Bioterrorism Agents - PowerPoint PPT Presentation

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Bioterrorism Agents

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Mass Casualty Setting Adults Preferred choices: Doxycycline - 100 mg orally twice daily Ciprofloxacin - 500 mg orally twice daily Alternative choices: ... – PowerPoint PPT presentation

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Title: Bioterrorism Agents


1
Bioterrorism Agents PlagueLesson 5
  • Medical Management

2
Objectives
  • Management of suspect and confirmed cases
  • Medications Controlled Situation
  • Medications Mass Casualty
  • Infection Control

3
Overview
  • Prompt treatment required
  • Y. pestis enterobacteriaceae
  • Responsive to most antimicrobials

4
Overview
  • Aerosol exposure plague pneumonia
  • Medical Management
  • Prompt antimicrobial administration
  • Respiratory droplet precautions
  • Intensive respiratory support
  • Management of consequences

5
Treatment Issues
  • Clinical improvement 36 to 48 hours, if
    responding to treatment
  • Cannot recover Y. pestis after 36 hours of
    treatment
  • All US strains have been sensitive to current
    treatments, to date

6
Treatment in Bioterrorism
  • BT Plague High suspicion of resistance
  • Perform testing rapidly
  • Watch for Health Alerts
  • Treatment/Prophylaxis recommendations may change

7
Streptomycin
  • Historically preferred
  • FDA-approved
  • Not widely and immediately available
  • Floroquinolones?

8
Treating an Outbreak
  • Gentamicin IND protocol
  • Contained Casualty parenteral antimicrobial
    therapy
  • Mass Casualty oral therapy

9
Recommended Plague TreatmentNotes on Options
  • Based on consensus of working group and not FDA
  • Choose one agent.
  • Treatment for 10 days
  • Substitute oral therapy when condition improves

10
Recommended Plague TreatmentContained Casualty -
Adults
Preferred Preferred
Streptomycin 1g IM BID
Gentamicin 5 mg/kg IM or IV daily OR 2 mg/kg loading with 1.7 mg/kg IM or IV TID
Alternative Alternative
Doxycycline 100mg IV BID or 200mg IV
Ciprofloxacin 400mg IV BID
Chloramphenicol 25 mg/kg IV QID
11
Recommended Plague TreatmentContained Casualty -
Children
Preferred Preferred
Streptomycin 15 mg/kg IM BID (max 2g daily)
Gentamicin 2.5 mg/kg IM or IV daily TID
Alternative Alternative
Doxycycline ?45kg - 100mg IV BID or 200mg IV
Ciprofloxacin 15 mg/kg BID
Chloramphenicol 25 mg/kg IV QID
12
Recommended Plague TreatmentMass Casualty -
Adults
Preferred Preferred
Doxycycline 100 mg PO BID
Ciprofloxacin 500 mg PO BID
Alternative Alternative
Chloramphenicol 25 mg/kg PO QID
13
Recommended Plague TreatmentChildren Mass
Casualty
Preferred Preferred
Doxycycline ?45kg - 100 mg PO BID lt45kg 2.2mg/kg PO BID
Ciprofloxacin 20 mg/kg PO BID
Alternative Alternative
Chloramphenicol 25 mg/kg IV QID
14
Recommended Plague TreatmentNotes on Gentamicin
  • Streptomycin preferred, but hard to find
  • Frequency at discretion of clinician
  • Initial loading dose 2 mg/kg standard when given
    three times per day
  • Not FDA-approved
  • Refer to package insert re renal insufficiency

15
Recommended Plague TreatmentNotes on Children
  • Gentamicin may be efficacious, but not widely
    accepted clinical practice
  • Neonates up to 1 wk 2.5 mg/kg IV BID
  • Can substitute other fluoroquinolones
  • Ciprofloxacin dosage no more than 1 g/d,
    concentrations between 5 20 µg/ml
  • Chloramphenicol dosage no more than 4g/d. No
    one younger than 2 years.

16
Plague Infection Control Precautions
Bubonic Standard
Pneumonic Standard and Respiratory
Septicemic Standard
Suspect Respiratory and Isolation
  • Isolation for 48 hours of antibiotic treatment or
    until clinical improvement

17
Plague Infection Control
  • Cohort and Droplet precautions if no isolation
    available
  • Isolation of contacts may increase in importance
    for outbreak control
  • Corpses Standard Precautions

18
Occupational ExposureHospital and Laboratory
  • Skin Exposures Nonabrasive soap and water,
    standard workplace exposure policy
  • Eye Exposures Flush with water or eye wash
    solution x 15 minutes
  • Post-Exposure doxycycline or ciprofloxacin x 7
    days
  • Laboratory avoid aerosolization

19
Occupational ExposuresLaboratory Spills
  • Cover in absorbent materials
  • 1100 bleach x 30 minutes
  • Wipe with absorbent materials soaked in 1100
    bleach
  • Clean with nonabrasive soap and water
  • Dispose all materials biohazard
  • BSL2 for all suspect materials

20
Occupational ExposuresField Workers
  • Incident Commander assigns PPE levels
  • Minimum of Level B PPE
  • Tyvek outer clothing
  • Gloves
  • Booties
  • Positive pressure HEPA filtered respirators
  • All PPE decontaminated or disposed of as
    biohazardous waste

21
Review Questions - PlagueLesson 5
  • Medical Management

22
Plague Review QuestionsLesson 5, Question 1
  • News report 75 cases of plague in area
  • Ambulances arriving at ER
  • Exposed to intentional plague bacteria release
  • Which antibiotic would you choose?

23
Plague Review QuestionsLesson 5, Question 1
  • Which antibiotic would you choose?
  • Streptomycin 1g IM BID
  • Doxycycline 100 mg PO BID
  • Gentamicin 5 mg/kg IM or IV daily
  • Any of the above

24
Plague Review QuestionsLesson 5, Question 1
  • Which antibiotic would you choose?
  • B. Doxycycline 100 mg PO BID

25
Plague Review QuestionsLesson 5, Question 2
  • Suspect pneumonic plague patient
  • What precautions would you take immediately?

26
Plague Review QuestionsLesson 5, Question 2
  • What precautions would you take immediately?
  • Standard precautions
  • Standard and contact precautions
  • Standard and respiratory droplet precautions
  • Negative pressure room

27
Plague Review QuestionsLesson 5, Question 2
  • What precautions would you take immediately?
  • C. Standard and respiratory droplet precautions

28
Plague Review QuestionsLesson 5, Question 3
  • Pneumonia patient
  • Lab unable to rule out plague
  • What medication do you prescribe for a controlled
    casualty situation?

29
Plague Review QuestionsLesson 5, Question 3
  • What medication do you prescribe for a controlled
    casualty situation?
  • Penicillin
  • Gentamicin
  • Zithromicin
  • Biaxin

30
Plague Review QuestionsLesson 5, Question 3
  • What medication do you prescribe for a controlled
    casualty situation?
  • B. Gentamicin

31
Plague Review QuestionsLesson 5, Question 4
  • Pneumonic plague patient
  • Gentamicin x 48 hours
  • How would you expect the patient to progress?

32
Plague Review QuestionsLesson 5, Question 4
  • How would you expect the patient to progress?
  • Spike in temperature, toxic
  • Still infectious, remain in isolation
  • Showing signs of clinical improvement
  • Signs of inflammatory response

33
Plague Review QuestionsLesson 5, Question 4
  • How would you expect the patient to progress?
  • C. Showing signs of clinical improvement
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