Can Anthrax be prevented and are there treatment options?

Anthrax can be prevented by avoiding items that may be contaminated with anthrax. The most common way to get anthrax is through exposure to an infected animal or animal waste and by-products. Veterinarians, farmers, or researchers working with animals are at higher risk, as are those working in industries that handle animal by-products like meat and animal skins.    Travelers to areas where anthrax is more common should be cautious about foods consumed and items touched. These regions include the Caribbean, Eastern and Southern Europe, Central and southwestern Asia, Sub-Saharan Africa, and South and Central America. 

Persons exposed to anthrax but who have no symptoms are recommended to receive a 60 days course of treatment with antibiotics that include doxycycline and ciprofloxacin.  Outcomes are better if persons receive prompt treatment as soon as symptoms develop. 

All pharmaceutical products, including antibiotics and vaccines, carry an inherent risk of injury or death for some individuals. When taking long-term antibiotic therapy, it is important to be aware of potential side effects. Overuse of antibiotics in the absence of bacterial infection has contributed to the development of antibiotic-resistant strains of organisms that can cause life-threatening illnesses. This has made it necessary to develop more powerful antibiotics, some of which carry serious side effects. 

In addition to killing unwanted toxic bacteria, such as anthrax, antibiotics also kill the normal flora of the gastrointestinal tract and can cause nausea, diarrhea, vomiting, and yeast infections. Rashes, hives, and other allergic reactions can occur, including anaphylactic shock leading to death. 

Some antibiotics can cause central nervous system problems, including severe headaches, drowsiness, dizziness, irritability and restlessness, nerve paralysis, and seizures.      Other antibiotic reactions include blood disorders, such as anemia and thrombocytopenia (which can lead to uncontrolled bleeding), kidney and liver dysfunction, and serum sickness that causes fatigue, muscle weakness, and joint damage.         

There are three licensed anthrax antitoxins available for use from the Strategic National Stockpile - anthrax immune globulin intravenous (AIGIV), obiltoxaximab (Anthim), and raxibacumab (ABthrax). Side effects from these products include:     

• Hypersensitivity reactions
• Anaphylaxis
• Headache
• Pruritis
• Upper respiratory infections
• Cough
• Bruising at the injection site
• Nasal congestion
• Infusion site pain
• Extremity pain
• Itching
• Fever
• Myalgia
• Fatigue
• Chest pain
• Cyanosis
• Dizziness/vertigo
• Vomiting
• Heart palpitations
• Shortness of breath
• Insomnia
• Muscle spasms

Prognosis for Treated Anthrax: The mortality rate for skin-acquired anthrax left untreated is five to 20 percent but very low with antibiotic therapy.  Fifty-five percent of persons exposed to anthrax by inhalation during the 2001 bioterrorism attack in the U.S. survived. There is only a 10 to 15 percent survival rate from inhalation anthrax without treatment.    The mortality rate for gastrointestinal anthrax is between 25 and 60 percent, and 33 percent for injection anthrax. 

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