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October 16, 2002

Guidelines for Treatment of Anthrax

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(15):1848-1849. doi:10.1001/jama.288.15.1845

To the Editor: Dr Inglesby and colleagues1 emphasize the importance of prompt and appropriate antimicrobial therapy for inhalational anthrax.

I was concerned, however, that the authors did not recommend loading doses of antibiotics. Without a loading dose, serum levels do not reach a steady state until after several doses of the drug have been administered. For compartments such as infected lymph nodes and the mediastinum, effective concentrations would be even more difficult to achieve. This may be a particular problem for doxycycline, which has a half-life of 18 hours.2 A loading dose of twice the standard intermittent dose should carry no more likelihood of toxicity than a regular dose and may be appropriate for ciprofloxacin as well.

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