Anthrax in Children: Prevention and Treatment

John S. Bradley, MD; Georgina Peacock, MD, MPH; Steven E. Krug, MD


May 27, 2014

Editorial Collaboration

Medscape &

Editor's Note: The guidance for the appropriate response to anthrax exposure and the management of different types of anthrax infection (inhalation, cutaneous, gastrointestinal, systemic) in children has just been updated and is summarized here. Expanded guidance is also available on the prevention and management of anthrax exposure and inhalation anthrax in adults and for anthrax during pregnancy and postpartum.

Anthrax in Children

Since the anthrax attacks in 2001, anthrax has remained a major focus of national emergency-preparedness planning. Bacillus anthracis, the bacterium that causes anthrax, is concerning because it can rapidly progress to systemic disease with high mortality if untreated.

If an intentional release of anthrax were to occur, children would require special consideration because the clinical presentation and progression of disease in children may differ from that in adults. Children could be at higher risk of developing systemic disease and/or meningoencephalitis, the symptoms they experience may mimic those of other illnesses, and little is known about the signs and symptoms of anthrax in infants younger than 2 months of age.

To address these issues, the American Academy of Pediatrics and the Centers for Disease Control and Prevention released a report[1] focusing specifically on the clinical needs of children during an anthrax emergency. The report provides the most current guidance on caring for children after an intentional release of B anthracis and includes information on the diagnosis and management of anthrax in pediatric populations, antimicrobial and vaccine use, and treatment options.

Postexposure Prophylaxis

All children exposed to B anthracis spores should receive at least 60 days of antimicrobial prophylaxis with the most effective agents, even if these agents are associated with increased side effects compared with antimicrobials more often used in children.

Oral ciprofloxacin and doxycycline are preferred, or if the strain is susceptible to penicillin, amoxicillin should be used.

In addition to antimicrobials, all exposed children aged 6 weeks and older should receive 3 doses of anthrax vaccine adsorbed (AVA) at 0, 2, and 4 weeks. Children younger than 6 weeks should immediately begin antimicrobial prophylaxis but delay starting the vaccine series until 6 weeks of age. During an event, immunization with AVA should be given priority over routine childhood vaccinations -- they should not be administered at the same time. Routine vaccinations can resume 4 weeks after the last shot of AVA.