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NY, a 30-year-old woman, is brought to the local acute care center by her roommate. Her roommate explains that NY has been feeling ill for 4 to 5 days. As of this morning, NY appears confused and is having difficulty breathing.
According to her roommate, NY's illness began with typical flu symptoms. She complained of fever and chills. Her symptoms worsened, and she experienced soaking sweats, along with nausea and vomiting. She also developed a mild cough. Her roommate did not think anything of NY's illness until this morning, when she noticed that NY was confused and appeared to be short of breath.
NY has no known significant medical history. She does not take any medications, and she exercises 5 days per week. She is currently employed in the local legislative office building.
Physical examination shows that she is a well-nourished woman in respiratory distress. Her vital signs are reported as follows: blood pressure 110/65, heart rate 140 bpm, respiratory rate 20. A neurological evaluation shows that she is not oriented to place or time. On her chest exam, she is found to have rales in the right base with diffuse wheezing.
NY's chest x-ray shows mediastinal widening with fullness of right hilar and peritracheal soft tissue. It also shows right pleural effusion and right, middle, and lower lobe infiltrates.
Laboratory results are reported as WBC 10,000/mm3, 85% neutrophils, 5% bands, 7% lymphocytes, and 8% monocytes; sodium 134 meq/L, potassium 5.5 meq/L, chloride 100 meq/L, serum creatinine 1.5 mg/dL; arterial pH 7.43, PaCO2 25, PaO2 65. Blood and CSF cultures grew Bacillus anthracis.
The physician has never treated anthrax before and is unsure what antibiotics are approved by the FDA for the treatment of inhalation anthrax infections. He calls the pharmacy to ask what antibiotics to prescribe.
What antibiotics are approved for the treatment of inhalation anthrax?
Dr. Schlesselman is a clinical pharmacist based in Niantic, Conn.