MMWR Recomm Rep. 2023 Nov 17;72(6):1-47. doi: 10.15585/mmwr.rr7206a1.
THIS REPORT UPDATES PREVIOUS CDC GUIDELINES AND RECOMMENDATIONS ON PREFERRED PREVENTION AND TREATMENT REGIMENS REGARDING NATURALLY OCCURRING ANTHRAX. ALSO PROVIDED ARE A WIDE RANGE OF ALTERNATIVE REGIMENS TO FIRST-LINE ANTIMICROBIAL DRUGS FOR USE IF PATIENTS HAVE CONTRAINDICATIONS OR INTOLERANCES OR AFTER A WIDE-AREA AEROSOL RELEASE OF: Bacillus anthracis spores if resources become limited or a multidrug-resistant B. anthracis strain is used (Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885-900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36). Specifically, this report updates antimicrobial drug and antitoxin use for both postexposure prophylaxis (PEP) and treatment from these previous guidelines best practices and is based on systematic reviews of the literature regarding 1) in vitro antimicrobial drug activity against B. anthracis; 2) in vivo antimicrobial drug efficacy for PEP and treatment; 3) in vivo and human antitoxin efficacy for PEP, treatment, or both; and 4) human survival after antimicrobial drug PEP and treatment of localized anthrax, systemic anthrax, and anthrax meningitis.
CHANGES FROM PREVIOUS CDC GUIDELINES AND RECOMMENDATIONS INCLUDE AN EXPANDED LIST OF ALTERNATIVE ANTIMICROBIAL DRUGS TO USE WHEN FIRST-LINE ANTIMICROBIAL DRUGS ARE CONTRAINDICATED OR NOT TOLERATED OR AFTER A BIOTERRORISM EVENT WHEN FIRST-LINE ANTIMICROBIAL DRUGS ARE DEPLETED OR INEFFECTIVE AGAINST A GENETICALLY ENGINEERED RESISTANT: B. anthracis strain. In addition, these updated guidelines include new recommendations regarding special considerations for the diagnosis and treatment of anthrax meningitis, including comorbid, social, and clinical predictors of anthrax meningitis. The previously published CDC guidelines and recommendations described potentially beneficial critical care measures and clinical assessment tools and procedures for persons with anthrax, which have not changed and are not addressed in this update. In addition, no changes were made to the Advisory Committee on Immunization Practices recommendations for use of anthrax vaccine (Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1-14). The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis.
本报告更新了之前美国疾病控制与预防中心（CDC）有关天然炭疽病的预防和治疗建议，包括首选预防和治疗方案。此外，还提供了多种替代方案，供患者在出现禁忌症或不耐受，或在大面积气溶胶释放：如果资源有限或使用抗药性强的炭疽杆菌（B. anthracis）菌株时，供患者选择（Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885-900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36）。具体而言，本报告根据针对 1）炭疽杆菌体外抗菌药物活性；2）PEP 和治疗中体内抗菌药物疗效；3）PEP、治疗或两者的体内和人类抗毒素疗效；以及 4）抗菌药物 PEP 和局部炭疽、全身炭疽和炭疽性脑膜炎治疗后的人类存活率等文献进行系统综述，更新了针对接触后预防（PEP）和治疗的抗菌药物和抗毒素使用的最佳实践。
与之前的 CDC 指南和建议相比，此次更新包括了在一线抗菌药物禁忌或不耐受，或在生物恐怖袭击后一线抗菌药物耗尽或对基因工程耐药的 B. anthracis 菌株无效时使用的替代抗菌药物的扩展清单。此外，这些更新后的指南还包括了炭疽性脑膜炎诊断和治疗的特殊注意事项的新建议，包括炭疽性脑膜炎的合并症、社会和临床预测因素。之前发布的 CDC 指南和建议描述了对炭疽患者有益的关键护理措施和临床评估工具及程序，这些内容没有变化，在本次更新中没有涉及。此外，本报告并未更新免疫实践咨询委员会（Advisory Committee on Immunization Practices）对炭疽疫苗的使用建议（Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1-14）。医疗保健提供者可使用本报告中的更新指南预防和治疗炭疽病，并指导应急准备官员和规划人员制定和更新大面积 B. anthracis 气溶胶释放计划。
