The success of treatment of anthrax depends to a great extent on the prompt recognition (diagnosis) of the disease and initiation of appropriate antibiotic therapy. Treatment of anthrax is generally successful if promptly diagnosed and adequately treated with suitable antibiotics. United States has licensed use of penicillin, ciprofloxacin, and doxycycline for treatment of anthrax. But other antibiotics such as clindamycin and rifampin are also useful and sometimes used by some doctors.

Before antibiotic sensitivity is known, anthrax should be treated with combination of more than one antibiotic. After the antibiotic sensitivity is known, the right antibiotic treatment regimen can be selected based on the antibiotic sensitivity report and if required can be given combination therapy. The duration of treatment is long (two months treatment is required) and in case of diagnosed cases of anthrax, should be given intravenous antibiotics till patient become stable and than switched over to oral antibiotics.

For treatment of anthrax, the patients need not be isolated as the anthrax patients are not contagious, even patients of pulmonary (inhalational) anthrax.

Treatment of active or diagnosed case of anthrax:

Active anthrax is treated with ciprofloxacin 400 mg (intravenously every 12 hourly) or doxycycline 100 mg (intravenously every 12 hourly), plus clindamycin, 900 mg (intravenously every 8 hourly) or rifampin, 300 mg (intravenously every 12 hourly). Switch over to oral preparation if the patient becomes stable. Treatment should be continued a total of 60 days (including intravenous and oral preparations).

Post exposure treatment of anthrax:

For post exposure treatment of anthrax ciprofloxacin 500 mg (orally twice a day) or doxycycline 100 mg (orally twice a day) for total 60 days. If organisms are penicillin sensitive, Amoxicillin 500 mg every 8 hourly for 60 days can be added with ciprofloxacin or doxycycline.

Presently, anti-toxins to neutralize monoclonal and polyclonal antibodies are under study and results are awaited.

If you are suffering from baldness or alopecia, you might have tried many treatment modalities in alternative medicines and could not get desired results, than it is high time you try modern medicine. Modern medicine can offer some remedy to baldness or alopecia. USFDA (United States Food and Drug Administration) has approved use of finesteride (Propecia) for treatment of alopecia or baldness in males.

Finesteride, marketed as Propecia, Proscar etc. is used for treatment of alopecia. Finesteride is a 5-alpha reductase enzyme inhibitor drug. 5-alpha reductase enzyme is responsible for conversion of testosterone to dihydrotestosterone (DHT) and by blocking 5-alpha reductase enzyme finesteride blocks the conversion of testosterone into dihydrotestosterone, which is more powerful androgen than testosterone. Due to lower level of powerful dihydrotestosterone, the androgenic activity in the scalp is reduced. By reducing androgenic activity in the scalp, finesteride helps in preventing hair fall and also helps in regrowing of hairs.

Studies have shown that men (approximately 2 out of 3 who takes finesteride 1 mg daily) with mild to moderate hair loss can get hairs regrow, as seen by increased hair count. Finesteride can also prevent fall of hairs. If a patient is taking finesteride for treatment of baldness (alopecia), if there is no increase in number of hairs (or regrowth of hairs) at least the hair fall can be prevented.

Side effects of finesteride:

Finesteride has several side effects, some of which are potentially serious. Side effects of finesteride include impotence, ejaculation disturbance, abnormal sexual performance, erectile dysfunction, gynecomastia (breast development in males), pain in testicles etc. The side effects generally disappear in those who discontinue the treatment with finesteride and also in most of the patients over time who continue to take finesteride despite side effects.

Finesteride is not recommended in females for treatment of baldness as it is not effective in treating baldness in females. Finesteride should be avoided during pregnancy and those women planning pregnancy.

Prevention of anthrax with vaccine is successful and vaccination is recommended if you are at risk of developing anthrax. Prevention of anthrax is required in risky population because if untreated anthrax is almost 100% fatal for inhalational anthrax and more than 20% fatal for cutaneous anthrax. Inhalational anthrax is the form most likely to be responsible for death in a setting of a bioterrorist attack. Patients with inhalational anthrax are not contagious and do not require special isolation.

The first successful anthrax vaccine was developed by Louis Pasteur in 1881 for animals. At present anthrax vaccine is produced from the cell-free culture supernatant of an attenuated, nonencapsulated strain of B. anthracis (known as anthrax vaccine adsorbed or AVA) and is licensed for human use.

As an alternative to AVA, clinical trials for safety in humans and efficacy in animals are currently under way to evaluate the role of recombinant protective antigen of B. anthracis toxins. In preventing the development of clinical disease and death in a post-exposure setting in non-human primates a 2 week trial course of AVA + ciprofloxacin was found to be superior to ciprofloxacin alone.

Chemoprophylaxis: The current recommendation for postexposure prophylaxis is 60 days of antibiotics (Ciprofloxacin or doxycycline); it would be better to include immunization with anthrax vaccine (AVA) if available. There is a potential for B. anthracis to engineer and express penicillin resistance, and due to that, the empirical regimen of antibiotics of choice in this setting is either ciprofloxacin or doxycycline.

The prevention of bioterrorist attacks is the responsibility of the Govt. and not discussed here. But support of the general public is must for the Govt. to prevent bioterrorist attacks successfully.  

Anthrax can be easily and successfully treated if diagnosed promptly and treatment instituted early and immediately after diagnosis. Anthrax is in the news because of the recent microbial bioterrorist attacks in the United States. Modern science has revealed methods and unleashed a devil of deliberately spreading anthrax and other diseases in ways not appreciated by our ancestors. The combination of basic scientific research, good medical practice, and constant vigil will be required by the public and the Govt. to defend against such attacks.

Clinical features of anthrax: the clinical feature depends on the route of entry of the organism mainly gastrointestinal, cutaneous, and inhalational. Symptoms include cutaneous lesions of papule to eschar (begins as a papule following the introduction of spores through an opening in the skin. This papule then evolves to a painless vesicle followed by the development of a coal-black, necrotic eschar). If the anthrax is due to inhalation the symptoms are fever, malaise, chest pain, abdominal discomfort etc. On chest x-ray there is pleural effusion and widened mediastinum.

Diagnosis of anthrax: Anthrax is diagnosed with laboratory tests like PCR (polymerase chain reaction) test, Wright stain of blood peripheral smear, Gram staining and blood culture of the organism causing anthrax (Bacillus anthracis a gram-positive, nonmotile, spore-forming rod that is found in soil and predominantly causes disease in herbivores like cattle, goats, and sheep).

Treatment of anthrax: penicillin (amoxicillin), ciprofloxacin, and doxycycline are the currently licensed antibiotics for treatment of anthrax. But clindamycin and rifampin can also used as part of treatment regimens and they are also being used to treat anthrax. Treatment is started with penicillin (amoxicillin), ciprofloxacin, and doxycycline till sensitivity results are known and once sensitivity results are known treatment is changed if required.

Post exposure treatment: It is done with Ciprofloxacin, 500 mg, orally twice a day for 60 days or doxycycline 100 mg orally twice a day for 60 days or amoxicillin (likely to be effective if strain penicillin sensitive) 500 mg, orally thrice a day for 60 days.

Treatment of active anthrax: Ciprofloxacin, 500 mg intravenously 12 hourly or doxycycline 100 mg intravenously 12 hourly plus Clindamycin, 900 mg IV 8 hourly and/or rifampin, 300 mg IV 12 hourly. Switch to oral route when stable for 60 days total treatment including intravenous route.