1057. FRENCH THERAPEUTIC RECOMMENDATIONS FOLLOWING NATURAL EXPOSURE TO BACILLUS ANTHRACIS
Session: Poster Abstract Session: Guidelines in Clinical Practice
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The current recommendations for exposure to Bacillus anthracis were made in a context of bioterrorism. Despite significant differences there are no specific recommendations for exposure in natural settings, even though anthrax epizootics regularly occur in many parts of the world. In France, 61 confirmed animal anthrax clusters have been reported since 2002, with an average of 14 cases of exposure per cluster [range 0-108], mainly farmers and relatives, veterinarians or laboratory technicians, or knackery workers. Four confirmed cutaneous  cases in humans were reported during the same period, all of them with a favorable outcome.

Methods: The authors' objectives were to assess the risk of infection and determine therapeutic recommendations for the management of patients potentially exposed to anthrax, in natural settings. A work group including ID specialists, veterinarians, microbiologists, and epidemiologists drafted new recommendations, by using published data when available (via a Pubmed search), from existing recommendations on the surveillance and prevention of animal and human anthrax, from personal experience, and after visiting a knackery.

Results: Limited indications of preemptive antibiotic treatment are proposed, depending on the type of contact (airborne, digestive, and/or cutaneous), the expected size and type of inoculum in the contaminated source, and the delay since latest exposure. Antibiotics have to be initiated as soon as possible following exposure when recommended, first with ciprofloxacin or doxycyclin, then switched to amoxicillin once penicillin susceptibility to is demonstrated. The recommended length of course is 10 days (cutaneous and digestive exposure) or 35 days (for rare respiratory exposure).

Conclusion: These French guidelines should help manage humans exposed to animal anthrax and avoid over prescription of antibiotics. Their relevance must be confirmed in follow-up surveys.


Subject Category: J. Clinical practice issues

Lionel Piroth, MD-PHD1, Joel Leroy, MD2, Olivier Rogeaux3, Jean Paul Stahl4, Michele Mock5, Bruno Garin-Bastuji6, Nora Madani6, Alexandra Mailles7 and Thierry May, MD-PHD8, (1)CHU Dijon, Dijon, France, (2)CHU Jean Minjoz, Besançon, France, (3)CH de Chambéry, Chambéry, France, (4)Infectious Diseases, University Hospital and Grenoble University, Grenoble, 38043, France, (5)Centre National de Référence du Charbon, Institut Pasteur, Paris, France, (6)Laboratoire National de Référence pour la Fièvre Charbonneuse, Maisons Alfort, France, (7)French Institute for Public Health (INVS), Saint Maurice, 94415, France, (8)CHU Nancy, Nancy, France

Disclosures:

L. Piroth, None

J. Leroy, None

O. Rogeaux, None

J. P. Stahl, None

M. Mock, None

B. Garin-Bastuji, None

N. Madani, None

A. Mailles, None

T. May, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.