Antitoxin Treatment of Inhalation Anthrax: A Systematic Review
Concern about use of anthrax as a bioweapon prompted development of novel anthrax antitoxins for treatment. Clinical guidelines for the treatment of anthrax recommend antitoxin therapy in combination with intravenous antimicrobials; however, a large-scale or mass anthrax incident may exceed antitoxi...
Gespeichert in:
| Veröffentlicht in: | Health security 2015-11, Vol.13 (6), p.365-377 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 377 |
|---|---|
| container_issue | 6 |
| container_start_page | 365 |
| container_title | Health security |
| container_volume | 13 |
| creator | Huang, Eileen Pillai, Satish K Bower, William A Hendricks, Katherine A Guarnizo, Julie T Hoyle, Jamechia D Gorman, Susan E Boyer, Anne E Quinn, Conrad P Meaney-Delman, Dana |
| description | Concern about use of anthrax as a bioweapon prompted development of novel anthrax antitoxins for treatment. Clinical guidelines for the treatment of anthrax recommend antitoxin therapy in combination with intravenous antimicrobials; however, a large-scale or mass anthrax incident may exceed antitoxin availability and create a need for judicious antitoxin use. We conducted a systematic review of antitoxin treatment of inhalation anthrax in humans and experimental animals to inform antitoxin recommendations during a large-scale or mass anthrax incident. A comprehensive search of 11 databases and the FDA website was conducted to identify relevant animal studies and human reports: 28 animal studies and 3 human cases were identified. Antitoxin monotherapy at or shortly after symptom onset demonstrates increased survival compared to no treatment in animals. With early treatment, survival did not differ between antimicrobial monotherapy and antimicrobial-antitoxin therapy in nonhuman primates and rabbits. With delayed treatment, antitoxin-antimicrobial treatment increased rabbit survival. Among human cases, addition of antitoxin to combination antimicrobial treatment was associated with survival in 2 of the 3 cases treated. Despite the paucity of human data, limited animal data suggest that adjunctive antitoxin therapy may improve survival. Delayed treatment studies suggest improved survival with combined antitoxin-antimicrobial therapy, although a survival difference compared with antimicrobial therapy alone was not demonstrated statistically. In a mass anthrax incident with limited antitoxin supplies, antitoxin treatment of individuals who have not demonstrated a clinical benefit from antimicrobials, or those who present with more severe illness, may be warranted. Additional pathophysiology studies are needed, and a point-of-care assay correlating toxin levels with clinical status may provide important information to guide antitoxin use during a large-scale anthrax incident. |
| doi_str_mv | 10.1089/hs.2015.0032 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4710135</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1751488040</sourcerecordid><originalsourceid>FETCH-LOGICAL-c384t-37f1ef04e99d13fa1b8aa68f69086228a9f9afa923db6c7558b767fcb4507a33</originalsourceid><addsrcrecordid>eNpVkEtLAzEUhYMottTuXMssXTj1JpmZJC4KpfgoFATtPmSmiROZR01Sbf-9U_pAV_dyz8e5h4PQNYYRBi7uSz8igNMRACVnqE8oyeK0U86PO4ikh4befwIAZgmBlF2iHskyAZTxPhpPmmBDu7FNtHBahVo3IWpNNGtKValg2ybqiNKpzUM0id63Pui6OxfRm_62-ucKXRhVeT08zAFaPD0upi_x_PV5Np3M44LyJMSUGawNJFqIJaZG4ZwrlXHTpeAZIVwJI5RRgtBlnhUsTXnOMmaKPEmBKUoHaLy3Xa3zWi-LLqRTlVw5Wyu3la2y8r_S2FJ-tN8yYRgwTTuD24OBa7_W2gdZW1_oqlKNbtdeYpbihHNIoEPv9mjhWu-dNqc3GOSudFl6uStd7krv8Ju_0U7wsWL6CwI8fT0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1751488040</pqid></control><display><type>article</type><title>Antitoxin Treatment of Inhalation Anthrax: A Systematic Review</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Huang, Eileen ; Pillai, Satish K ; Bower, William A ; Hendricks, Katherine A ; Guarnizo, Julie T ; Hoyle, Jamechia D ; Gorman, Susan E ; Boyer, Anne E ; Quinn, Conrad P ; Meaney-Delman, Dana</creator><creatorcontrib>Huang, Eileen ; Pillai, Satish K ; Bower, William A ; Hendricks, Katherine A ; Guarnizo, Julie T ; Hoyle, Jamechia D ; Gorman, Susan E ; Boyer, Anne E ; Quinn, Conrad P ; Meaney-Delman, Dana</creatorcontrib><description>Concern about use of anthrax as a bioweapon