Biomedical Engineering Reference
In-Depth Information
vaccination, VIG should not be offered. If a preg-
nant woman experiences a vaccine complication
for which VIG is recommended, the intravenous
preparation should be administered without hesita-
tion. The Centers for Disease Control and Depart-
ment of Defense maintain a registry for women in
whom pregnancy is identified after vaccination.
antibiotic therapy and pregnancy is no excep-
tion. The Working Group on Civilian Biode-
fense has developed guidelines for management
of plague including antibiotic administration to all
patients, either parenteral or oral depending upon
the magnitude of the infection, supportive care and
treatment of septic complications. The preferred
antibiotic choices in adults include streptomycin
or gentamycin although streptomycin is contraindi-
cated during pregnancy. Therefore gentamycin
5mg/kg intramuscular or intravenous once daily
(or 2mg/kg load followed by 1.7mg/kg IM or IV
3 times daily) for 10 days is first-line therapy for
pregnant women. Treatment alternatives include
doxycycline (100mg IV twice daily or 200mg IV
once daily), ciprofloxacin (400mg IV twice daily)
or chloramphenicol (25mg/kg IV 4 times daily) 10
days. Prophylaxis for the pregnant woman is doxy-
cycline 100mg orally twice daily for 7 days. Since
doxycycline can be hepatotoxic in pregnancy, liver
function tests should be considered during therapy.
Currently a plague vaccine is not available and
while there has been interest in its development,
no information regarding its use in pregnancy is
available.
12.3.1.2 Bacillus anthracis
(Anthrax)
Information regarding anthrax during pregnancy
is not available. The CDC, Infectious Disease
Society of American and American College of
Obstetricians and Gynecologists have formulated
the following recommendations.
Pre-exposure vaccination is recommended for a
small subset of individuals. The vaccine alone is
not recommended for post-exposure use but can be
used in combination with antibiotics. Although the
vaccine contains no live or killed bacteria, vacci-
nation of pregnant women is not recommended
until further data are available. Antimicrobials
are not indicated for asymptomatic individuals
with low risk exposure. Prophylaxis is recom-
mended for gravidas with anthrax exposure as
determined by the local Department of Health.
Prophylaxis consists of ciprofloxacin 500mg orally
every 12 hours for 60 days. If the bacteria
are proven sensitive to penicillin, ciprofloxacin
may be changed to amoxicillin 500mg orally
three times daily to complete a 60 day course.
Cutaneous anthrax is treated with ciprofloxacin
500mg p.o. twice daily for 60 days. In the
event of inhalational, gastrointestinal or oropha-
ryngeal anthrax, initial therapy is via the intra-
venous route with ciprofloxacin 400mg q12 hours
or doxycycline 100mg q12 hours plus one or two
additional antimicrobials (rifampin, vancomycin,
penicillin, ampicillin, imipenem, clindamycin, and
clarithromycin). The above regimens are also
appropriate for women who are breastfeeding.
12.3.1.4 Clostridium botulinum
(Botulism)
The botulinum toxin is a large molecule that theo-
retically should not cross the placenta, but data
are lacking. Anti-toxin and supportive care of the
mother are the mainstays of treatment just as with
the non-pregnant patient. The FDA labels the anti-
toxin as Pregnancy Category C.
12.3.1.5 Francisella tularensis
(Tularemia)
Tularemia in pregnancy was last described in the
literature 70 years ago. Post-exposure prophylaxis
for pregnant women includes doxycycline 100mg
orally twice daily or ciprofloxacin 500mg orally
twice daily for 14 days. Treatment of tularemia in
pregnancy consists of gentamycin 5mg/kg IM or
IV once daily for 10 days.
12.3.1.3 Yersinia pestis
(Plague)
Similar to other potential bioterror agents,
information regarding plague during pregnancy
is limited. The most
12.3.1.6 Viral hemorrhagic fever
Viral Hemorrhagic Fever (VHF) may be caused
by any one of the four agents: Ebola, Marburg,
important
factor
in the
management of plague is prompt
institution of
