second-vaccinedose-antimicrobial-pregnant-pd
type: PlanDefinition
node role: treeRoot
id:
  v: second-vaccinedose-antimicrobial-pregnant-pd
text:
  status:
    v: generated
  div: Generated Narrative: PlanDefinition second-vaccinedose-antimicrobial-pregnant-pd url: PlanDefinition Second vaccine antimicrobial pregnant identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet version: 1.1.0 name: Anthrax_Post_Exposure_Prophylaxis_Adults title: Second vaccine antimicrobial 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. a…
contained: ActivityDefinition
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    value:
      v: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest
  name:
    v: Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request
  title:
    v: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request
  status:
    v: draft
  experimental:
    v: true
  description:
    v: 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).
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  approval date:
    v: 2019-06-07
  last review date:
    v: 2019-06-07
  effective period:
    start:
      v: 2019-06-07
  topic:
    text:
      v: Anthrax
  topic:
    text:
      v: Emergency Medicine
  topic:
    text:
      v: Post-Exposure Prophylaxis
  author:
    name:
      v: Alliance to Modernize Healthcare FFRDC
  endorser:
    name:
      v: Centers for Disease Control and Prevention
  kind:
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      code:
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      display:
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    text:
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    code:
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    text:
      v: One every 12 hours for 60 days
    additional instruction:
      text:
        v: Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.
    additional instruction:
      text:
        v: CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine.
    additional instruction:
      text:
        v: 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.
    additional instruction:
      text:
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    patient instruction:
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    route:
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    method:
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contained: ActivityDefinition
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  url:
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  name:
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  title:
    v: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request
  status:
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    v: true
  description:
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      code:
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    value: Range
  use context:
    code:
      system:
        v: http://terminology.hl7.org/CodeSystem/usage-context-type
      code:
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      display:
        v: Clinical Venue
    value: CodeableConcept
      coding: http://snomed.info/id/440655000
  use context:
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      code:
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        v: Clinical Focus
    value: CodeableConcept
  product: CodeableConcept

v: 18

v: 440655000

v: Outpatient environment

v: Z20.810

v: Contact with and (suspected) exposure to anthrax

v: 170475009

v: Exposure to Bacillus anthracis (event)

v: 84387000

v: Asymptomatic (finding)

v: 1

v: 12

v: h

v: 26643006

v: Oral Route

v: 421521009

v: Swallow - dosing instruction imperative (qualifier value)

v: 18

v: 440655000

v: Outpatient environment

v: Z20.810

v: Contact with and (suspected) exposure to anthrax

v: 170475009

v: Exposure to Bacillus anthracis (event)

CodeableConcept
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  code:
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  display:
    v: Asymptomatic (finding)

v: 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.

v: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

v: 2019-06-07

v: 2019-06-07

start:
  v: 2019-06-07

text:
  v: Anthrax

text:
  v: Emergency Medicine

text:
  v: Post-Exposure Prophylaxis

name:
  v: Alliance to Modernize Healthcare FFRDC

name:
  v: Centers for Disease Control and Prevention

v: MedicationRequest

CodeableConcept
coding:
  system:
    v: http://www.nlm.nih.gov/research/umls/rxnorm
  code:
    v: 1650143
  display:
    v: doxycycline hyclate 100 MG Oral Tablet
text:
  v: SECOND CHOICE: doxycycline hyclate 100 MG Oral Tablet

value:
  v: 120
system:
  v: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm
code:
  v: ORTAB

text:
  v: One every 12 hours for 60 days
additional instruction:
  text:
    v: Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.
additional instruction:
  text:
    v: 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.
additional instruction:
  text:
    v: Provide patient education on medications.
patient instruction:
  v: Take with full glass of water
timing:
  repeat:
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    period:
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    period unit:
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route:
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    display:
      v: Oral Route
method:
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    system:
      v: http://snomed.info/sct
    code:
      v: 421521009
    display:
      v: Swallow - dosing instruction imperative (qualifier value)

ActivityDefinition
id:
  v: Inline-Levofloxacin-Request-4
url:
  v: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Levofloxacin-Request-4
identifier:
  value:
    v: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest
name:
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title:
  v: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request
status:
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experimental:
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description:
  v: 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).
use context:
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    system:
      v: http://terminology.hl7.org/CodeSystem/usage-context-type
    code:
      v: age
    display:
      v: Age Range
  value: Range
    low:
      value:
        v: 18
use context:
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    system:
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    code:
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    display:
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  value: CodeableConcept
    coding: http://snomed.info/id/440655000
      system:
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      code:
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use context:
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    code:
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    coding:
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      display:
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use context:
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      system:
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      code:
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      display:
        v: Exposure to Bacillus anthracis (event)
use context:
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    code:
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    display:
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      system:
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      display:
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purpose:
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usage:
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approval date:
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last review date:
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effective period:
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topic:
  text:
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topic:
  text:
    v: Emergency Medicine
topic:
  text:
    v: Post-Exposure Prophylaxis
author:
  name:
    v: Alliance to Modernize Healthcare FFRDC
endorser:
  name:
    v: Centers for Disease Control and Prevention
kind:
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product: CodeableConcept
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    display:
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  text:
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quantity:
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  system:
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  code:
    v: ORTAB
dosage:
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    v: One every day for 60 days
  additional instruction:
    text:
      v: Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.
  timing:
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      period:
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      period unit:
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      display:
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      system:
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      code:
        v: 421521009
      display:
        v: Swallow - dosing instruction imperative (qualifier value)

ActivityDefinition
id:
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url:
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identifier:
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    v: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest
name:
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title:
  v: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request
status:
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experimental:
  v: true
description:
  v: 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).
use context:
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use context:
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    code:
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      system:
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      code:
        v: 440655000
      display:
        v: Outpatient environment
use context:
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    code:
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  value: CodeableConcept
    coding:
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      code:
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      display:
        v: Contact with and (suspected) exposure to anthrax
use context:
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      display:
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use context:
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    coding: http://snomed.info/id/84387000
      system:
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      display:
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purpose:
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usage:
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approval date:
  v: 2019-06-07
last review date:
  v: 2019-06-07
effective period:
  start:
    v: 2019-06-07
topic:
  text:
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topic:
  text:
    v: Emergency Medicine
topic:
  text:
    v: Post-Exposure Prophylaxis
author:
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    v: Alliance to Modernize Healthcare FFRDC
endorser:
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kind:
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product: CodeableConcept
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    code:
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    display:
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quantity:
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  system:
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  code:
    v: ORTAB
dosage:
  text:
    v: One every day for 60 days
  additional instruction:
    text:
      v: Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.
  timing:
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        v: 1
      period:
        v: 1
      period unit:
        v: d
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      system:
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      display:
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      system:
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      code:
        v: 421521009
      display:
        v: Swallow - dosing instruction imperative (qualifier value)

ActivityDefinition
id:
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url:
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identifier:
  value:
    v: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest
name:
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title:
  v: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request
status:
  v: draft
experimental:
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