prompted development of novel anthrax antitoxins for treatment. Clinical guidelines for the treatment of anthrax recommend antitoxin therapy in combination with intravenous antimicrobials; however, a large-scale or mass anthrax incident may exceed antitoxin availability and create a need for judicious antitoxin use. We conducted a systematic review of antitoxin treatment of inhalation anthrax in humans and experimental animals to inform antitoxin recommendations during a large-scale or mass anthrax incident. A comprehensive search of 11 databases and the FDA website was conducted to identify relevant animal studies and human reports: 28 animal studies and 3 human cases were identified. Antitoxin monotherapy at or shortly after symptom onset demonstrates increased survival compared to no treatment in animals. With early treatment, survival did not differ between antimicrobial monotherapy and antimicrobial-antitoxin therapy in nonhuman primates and rabbits. With delayed treatment, antitoxin-antimicrobial treatment increased rabbit survival. Among human cases, addition of antitoxin to combination antimicrobial treatment was associated with survival in 2 of the 3 cases treated. Despite the paucity of human data, limited animal data suggest that adjunctive antitoxin therapy may improve survival. Delayed treatment studies suggest improved survival with combined antitoxin-antimicrobial therapy, although a survival difference compared with antimicrobial therapy alone was not demonstrated statistically. In a mass anthrax incident with limited antitoxin supplies, antitoxin treatment of individuals who have not demonstrated a clinical benefit from antimicrobials, or those who present with more severe illness, may be warranted. Additional pathophysiology studies are needed, and a point-of-care assay correlating toxin levels with clinical status may provide important information to guide antitoxin use during a large-scale anthrax incident.</description><identifier>ISSN: 2326-5094</identifier><identifier>EISSN: 2326-5108</identifier><identifier>DOI: 10.1089/hs.2015.0032</identifier><identifier>PMID: 26690378</identifier><language>eng</language><publisher>United States</publisher><subject>Administration, Intravenous ; Animals ; Anthrax - drug therapy ; Anti-Bacterial Agents - therapeutic use ; Antibodies, Monoclonal - therapeutic use ; Antigens, Bacterial - immunology ; Antitoxins - therapeutic use ; Bioterrorism ; Drug Therapy, Combination ; Humans ; Immunoglobulin G - therapeutic use ; Immunoglobulins, Intravenous - therapeutic use ; Mass Casualty Incidents ; Rabbits ; Respiratory Tract Infections - drug therapy</subject><ispartof>Health security, 2015-11, Vol.13 (6), p.365-377</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-37f1ef04e99d13fa1b8aa68f69086228a9f9afa923db6c7558b767fcb4507a33</citedby><cites>FETCH-LOGICAL-c384t-37f1ef04e99d13fa1b8aa68f69086228a9f9afa923db6c7558b767fcb4507a33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26690378$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Eileen</creatorcontrib><creatorcontrib>Pillai, Satish K</creatorcontrib><creatorcontrib>Bower, William A</creatorcontrib><creatorcontrib>Hendricks, Katherine A</creatorcontrib><creatorcontrib>Guarnizo, Julie T</creatorcontrib><creatorcontrib>Hoyle, Jamechia D</creatorcontrib><creatorcontrib>Gorman, Susan E</creatorcontrib><creatorcontrib>Boyer, Anne E</creatorcontrib><creatorcontrib>Quinn, Conrad P</creatorcontrib><creatorcontrib>Meaney-Delman, Dana</creatorcontrib><title>Antitoxin Treatment of Inhalation Anthrax: A Systematic Review</title><title>Health security</title><addtitle>Health Secur</addtitle><description>Concern about use of anthrax as a bioweapon prompted development of novel anthrax antitoxins for treatment. Clinical guidelines for the treatment of anthrax recommend antitoxin therapy in combination with intravenous antimicrobials; however, a large-scale or mass anthrax incident may exceed antitoxin availability and create a need for judicious antitoxin use. We conducted a systematic review of antitoxin treatment of inhalation anthrax in humans and experimental animals to inform antitoxin recommendations during a large-scale or mass anthrax incident. A comprehensive search of 11 databases and the FDA website was conducted to