Generated Narrative: PlanDefinition first-vaccine-dose-pregnant-pd url: PlanDefinition First vaccine pregnant identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet version: 1.1.0 name: Anthrax_Post_Exposure_Prophylaxis_Adults title: First vaccine pregnant type: ECA Rule status: Draft experimental: true date: 2024-11-18 16:43:41+0000 publisher: HL7 International - Clinical Decision Support WG contact: HL7 International - Clinical Decision Support WG: http://www.hl7.org/Special/committees/dss/index.cfm description: Provides information for treating patients greater than or equal to 18 years old exposed to anthrax within the past 60 days, who do not have anthrax. It is divided into two parts: \n- Part #1: For patients that may be symptomatic to flag the need to conduct a full diagnostic evaluation to rule out anthrax before proceeding with post-exposure prophylaxis (PEP) \n- Part #2: For patients who are asymptomatic (not displaying signs and symptoms of anthrax), it provides recommended PEP regimen UseContexts - Code Value[x] * UsageContextType age: Age Range 18-? * UsageContextType venue: Clinical Venue Outpatient environment * UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax * UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) * UsageContextType focus: Clinical Focus Asymptomatic (finding) jurisdiction: World purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series. usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting. approvalDate: 2019-06-07 lastReviewDate: 2019-06-07 effectivePeriod: 2019-06-07 --> (ongoing) topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis author: Alliance to Modernize Healthcare FFRDC: endorser: Centers for Disease Control and Prevention: library: Anthrax Post Exposure Prophylaxis (PEP) for Adults FHIRv400 Logic action title: Anthrax Post Exposure Prophylaxis 7 trigger type: Data Added data type: Condition codeFilter path: code code: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT 170475009: Exposure to Bacillus anthracis (event) trigger type: Data Added data type: Observation codeFilter path: code code: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT 170475009: Exposure to Bacillus anthracis (event), SNOMED CT 84387000: Asymptomatic (finding) condition kind: Applicability Expressions - Language Expression * CQL GenerateOrderSet groupingBehavior: Logical Group selectionBehavior: Any action title: Antimicrobial medications for anthrax post-exposure prophylaxis groupingBehavior: Visual Group selectionBehavior: At Most One action title: First line antimicrobial medications for anthrax post-exposure prophylaxis groupingBehavior: Visual Group selectionBehavior: At Most One Actions - Type Definition[x] * Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request * Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request action title: Second line antimicrobial medications for anthrax post-exposure prophylaxis groupingBehavior: Visual Group selectionBehavior: At Most One Actions - Type Definition[x] * Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request * Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request * Create ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request action title: Anthrax Vaccination - 1st dose type: Create definition: ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request Generated Narrative: ActivityDefinition #Inline-Ciprofloxacin-Request-3 url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Ciprofloxacin-Request-3 identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest name: Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request status: Draft experimental: true description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014). UseContexts - Code Value[x] * UsageContextType age: Age Range 18-? * UsageContextType venue: Clinical Venue Outpatient environment * UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax * UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) * UsageContextType focus: Clinical Focus Asymptomatic (finding) purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series. usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting. approvalDate: 2019-06-07 lastReviewDate: 2019-06-07 effectivePeriod: 2019-06-07 --> (ongoing) topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis author: Alliance to Modernize Healthcare FFRDC: endorser: Centers for Disease Control and Prevention: kind: MedicationRequest product: FIRST CHOICE: Ciprofloxacin 500 MG Oral Tablet quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet') Dosages - Text AdditionalInstruction PatientInstruction Timing Route Method * One every 12 hours for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester., CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine., CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, theophylline, drugs that prolong QT interval, duloxetine (Cymbalta), zolpidem (Ambien), clozapine or any other drug that may interact and cause serious side effects, consider another antibiotic regimen., Provide patient education on medications. Take with full glass of water Once per 12 hours Oral Route Swallow - dosing instruction imperative (qualifier value) Generated Narrative: ActivityDefinition #Inline-Doxycycline-Request-3 url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Doxycycline-Request-3 identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest name: Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request status: Draft experimental: true description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014). UseContexts - Code Value[x] * UsageContextType age: Age Range 18-? * UsageContextType venue: Clinical Venue Outpatient environment * UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax * UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) * UsageContextType focus: Clinical Focus Asymptomatic (finding) purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series. usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting. approvalDate: 2019-06-07 lastReviewDate: 2019-06-07 effectivePeriod: 2019-06-07 --> (ongoing) topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis author: Alliance to Modernize Healthcare FFRDC: endorser: Centers for Disease Control and Prevention: kind: MedicationRequest product: SECOND CHOICE: doxycycline hyclate 100 MG Oral Tablet quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet') Dosages - Text AdditionalInstruction PatientInstruction Timing Route Method * One every 12 hours for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester., CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, or any other drug that may interact and cause serious side effects, consider another antibiotic regimen., Provide patient education on medications. Take with full glass of water Once per 12 hours Oral Route Swallow - dosing instruction imperative (qualifier value) Generated Narrative: ActivityDefinition #Inline-Levofloxacin-Request-3 url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Levofloxacin-Request-3 identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest name: Anthrax_Post_Exposure_Prophylaxis_Adults_Levofloxacin_Request title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request status: Draft experimental: true description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014). UseContexts - Code Value[x] * UsageContextType age: Age Range 18-? * UsageContextType venue: Clinical Venue Outpatient environment * UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax * UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) * UsageContextType focus: Clinical Focus Asymptomatic (finding) purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series. usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting. approvalDate: 2019-06-07 lastReviewDate: 2019-06-07 effectivePeriod: 2019-06-07 --> (ongoing) topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis author: Alliance to Modernize Healthcare FFRDC: endorser: Centers for Disease Control and Prevention: kind: MedicationRequest product: Levofloxacin 750 MG Oral Tablet quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet') Dosages - Text AdditionalInstruction Timing Route Method * One every day for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. Once per 1 days Oral Route Swallow - dosing instruction imperative (qualifier value) Generated Narrative: ActivityDefinition #Inline-Moxifloxacin-Request-3 url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Moxifloxacin-Request-3 identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest name: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request status: Draft experimental: true description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014). UseContexts - Code Value[x] * UsageContextType age: Age Range 18-? * UsageContextType venue: Clinical Venue Outpatient environment * UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax * UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) * UsageContextType focus: Clinical Focus Asymptomatic (finding) purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series. usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting. approvalDate: 2019-06-07 lastReviewDate: 2019-06-07 effectivePeriod: 2019-06-07 --> (ongoing) topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis author: Alliance to Modernize Healthcare FFRDC: endorser: Centers for Disease Control and Prevention: kind: MedicationRequest product: moxifloxacin HCl 400 MG Oral Tablet quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet') Dosages - Text AdditionalInstruction Timing Route Method * One every day for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. Once per 1 days Oral Route Swallow - dosing instruction imperative (qualifier value) Generated Narrative: ActivityDefinition #Inline-Clindamycin-Request-3 url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Clindamycin-Request-3 identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest name: Anthrax_Post_Exposure_Prophylaxis_Adults_Clindamycin_Request title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request status: Draft experimental: true description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014). UseContexts - Code Value[x] * UsageContextType age: Age Range 18-? * UsageContextType venue: Clinical Venue Outpatient environment * UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax * UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) * UsageContextType focus: Clinical Focus Asymptomatic (finding) purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series. usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting. approvalDate: 2019-06-07 lastReviewDate: 2019-06-07 effectivePeriod: 2019-06-07 --> (ongoing) topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis author: Alliance to Modernize Healthcare FFRDC: endorser: Centers for Disease Control and Prevention: kind: MedicationRequest product: clindamycin HCl 300 MG Oral Capsule quantity: 360(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet') Dosages - Text AdditionalInstruction Timing Route Method * Two tablets every 8 hours for 60 days Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. 2 per 8 hours Oral Route Swallow - dosing instruction imperative (qualifier value) Generated Narrative: ActivityDefinition #Inline-Vaccine-Request-3 url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-3 identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/VaccineRequest name: Anthrax_Post_Exposure_Prophylaxis_Adults_Vaccine_Request title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request status: Draft experimental: true description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014). UseContexts - Code Value[x] * UsageContextType age: Age Range 18-? * UsageContextType venue: Clinical Venue Outpatient environment * UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax * UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) * UsageContextType focus: Clinical Focus Asymptomatic (finding) purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series. usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting. approvalDate: 2019-06-07 lastReviewDate: 2019-06-07 effectivePeriod: 2019-06-07 --> (ongoing) topic: Anthrax, Emergency Medicine, Post-Exposure Prophylaxis author: Alliance to Modernize Healthcare FFRDC: endorser: Centers for Disease Control and Prevention: kind: ImmunizationRecommendation code: Anthrax vaccination product: Anthrax vaccine dosage text: 0.5mL additionalInstruction: Pregnant women at risk for inhalation anthrax should receive the anthrax vaccine regardless of pregnancy trimester., Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs. route: Subcutaneous route DoseAndRates - Dose[x] * 0.5 mL (Details: UCUM codemL = 'mL')
Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request
In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).
Contact with and (suspected) exposure to anthrax
Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.
Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.
Centers for Disease Control and Prevention
FIRST CHOICE: Ciprofloxacin 500 MG Oral Tablet
Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.
CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine.
CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, theophylline, drugs that prolong QT interval, duloxetine (Cymbalta), zolpidem (Ambien), clozapine or any other drug that may interact and cause serious side effects, consider another antibiotic regimen.
Provide patient education on medications.
Swallow - dosing instruction imperative (qualifier value)
Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request
SECOND CHOICE: doxycycline hyclate 100 MG Oral Tablet
CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, or any other drug that may interact and cause serious side effects, consider another antibiotic regimen.
Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request
Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request
Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request
Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request
Pregnant women at risk for inhalation anthrax should receive the anthrax vaccine regardless of pregnancy trimester.
Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs.
HL7 International - Clinical Decision Support WG
Provides information for treating patients greater than or equal to 18 years old exposed to anthrax within the past 60 days, who do not have anthrax. It is divided into two parts: \n- Part #1: For patients that may be symptomatic to flag the need to conduct a full diagnostic evaluation to rule out anthrax before proceeding with post-exposure prophylaxis (PEP) \n- Part #2: For patients who are asymptomatic (not displaying signs and symptoms of anthrax), it provides recommended PEP regimen
Antimicrobial medications for anthrax post-exposure prophylaxis
First line antimicrobial medications for anthrax post-exposure prophylaxis
Second line antimicrobial medications for anthrax post-exposure prophylaxis