Volume 70, Issue Supplement_1, 1 May 2020
Plague and Bioterrorism Preparedness
Yersinia pestis continues to cause naturally occurring outbreaks in certain regions worldwide and is a potential bioterrorism agent. This supplement presents new data on plague to advance current knowledge and inform new clinical guidelines for treatment and prophylaxis.
Antimicrobial Treatment of Human Plague: A Systematic Review of the Literature on Individual Cases, 1937–2019
Among 744 published cases of plague, fatality rates were similar for patients treated with aminoglycosides, tetracyclines, and fluoroquinolones. Treatment with sulfonamides was not commonly reported in recent decades. Dual antimicrobial therapy did not appear to improve outcomes compared to monotherapy.
Treatment of Human Plague: A Systematic Review of Published Aggregate Data on Antimicrobial Efficacy, 1939–2019
Aggregate data on plague antimicrobial treatment from 1939 to 2019 were reviewed. Tetracyclines, chloramphenicol, and aminoglycosides had the lowest associated case fatality rates. Monotherapy with fluoroquinolones could not be evaluated; patients treated with penicillin had the highest case fatality rate.
Antimicrobial Treatment Patterns and Illness Outcome Among United States Patients With Plague, 1942–2018
Most US patients with plague have received effective antimicrobials. In this retrospective review, we demonstrate that although many factors contribute to survival, use of aminoglycosides and tetracyclines substantially improves survival, and fluoroquinolones may be equally as effective.
This commentary introduces key issues for pregnant women during a plague outbreak or bioterrorism event and summarizes 2 systematic reviews in this supplement that will inform clinical recommendations for treatment and prophylaxis of plague among pregnant women.
Untreated Yersinia pestis infection during pregnancy is associated with high maternal mortality, pregnancy complications, fetal loss, and neonatal death. Appropriate antimicrobial treatment can improve maternal survival, although even with antimicrobial treatment, the risk of maternal death and pregnancy loss remains.
Safety of Antimicrobials During Pregnancy: A Systematic Review of Antimicrobials Considered for Treatment and Postexposure Prophylaxis of Plague
Most antimicrobials considered for plague during pregnancy have not been associated with consistent maternal/fetal/neonatal risks following prenatal exposure. Antimicrobials should be used for treatment and PEP of plague during pregnancy; the choice of antimicrobials may be influenced by these data.
The African Green Monkey Model of Pneumonic Plague and US Food and Drug Administration Approval of Antimicrobials Under the Animal Rule
Pneumonic plague in the African green monkey model is very similar to the course of disease in humans; therefore, antimicrobials effective in this model have been approved for plague indications under the US Food and Drug Administration’s Animal Efficacy Rule.
Effect of Delaying Treatment on Efficacy of Ciprofloxacin and Levofloxacin in the African Green Monkey Model of Pneumonic Plague
Delaying the treatment of pneumonic plague with ciprofloxacin and levofloxacin by 20–27 hours after fever onset substantially reduces their efficacy in African green monkeys.