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2015 ; 13
(6
): 365-77
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Antitoxin Treatment of Inhalation Anthrax: A Systematic Review
#MMPMID26690378
Huang E
; Pillai SK
; Bower WA
; Hendricks KA
; Guarnizo JT
; Hoyle JD
; Gorman SE
; Boyer AE
; Quinn CP
; Meaney-Delman D
Health Secur
2015[Nov]; 13
(6
): 365-77
PMID26690378
show ga
Concern about use of anthrax as a bioweapon prompted development of novel anthrax
antitoxins for treatment. Clinical guidelines for the treatment of anthrax
recommend antitoxin therapy in combination with intravenous antimicrobials;
however, a large-scale or mass anthrax incident may exceed antitoxin availability
and create a need for judicious antitoxin use. We conducted a systematic review
of antitoxin treatment of inhalation anthrax in humans and experimental animals
to inform antitoxin recommendations during a large-scale or mass anthrax
incident. A comprehensive search of 11 databases and the FDA website was
conducted to identify relevant animal studies and human reports: 28 animal
studies and 3 human cases were identified. Antitoxin monotherapy at or shortly
after symptom onset demonstrates increased survival compared to no treatment in
animals. With early treatment, survival did not differ between antimicrobial
monotherapy and antimicrobial-antitoxin therapy in nonhuman primates and rabbits.
With delayed treatment, antitoxin-antimicrobial treatment increased rabbit
survival. Among human cases, addition of antitoxin to combination antimicrobial
treatment was associated with survival in 2 of the 3 cases treated. Despite the
paucity of human data, limited animal data suggest that adjunctive antitoxin
therapy may improve survival. Delayed treatment studies suggest improved survival
with combined antitoxin-antimicrobial therapy, although a survival difference
compared with antimicrobial therapy alone was not demonstrated statistically. In
a mass anthrax incident with limited antitoxin supplies, antitoxin treatment of
individuals who have not demonstrated a clinical benefit from antimicrobials, or
those who present with more severe illness, may be warranted. Additional
pathophysiology studies are needed, and a point-of-care assay correlating toxin
levels with clinical status may provide important information to guide antitoxin
use during a large-scale anthrax incident.
|Administration, Intravenous
[MESH]
|Animals
[MESH]
|Anthrax/*drug therapy
[MESH]
|Anti-Bacterial Agents/therapeutic use
[MESH]
|Antibodies, Monoclonal, Humanized
[MESH]
|Antibodies, Monoclonal/*therapeutic use
[MESH]
|Antigens, Bacterial/immunology
[MESH]
|Antitoxins/*therapeutic use
[MESH]
|Bioterrorism
[MESH]
|Drug Therapy, Combination
[MESH]
|Humans
[MESH]
|Immunoglobulin G/*therapeutic use
[MESH]
|Immunoglobulins, Intravenous/therapeutic use
[MESH]
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