Tularemia

Prophylaxis

Vaccine: An investigational (IND) live-attenuated vaccine (live vaccine strain - LVS), administered by scarification, has been given to > 5,000 persons without significant adverse reactions. The vaccine prevents typhoidal and ameliorates ulceroglandular forms of laboratory-acquired tularemia. Aerosol challenge tests in laboratory animals and human volunteers have demonstrated significant protection. As with all vaccines, the degree of protection depends upon the magnitude of the challenge dose. Vaccine-induced protection could be overwhelmed by extremely high doses of the tularemia bacteria.

Immunoprophylaxis. There is no passive immunoprophylaxis (i.e., immune globulin) available for pre- or postexposure management of tularemia.

Preexposure prophylaxis: No antibiotics are licensed by the FDA for use before exposure to tularemia. However, chemoprophylaxis with ciprofloxacin or doxycycline) may protect against tularemia based upon in vitro susceptibilities.

Postexposure prophylaxis:

Preferred

  • Doxycycline 100 mg po bid for adults and children >45 kg (for children <45 kg use 2.2 mg / kg po bid), or
  • Ciprofloxacin 500 mg po bid for adults (15 mg/kg po bid (up to 1 g/day) for children)

Postexposure prophylaxis should ideally begin within 24 hr of exposure and continue for at least 14 days. These oral antibiotic dosages may also be appropriate for treatment in mass casualty settings in which intravenous antibiotics are not available.

Chemoprophylaxis is not recommended after potential natural exposures (tick bite, rabbit, or other animal exposures).

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