Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism

Table 4 Management of biologic agents

Agent	Pediatric dosing	Notes
Inhalational anthrax	Ciprofloxacin 10-15 mg/kg iv q 12 h (max 400 mg) or doxycycline 2.2 mg/kg iv q 12 h (max 100 mg) plus clindamycin 10-15 mg/kg q 8 plus penicillin G 400-600 k U/kg per day iv divided q 4 h prophylaxis for exposed contacts ciprofloxacin 15 mg/kg po q 12 h or doxycycline 2.2 mg/kg po q 12 h	Switch to oral therapy when patient shows signs of improvement At least one agent should have good CNS penetration Prophylaxis is for a 60 d course Amoxicillin or levofloxacin are second line
Plague	Gentamycin 2.5 mg/kg iv q 8 h or streptomycin 15 mg/kg im q 12 h (max 2 mg/d) or doxycycline 2.2 mg/kg iv q 12 h (max 200 mg/d) or ciprofloxacin 15 mg/kg iv q 12 h prophylaxis for exposed contacts trimethoprim/sulfa 4 mg/kg po q 12 h	Chloramphenical or Levofloxacin can also be used Prophylaxis should be continued for 5-7 d
Tularemia	Same as therapy for plague
Botulism	Infants < 1 yr human-derived botulinum immunoglobulin children > 1 yr equine serum botulism antitoxin	In United States call 1-800-222-1222 or 770-488-7100 Outside United States contact local health agencies

CNS: Central nervous system.