Infectious Disease Guidelines: Bacterial Infections

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Bacillus anthracis (anthrax)

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Interim Recommendations for Protecting Workers from Exposure to Bacillus anthracis in Work Sites in which Mail is Handled or Processed

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Updated Recommendations for Antimicrobial Prophylaxis Among Asymptomatic Pregnant Women After Exposure to Bacillus anthracis

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The antimicrobial of choice for initial prophylactic therapy among asymptomatic pregnant women exposed to Bacillus anthracis is ciprofloxacin, 500 mg twice a day for 60 days. In instances in which the specific B. anthracis strain has been shown to be penicillin-sensitive, prophylactic therapy with amoxicillin, 500 mg three times a day for 60 days, may be considered. Isolates of B. anthracis implicated in the current bioterrorist attacks are susceptible to penicillin in laboratory tests, but may contain penicillinase activity (2). Pencillins are not recommended for treatment of anthrax, where such penicillinase activity may decrease their effectiveness. However, penicillins are likely to be effective for preventing anthrax, a setting where relatively few organisms are present. Doxycycline should be used with caution in asymptomatic pregnant women and only when contraindications are indicated to the use of other appropriate antimicrobial drugs.

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Responding to Detection of Aerosolized Bacillus anthracis by Autonomous Detection Systems in the Workplace

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1) response and consequence management planning, including the minimum components of a facility response plan; 2) immediate response and evacuation; 3) decontamination of potentially exposed workers to remove spores from clothing and skin and prevent introduction of B. anthracis into the worker's home and conveyances; 4) laboratory confirmation of an ADS signal; 5) steps for evaluating potentially contaminated environments; and 6) postexposure prophylaxis and follow-up.

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Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines

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Prelicensure studies demonstrated safety and efficacy against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adolescents. To reduce pertussis morbidity in adolescents and maintain the standard of care for tetanus and diphtheria protection, the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) adolescents aged 11--18 years should receive a single dose of Tdap instead of tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP)/ diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) vaccination series (five doses of pediatric DTP/DTaP before the seventh birthday; if the fourth dose was administered on or after the fourth birthday, the fifth dose is not needed) and have not received Td or Tdap. The preferred age for Tdap vaccination is 11--12 years; 2) adolescents aged 11--18 years who received Td, but not Tdap, are encouraged to receive a single dose of Tdap to provide protection against pertussis if they have completed the recommended childhood DTP/DTaP vaccination series. An interval of at least 5 years between Td and Tdap is encouraged to reduce the risk for local and systemic reactions after Tdap vaccination. However, an interval less than 5 years between Td and Tdap can be used; and 3) vaccine providers should administer Tdap and tetravalent meningococcal conjugate vaccine (Menactra®, sanofi pasteur, Swiftwater, Pennsylvania) to adolescents aged 11--18 years during the same visit if both vaccines are indicated and available.

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Prevention and Control of Meningococcal Disease

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CDC's Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of young adolescents (defined in this report as persons aged 11--12 years) with MCV4 at the preadolescent health-care visit (at age 11--12 years).

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Pneumococcal pneumonia

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S. pneumoniae, the most common identifiable etiologic agent of pneumonia in virtually all studies, accounts for about two-thirds of bacteremic pneumonia cases, and pneumococci are the most frequent cause of lethal community-acquired pneumonia. Management has been complicated in recent years by the evolution of multidrug resistance. -lactams (amoxicillin, cefotaxime, and ceftriaxone) are generally regarded as the drugs of choice, although pneumonia caused by resistant strains (MIC, 2 g/mL) may not respond as readily as pneumonia caused by more susceptible strains.

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Prevention of Perinatal Group B Streptococcal Disease

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Group B streptococcus (GBS) remains a leading cause of serious neonatal infection despite great progress in perinatal GBS disease prevention in the 1990s. In 1996, CDC, in collaboration with other agencies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45[RR-7]:1--24). Data collected after the issuance of the 1996 guidelines prompted reevaluation of prevention strategies at a meeting of clinical and public health representatives in November 2001. This report replaces CDC's 1996 guidelines. The recommendations are based on available evidence and expert opinion where sufficient evidence was lacking. Although many of the recommendations in the 2002 guidelines are the same as those in 1996, they include some key changes:

Recommendation of universal prenatal screening for vaginal and rectal GBS colonization of all pregnant women at 35--37 weeks' gestation, based on recent documentation in a large retrospective cohort study of a strong protective effect of this culture-based screening strategy relative to the risk-based strategy
Updated prophylaxis regimens for women with penicillin allergy
Detailed instruction on prenatal specimen collection and expanded methods of GBS culture processing, including instructions on antimicrobial susceptibility testing
Recommendation against routine intrapartum antibiotic prophylaxis for GBS-colonized women undergoing planned cesarean deliveries who have not begun labor or had rupture of membranes
A suggested algorithm for management of patients with threatened preterm delivery
An updated algorithm for management of newborns exposed to intrapartum antibiotic prophylaxis
Although universal screening for GBS colonization is anticipated to result in further reductions in the burden of GBS disease, the need to monitor for potential adverse consequences of intrapartum antibiotic use, such as emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens, continues, and intrapartum antibiotics are still viewed as an interim strategy until GBS vaccines achieve licensure.