identify relevant animal studies and human reports: 28 animal studies and 3 human cases were identified. Antitoxin monotherapy at or shortly after symptom onset demonstrates increased survival compared to no treatment in animals. With early treatment, survival did not differ between antimicrobial monotherapy and antimicrobial-antitoxin therapy in nonhuman primates and rabbits. With delayed treatment, antitoxin-antimicrobial treatment increased rabbit survival. Among human cases, addition of antitoxin to combination antimicrobial treatment was associated with survival in 2 of the 3 cases treated. Despite the paucity of human data, limited animal data suggest that adjunctive antitoxin therapy may improve survival. Delayed treatment studies suggest improved survival with combined antitoxin-antimicrobial therapy, although a survival difference compared with antimicrobial therapy alone was not demonstrated statistically. In a mass anthrax incident with limited antitoxin supplies, antitoxin treatment of individuals who have not demonstrated a clinical benefit from antimicrobials, or those who present with more severe illness, may be warranted. Additional pathophysiology studies are needed, and a point-of-care assay correlating toxin levels with clinical status may provide important information to guide antitoxin use during a large-scale anthrax incident.</description><subject>Administration, Intravenous</subject><subject>Animals</subject><subject>Anthrax - drug therapy</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Antigens, Bacterial - immunology</subject><subject>Antitoxins - therapeutic use</subject><subject>Bioterrorism</subject><subject>Drug Therapy, Combination</subject><subject>Humans</subject><subject>Immunoglobulin G - therapeutic use</subject><subject>Immunoglobulins, Intravenous - therapeutic use</subject><subject>Mass Casualty Incidents</subject><subject>Rabbits</subject><subject>Respiratory Tract Infections - drug therapy</subject><issn>2326-5094</issn><issn>2326-5108</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkEtLAzEUhYMottTuXMssXTj1JpmZJC4KpfgoFATtPmSmiROZR01Sbf-9U_pAV_dyz8e5h4PQNYYRBi7uSz8igNMRACVnqE8oyeK0U86PO4ikh4befwIAZgmBlF2iHskyAZTxPhpPmmBDu7FNtHBahVo3IWpNNGtKValg2ybqiNKpzUM0id63Pui6OxfRm_62-ucKXRhVeT08zAFaPD0upi_x_PV5Np3M44LyJMSUGawNJFqIJaZG4ZwrlXHTpeAZIVwJI5RRgtBlnhUsTXnOMmaKPEmBKUoHaLy3Xa3zWi-LLqRTlVw5Wyu3la2y8r_S2FJ-tN8yYRgwTTuD24OBa7_W2gdZW1_oqlKNbtdeYpbihHNIoEPv9mjhWu-dNqc3GOSudFl6uStd7krv8Ju_0U7wsWL6CwI8fT0</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Huang, Eileen</creator><creator>Pillai, Satish K</creator><creator>Bower, William A</creator><creator>Hendricks, Katherine A</creator><creator>Guarnizo, Julie T</creator><creator>Hoyle, Jamechia D</creator><creator>Gorman, Susan E</creator><creator>Boyer, Anne E</creator><creator>Quinn, Conrad P</creator><creator>Meaney-Delman, Dana</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20151101</creationdate><title>Antitoxin Treatment of Inhalation Anthrax: A Systematic Review</title><author>Huang, Eileen ; Pillai, Satish K ; Bower, William A ; Hendricks, Katherine A ; Guarnizo, Julie T ; Hoyle, Jamechia D ; Gorman, Susan E ; Boyer, Anne E ; Quinn, Conrad P ; Meaney-Delman, Dana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-37f1ef04e99d13fa1b8aa68f69086228a9f9afa923db6c7558b767fcb4507a33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Administration, Intravenous</topic><topic>Animals</topic><topic>Anthrax - drug therapy</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibodies, Monoclonal - therapeutic use</topic><topic>Antigens, Bacterial - immunology</topic><topic>Antitoxins - therapeutic use</topic><topic>Bioterrorism</topic><topic>Drug Therapy, Combination</topic><topic>Humans</topic><topic>Immunoglobulin G - therapeutic use</topic><topic>Immunoglobulins, Intravenous - therapeutic use</topic><topic>Mass Casualty Incidents</topic><topic>Rabbits</topic><topic>Respiratory Tract Infections - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Eileen</creatorcontrib><creatorcontrib>Pillai, Satish K</creatorcontrib><creatorcontrib>Bower, William A</creatorcontrib><creatorcontrib>Hendricks, Katherine A</creatorcontrib><creatorcontrib>Guarnizo, Julie T</creatorcontrib><creatorcontrib>Hoyle, Jamechia D</creatorcontrib><creatorcontrib>Gorman, Susan