Pediatric emergency medicine trisk 4542 4542
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Viral hemorrhagic
fever (e.g.,
Ebola)
Botulism
mg PO q12h (for children
>40 kg)
Supportive therapy; consider Supportive therapy
ribavirin in select cases
Supportive therapy; an
antitoxin may prevent
disease progression
Supportive therapy
a Rifampin
or clarithromycin also targets bacterial protein synthesis may thus be acceptable alternatives to
clindamycin. If ciprofloxacin or another quinolone is employed, doxycycline may be used as a second agent,
as it also targets protein synthesis.
b Ampicillin, imipenem, meropenem, or chloramphenicol penetrates the CSF well and may thus be
acceptable alternatives to penicillin.
c Treatment for cutaneous anthrax would be the same as for postexposure prophylaxis. Sixty days of
treatment is indicated if concern for concomitant inhalation exposure.
d If signs/symptoms of sepsis, treatment of patient with bubonic plague is same as for pneumonic plague.
e Levofloxacin and moxifloxacin are licensed by the Food and Drug Administration for the prophylaxis and
treatment of plague in the setting of a bioterror attack, but not tularemia.
GOALS OF TREATMENT
The goals of emergency therapy include early recognition of a potential biologic
agent attack, efficient and accurate triage of victims, rapid institution of proper
isolation and infection control precautions to protect healthcare workers and other
patients, and administration of proper antibiotics or antitoxins, when appropriate.
CLINICAL CONSIDERATIONS
Clinical Recognition
Recognition of a biologic agent exposure may be difficult because pediatricians
and emergency department (ED) physicians rarely encounter victims of such
attacks. Considering three critical epidemiologic characteristics of such an attack
might enhance early recognition: an epidemic number of patients, a common
exposure history, and exotic disease presentations. A large number of patients, out
of proportion to time of year and expected clinical syndromes, might trigger
suspicion. Although some variations in the incubation period may occur after a
biologic agent attack, most persons would initially be exposed at the same time,
and thus become ill and present in a relatively compressed time frame. In
contrast, most natural epidemics evolve with a gradual rise in disease incidence
