial, because retained spores may germinate and cause disease after antibiotics are discontinued. Using rhesus macaques, we determined whether a short course of antibiotic treatment, as opposed to prophylaxis, could effectively treat inhalational anthrax and prevent disease caused by the germination of spores after discontinuation of antibiotics.
Two groups of 10 rhesus macaques were exposed to an aerosol dose of Bacillus anthracis spores. Animals in group 1 received ciprofloxacin prophylaxis beginning 1-2 h after exposure. Those in group 2 began receiving ciprofloxacin after becoming bacteremic, and treatment was continued for 10 days. When each group 2 animal completed 10 days of therapy, the prophylactic antibiotic was discontinued in the paired group 1 animal.
In group 1 (prophylaxis), no deaths occurred during antibiotic treatment, but only 2 (20%) of 10 animals survived after antibiotics were discontinued. In contrast, in group 2 (treatment), 3 deaths occurred during antibiotic treatment, but all 7 animals (100%) alive after 10 days of therapy survived when antibiotics were discontinued.
In the treatment of inhalational anthrax, the prolonged course of antibiotics required to achieve prophylaxis may not be necessary to prevent anthrax that results from the germination of retained spores after the discontinuation of antibiotics.
吸入性炭疽暴露后预防需要长期抗生素治疗或抗生素与疫苗联合使用。已确诊炭疽的治疗疗程存在争议，因为留存的孢子可能在停用抗生素后萌发并引发疾病。我们利用恒河猴确定了与预防性治疗相反的短期抗生素治疗能否有效治疗吸入性炭疽，并预防停用抗生素后孢子萌发所致疾病。
两组各10只恒河猴暴露于气溶胶剂量的炭疽芽孢杆菌孢子。第1组动物在暴露后1 - 2小时开始接受环丙沙星预防性治疗。第2组动物在出现菌血症后开始接受环丙沙星治疗，并持续治疗10天。当第2组的每只动物完成10天治疗后，配对的第1组动物停用预防性抗生素。
在第1组（预防性治疗组），抗生素治疗期间无死亡发生，但停用抗生素后10只动物中仅2只（20%）存活。相比之下，在第2组（治疗组），抗生素治疗期间有3只死亡，但治疗10天后存活的所有7只动物（100%）在停用抗生素后均存活。
在治疗吸入性炭疽时，实现预防所需的延长抗生素疗程可能并非预防停用抗生素后留存孢子萌发所致炭疽所必需。