E</creatorcontrib><creatorcontrib>Boyer, Anne E</creatorcontrib><creatorcontrib>Quinn, Conrad P</creatorcontrib><creatorcontrib>Meaney-Delman, Dana</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Health security</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Eileen</au><au>Pillai, Satish K</au><au>Bower, William A</au><au>Hendricks, Katherine A</au><au>Guarnizo, Julie T</au><au>Hoyle, Jamechia D</au><au>Gorman, Susan E</au><au>Boyer, Anne E</au><au>Quinn, Conrad P</au><au>Meaney-Delman, Dana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antitoxin Treatment of Inhalation Anthrax: A Systematic Review</atitle><jtitle>Health security</jtitle><addtitle>Health Secur</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>13</volume><issue>6</issue><spage>365</spage><epage>377</epage><pages>365-377</pages><issn>2326-5094</issn><eissn>2326-5108</eissn><abstract>Concern about use of anthrax as a bioweapon prompted development of novel anthrax antitoxins for treatment. Clinical guidelines for the treatment of anthrax recommend antitoxin therapy in combination with intravenous antimicrobials; however, a large-scale or mass anthrax incident may exceed antitoxin availability and create a need for judicious antitoxin use. We conducted a systematic review of antitoxin treatment of inhalation anthrax in humans and experimental animals to inform antitoxin recommendations during a large-scale or mass anthrax incident. A comprehensive search of 11 databases and the FDA website was conducted to identify relevant animal studies and human reports: 28 animal studies and 3 human cases were identified. Antitoxin monotherapy at or shortly after symptom onset demonstrates increased survival compared to no treatment in animals. With early treatment, survival did not differ between antimicrobial monotherapy and antimicrobial-antitoxin therapy in nonhuman primates and rabbits. With delayed treatment, antitoxin-antimicrobial treatment increased rabbit survival. Among human cases, addition of antitoxin to combination antimicrobial treatment was associated with survival in 2 of the 3 cases treated. Despite the paucity of human data, limited animal data suggest that adjunctive antitoxin therapy may improve survival. Delayed treatment studies suggest improved survival with combined antitoxin-antimicrobial therapy, although a survival difference compared with antimicrobial therapy alone was not demonstrated statistically. In a mass anthrax incident with limited antitoxin supplies, antitoxin treatment of individuals who have not demonstrated a clinical benefit from antimicrobials, or those who present with more severe illness, may be warranted. Additional pathophysiology studies are needed, and a point-of-care assay correlating toxin levels with clinical status may provide important information to guide antitoxin use during a large-scale anthrax incident.</abstract><cop>United States</cop><pmid>26690378</pmid><doi>10.1089/hs.2015.0032</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2326-5094 |
| ispartof | Health security, 2015-11, Vol.13 (6), p.365-377 |
| issn | 2326-5094 2326-5108 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4710135 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Administration, Intravenous Animals Anthrax - drug therapy Anti-Bacterial Agents - therapeutic use Antibodies, Monoclonal - therapeutic use Antigens, Bacterial - immunology Antitoxins - therapeutic use Bioterrorism Drug Therapy, Combination Humans Immunoglobulin G - therapeutic use Immunoglobulins, Intravenous - therapeutic use Mass Casualty Incidents Rabbits Respiratory Tract Infections - drug therapy |
| title | Antitoxin Treatment of Inhalation Anthrax: A Systematic Review |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-01T05%3A51%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Antitoxin%20Treatment%20of%20Inhalation%20Anthrax:%20A%20Systematic%20Review&rft.jtitle=Health%20security&rft.au=Huang,%20Eileen&rft.date=2015-11-01&rft.volume=13&rft.issue=6&rft.spage=365&rft.epage=377&rft.pages=365-377&rft.issn=2326-5094&rft.eissn=2326-5108&rft_id=info:doi/10.1089/hs.2015.0032&rft_dat=%3Cproquest_pubme%3E1751488040%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1751488040&rft_id=info:pmid/26690378&rfr_iscdi=true |