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Antitoxin for anthrax[1]

Antitoxin for anthrax[1]
  Dosing for adults Dosing for children and adolescents (age ≥1 month through 17 years) Comments
Raxibacumab 40 mg/kg intravenously once
  • Weight ≤10 kg: 80 mg/kg intravenously once
  • Weight >10 to 40 kg: 60 mg/kg intravenously once
  • Weight >40 kg: 40 mg/kg intravenously once
  • Premedicate with diphenhydramine 1 hour prior to administration.
  • Hypersensitivity and anaphylaxis have been reported.
Obiltoxaximab 16 mg/kg intravenously once
  • Weight ≤15 kg: 32 mg/kg intravenously once
  • Weight >15 to 40 kg: 24 mg/kg intravenously once
  • Weight >40 kg: 16 mg/kg intravenously once
  • Premedicate with diphenhydramine 1 hour prior to administration.
  • Hypersensitivity and anaphylaxis have been reported.
Anthrax immunoglobulin (AIGIV) 420 units intravenously once
  • Weight <10 kg: 1 vial (~60 units) intravenously once
  • Weight 10 to <18 kg: 2 vials (~120 units) intravenously once
  • Weight 18 to <25 kg: 3 vials (~180 units) intravenously once
  • Weight 25 to <35 kg: 4 vials (~240 units) intravenously once
  • Weight 35 to <50 kg: 5 vials (~300 units) intravenously once
  • Weight 50 to <60 kg: 6 vials (~360 units) intravenously once
  • Weight ≥60 kg: 7 vials (~420 units) intravenously once
  • If raxibacumab and obiltoxaximab are unavailable.
  • The dose listed for age or weight can be doubled for severe cases in patients who weigh >5 kg.

Antitoxin therapy is used as an adjunct to antibiotic therapy in patients with systemic anthrax, including meningitis. It can be used as an alternative to antibiotics when the latter are unavailable for treatment of cutaneous anthrax or for post exposure prophylaxis. The dose for all indications is the same.

These recommendations are consistent with those from the Centers for Disease Control and Prevention (CDC) in the United States. For dosing in neonates, refer directly to CDC documents.
Reference:
  1. Bower WA, Yu Y, Person MK, et al. CDC Guidelines for the Prevention and Treatment of Anthrax, 2023. MMWR Recomm Rep 2023; 72:1.
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