infectious diseases
Plague and Other Yersinia Infections
Treatment of Plague
Streptomycinorgentamicin Alternatively,doxycycline,ciprofloxacin,levofloxacin,moxifloxacin, orchloramphenicol Before antibiotics (1900–1941), case fatality among those infected with plague in the US was 66%. By 1990–2010, antibiotic treatment of plague reduced case fatality to 11% ( Treatment references ). In septicemic or pneumonic plague, treatment must begin within 24 hours with one of the following if renal function is normal ( Treatment references ; see also the Centers for Disease Control and Prevention's [CDC] Streptomycin1 g IM 2 times a day Gentamicin5 mg/kg IM or IV once a day (or 2 mg/kg loading dose followed by 1.7 mg/kg every 8 hours) The drug is given for 10 days or until 3 days after temperature has returned to normal.Doxycycline200-mg loading dose IV or orally, then 100 mg IV or orally every 12 hours is an alternative.Ciprofloxacin,levofloxacin,moxifloxacin, andchloramphenicolare also effective. Chloramphenicolis preferred for patients with infection of tissue spaces into which other drugs pass poorly (eg, plague meningitis, endophthalmitis).Chloramphenicolshould be given in a loading dose of 25 mg/kg IV, followed by 12.5 mg/kg IV or orally every 6 hours. Routine isolation precautions are adequate for patients with bubonic plague. Those with primary or secondary pneumonic plague require strict respiratory isolation and droplet precautions (see the Centers for Disease Control and Prevention's2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings). 1.CDC: What is the death rate of plague? Accessed 03/14/2022. 2.Nelson CA, Meaney-Delman D, Fleck-Derderian S, et al: Antimicrobial treatment and prophylaxis of plague: Recommendations for naturally acquired infections and bioterrorism response.MMWR Recomm Rep70(3);1–27, 2021. doi: 10.15585/mmwr.rr7003a1 