Guidelines for Treatment of Anthrax—Reply

In Reply: We appreciate the clarifications from Drs Meyerhoff and Murphy. The accompanying corrections clarify the status of FDA approval for specific medication indications and adjust the Working Group's recommended doses for 3 drugs used in the treatment or postexposure prophylaxis of anthrax. Although these corrections do not substantively change any of the key Working Group recommendations, they are important enough to warrant specific notice.

Meyerhoff and Murphy emphasize that ciprofloxacin has been approved by the FDA for both children and adults for postexposure prophylaxis for inhalational anthrax. They also state that the FDA has not approved any therapy specifically for the treatment of inhalational anthrax while "penicillin G procaine and doxycycline are both approved by the FDA for the treatment of disease due to B anthracis, as well as for anthrax PEP. Ciprofloxacin is only approved for "inhalational anthrax (postexposure)" and is not approved by the FDA for the treatment of inhalational anthrax." At this time, then, clinicians have no options that have been approved by the FDA for the treatment of inhalational anthrax. In the absence of FDA approval for any specific treatment for inhalational anthrax, clinicians must rely on other sources of guidance regarding treatment recommendations for this disease process.