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  5. Doxycycline and Penicillin G Procaine for Inhalational Anthrax (Post-Exposure)
  1. Bioterrorism and Drug Preparedness

Doxycycline and Penicillin G Procaine for Inhalational Anthrax (Post-Exposure)

Doxycycline and penicillin G procaine are antibiotics used to treat bacterial infections in many different parts of the body. Antibiotics do not work for viral infections (for example, the common cold). Doxycycline and penicillin G procaine have been approved for all forms of anthrax. (inhalational, gastrointestinal, and cutaneous). On November 2, 2001, FDA published a Federal Register notice (66 FR 55679) clarifying that these drugs are approved for inhalational anthrax (post-exposure). Use of doxycycline in children under 8 years presents special concerns because of possible tooth discoloration. Long-term use of intravenous doxycycline or penicillin G procaine presents safety concerns, and patients should be switched, when appropriate, to oral antibiotics to complete a 60 day course of therapy for inhalational anthrax (post-exposure). For more information, see Doxycycline Use by Pregnant and Lactating Women.

List of Published Literature Relied on in Issuing the Federal Register Notice on Doxycycline and Penicillin G Procaine Administration for Inhalational Anthrax (Post-Exposure)

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51. Henderson, D. W., S. Peacock, and F. C. Belton, "Observations on the prophylaxis of experimental pullmonary anthrax in the monkey," Journal of Hygiene, 54:28-36, 1956.

52. Hoigne, R. et al., "Penicillins," in Meyler's Side Effects of Drugs, ed. M. N. G. Dukes, 12th ed., Amsterdam: Elsevier, 1992, pp. 600-622.

53. Hoigne, R. et al., "Penicillins, Cephalosporins and Other Beta-Lactam Antibiotics," in Meyler's Side Effects of Drugs, ed. M. N. G. Dukes, 12th ed. Amsterdam: Elsevier, 1992, pp. 593-599.

54. Huang, N. N., and R. H. High, "Comparison of serum levels following administration of oral and parenteral preparations of penicillin to infants and children of various age groups," Journal of Pediatrics, 42:657, 1953.

55. International Rheumatic Fever Study Group, "Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever," Lancet, 37:1308-1310, 1991.

56. Inglesby, T. V. et al., "Anthrax as a biological weapon: medical and public health management. Working Group on Civilian Biodefense," Journal of the American Medical Association, 281:1735-1745 1999.

57. John, A. B. et al., "Prevention of pneumococcal infection in children with homozygous sickle cell disease," British Medical Journal (Clinical Research Edition), 288:1567-1570, 1984.

58. Jones, M. N. et al., "Antibiotic prophylaxis for inhalation anthrax," Salisbury Medical Bulletin, Suppl 87:127-128, 1996.

59. Joorabchi, B., and E. Kohout. "Apparent penicillin-induced arrest of mature bone marrow elements," British Medical Journal, 2:26-27, 1973.

60. Joshi, N., "Doxycycline revisited," Archives of Internal Medicine, 157:1421-1428, 1997.

61. Kaplan, M. M., "Acute fatty liver of pregnancy," New England Journal of Medicine, 313:367-370, 1985.

62. Karchmer, A. W. et al., "Single-antibiotic therapy for streptococcal endocarditis," Journal of the American Medical Association, 241:1801-1806, 1979.

63. Kaye, D., "Endocarditis," in Cecil Textbook of Medicine, ed. P. B. Beeson, W. McDermott, and J. B. Wyngaarden, 15th ed., Philadelpha: W.B. Saunders Company, 1979, pp. 386-396.

64. Kees, F. et al., "The bioavailability of doxycycline." Arzneimittel-Forschung (Aulendorf), 40:1039-1043, 1990.

65. Kelly, D. J. et al., "Serum concentrations of penicillin, doxycycline, and ciprofloxacin during prolonged therapy in Rhesus monkeys," Journal of Infectious Diseases, 166:1184-1187, 1992.

66. Kendall, C. E., "Occupational anthrax in the United States," Journal of Occupational Medicine, 1:174-177, 1959.

67. Klein, J. O. et al., "Levels of penicillin in serum of newborn infants after single intramuscular doses of benzathine penicillin G," Journal of Pediatrics, 82:1065-1968, 1973.

68. Klempner, M. S. et al., "Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease," New England Journal of Medicine, 345:85-92, 2001.

69. Kunelis, C. T., J. L. Peters, and H. A. Edmonson, "Fatty liver of pregnancy and its relationship to tetracycline therapy," American Journal of Medicine, 38:359-377, 1965.

70. LaBoccetta, A. C., "Anthrax: 36 human cases of the external type treated successfully with penicillin," American Journal of the Medical Sciences, 216:407-410, 1948.

71. Levy, P. Y. et al., "Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis," Antimicrobial Agents and Chemotherapy, 35:533-537, 1991.

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