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Antibiotics for treatment of plague (Yersinia pestis infection)[1]

Antibiotics for treatment of plague (Yersinia pestis infection)[1]
Drug Adult dosing Pediatric dosing
Aminoglycosides
Gentamicin IV/IM: 5 mg/kg every 24 hours IV/IM: 4.5 to 7.5 mg/kg every 24 hours
Streptomycin IV/IM: 1 g every 12 hours IV/IM: 15 mg/kg every 12 hours (maximum 1 g/dose)
Fluoroquinolones
Ciprofloxacin

IV: 400 mg every 8 hours

Oral: 750 mg every 12 hours

IV: 10 mg/kg every 8 or 12 hours (maximum 400 mg/dose)

Oral: 15 mg/kg every 8 or 12 hours (maximum 500 mg/dose every 8 hours or 750 mg/dose every 12 hours)
Levofloxacin IV/oral: 750 mg every 24 hours Weight <50 kg:
  • IV/oral: 8 mg/kg every 12 hours (maximum 250 mg/dose)
Weight ≥50 kg:
  • IV/oral: 500 to 750 mg every 24 hours
Moxifloxacin* IV/oral: 400 mg every 24 hours Age ≥3 to ≤23 months:
  • IV/oral: 6 mg/kg every 12 hours (maximum 200 mg/dose)
Age 2 to 5 years:
  • IV/oral: 5 mg/kg every 12 hours (maximum 200 mg/dose)
Age 6 to 11 years:
  • IV/oral: 4 mg/kg every 12 hours (maximum 200 mg/dose)
Age 12 to ≤17 years:
  • Weight <45 kg – IV/oral: 4 mg/kg every 12 hours (maximum 200 mg/dose)
  • Weight ≥45 kg – IV/oral: 400 mg every 24 hours
Tetracyclines
Doxycycline IV/oral: 200 mg loading dose then 100 mg every 12 hours Weight <45 kg:
  • IV/oral: 4.4 mg/kg loading dose, then 2.2 mg/kg every 12 hours
Weight ≥45 kg:
  • IV/oral: 200 mg loading dose, then 100 mg every 12 hours
For discussion of agent selection and duration of therapy, refer to the UpToDate clinical topic review of plague (Yersinia pestis infection).
IV: intravenous; IM: intramuscular.
* For pediatric patients with plague, other agents are recommended due to higher rates of QTc prolongation with moxifloxacin.
¶ Not recommended as first-line treatment of pneumonic or septicemic plague.
Reference:
  1. Nelson CA, Meaney-Delman D, Fleck-Derderian S, et al. Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response. MMWR Recomm Rep 2021; 70:1.
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