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One of the following for 60 days: 3-dose subcutaneous (SC) series: first dose administered as soon as possible, second and third doses administered 2 and 4 wks after the first dose Ciprofloxacin,Δ 500 mg orally twice daily Doxycycline, 100 mg orally twice daily Pregnant women◊

One of the following for 60 days: 3-dose SC series; first dose administered as soon as possible, second and third doses administered 2 and 4 wks after the first dose Ciprofloxacin, 500 mg orally twice daily Doxycycline, 100 mg orally twice daily Amoxicillin,§ 500 mg every 8 hrs Children (<18 yrs)¥

One of the following for 60 days: Recommendations for use of AVA in children are made on an event-by-event basis Ciprofloxacin,Δ¥������ 15 mg/kg every 12 hrs Doxycycline,¥������ (maximum of 100 mg/dose) >8 yrs and >45 kg: 100 mg every 12 hrs >8 yrs and ≤45 kg: 2.2 mg/kg every 12 hrs ≤8 yrs: 2.2 mg/kg every 12 hrs Amoxicillin,§ ** 45 mg/kg/day orally divided into 3 daily doses given every 8 hrs; each dose should not exceed 500 mg

Recommendations for use of AVA in children are made on an event-by-event basis Ciprofloxacin,Δ¥������ 15 mg/kg every 12 hrs Doxycycline,¥������ (maximum of 100 mg/dose) >8 yrs and >45 kg: 100 mg every 12 hrs >8 yrs and ≤45 kg: 2.2 mg/kg every 12 hrs ≤8 yrs: 2.2 mg/kg every 12 hrs Amoxicillin,§ ** 45 mg/kg/day orally divided into 3 daily doses given every 8 hrs; each dose should not exceed 500 mg * Antimicrobials should continue for 14 days after administration of the third dose of vaccine. • AVA used for PEP must be administered subcutaneously. Δ Levofloxacin is a second-line antimicrobial agent for PEP for persons aged ≥6 mos with medical issues (eg, tolerance or resistance to ciprofloxacin) that indicate its use. Children: 16 mg/kg/day divided every 12 hrs; each dose should not exceed 250 mg. Adults: 500 mg every 24 hrs. Safety data on extended use of levofloxacin in any population for >28 days are limited; therefore, levofloxacin PEP should only be used when the benefit outweighs the risk. ◊ The antimicrobial of choice for initial prophylactic therapy among pregnant women is ciprofloxacin. Doxycycline should be used with caution in asymptomatic pregnant women and only when other appropriate antimicrobial drugs are contraindicated. Although tetracyclines are not recommended during pregnancy, their use might be indicated for life-threatening illness. § If susceptibility testing demonstrates an amoxicillin MIC ≤0.125 μg/mL, oral amoxicillin should be used to complete therapy. ¥ Use of tetracyclines and fluoroquinolones in children can have adverse effects. These effects must be weighed carefully against the risk for developing life-threatening disease. If exposure to B. anthracis is confirmed, children may be treated initially with ciprofloxacin or doxycycline as prophylaxis. However, amoxicillin is preferred for antimicrobial PEP in children when susceptibility testing indicates that the B. anthracis isolate is susceptible to penicillins. ������ Each ciprofloxacin dose should not exceed 500 mg, or 1 g/day. ������ In 1991, the American Academy of Pediatrics (AAP) amended the recommendation to allow treatment of young children with tetracyclines for serious infections such as Rocky Mountain spotted fever for which doxycycline might be indicated. Doxycycline is preferred for its twice daily dosage and low incidence of gastrointestinal side effects. ** Because of the lack of data on amoxicillin dosages for treating anthrax (and the associated high mortality rate), AAP recommends a higher dosage of 80 mg/kg/day, divided into 3 daily doses; each dose should not exceed 500 mg. If this higher dosage of amoxicillin is used, recipients should be carefully monitored for side effects from long-term treatment.

* Antimicrobials should continue for 14 days after administration of the third dose of vaccine. • AVA used for PEP must be administered subcutaneously. Δ Levofloxacin is a second-line antimicrobial agent for PEP for persons aged ≥6 mos with medical issues (eg, tolerance or resistance to ciprofloxacin) that indicate its use. Children: 16 mg/kg/day divided every 12 hrs; each dose should not exceed 250 mg. Adults: 500 mg every 24 hrs. Safety data on extended use of levofloxacin in any population for >28 days are limited; therefore, levofloxacin PEP should only be used when the benefit outweighs the risk. ◊ The antimicrobial of choice for initial prophylactic therapy among pregnant women is ciprofloxacin. Doxycycline should be used with caution in asymptomatic pregnant women and only when other appropriate antimicrobial drugs are contraindicated. Although tetracyclines are not recommended during pregnancy, their use might be indicated for life-threatening illness. § If susceptibility testing demonstrates an amoxicillin MIC ≤0.125 μg/mL, oral amoxicillin should be used to complete therapy. ¥ Use of tetracyclines and fluoroquinolones in children can have adverse effects. These effects must be weighed carefully against the risk for developing life-threatening disease. If exposure to B. anthracis is confirmed, children may be treated initially with ciprofloxacin or doxycycline as prophylaxis. However, amoxicillin is preferred for antimicrobial PEP in children when susceptibility testing indicates that the B. anthracis isolate is susceptible to penicillins. ������ Each ciprofloxacin dose should not exceed 500 mg, or 1 g/day. ������ In 1991, the American Academy of Pediatrics (AAP) amended the recommendation to allow treatment of young children with tetracyclines for serious infections such as Rocky Mountain spotted fever for which doxycycline might be indicated. Doxycycline is preferred for its twice daily dosage and low incidence of gastrointestinal side effects. ** Because of the lack of data on amoxicillin dosages for treating anthrax (and the associated high mortality rate), AAP recommends a higher dosage of 80 mg/kg/day, divided into 3 daily doses; each dose should not exceed 500 mg. If this higher dosage of amoxicillin is used, recipients should be carefully monitored for side effects from long-term treatment. Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2010; 59(RR-6):1-36.