Materiały źródłowe

• #1 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Begin appropriate therapy as soon as plague is suspected. […] Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors. […] The decision to initiate antibiotic therapy for plague should be made based on clinical signs and symptoms and a careful patient history. […] Gentamicin and fluoroquinolones are first-line treatments in the United States. […] Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs. […] The regimens listed below may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Recommended antibiotic treatment for plague […] Recommended antimicrobial treatment of adults and children with pneumonic or septicemic plague

• #2 Plague Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/plague

  Plague is treated with antibiotics. People with plague need to be treated right away. Treatment should be given if plague is suspected, even before test results come back. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. […] Antibiotics used to treat plague include: Ciprofloxacin, Doxycycline, Gentamicin, Levofloxacin, Moxifloxacin, Streptomycin. […] Oxygen, intravenous fluids, and respiratory support are usually also needed. […] People with pneumonic plague must be kept away from other patients and isolation procedures will be followed in the hospital. People who have had close contact with anyone infected by pneumonic plague should be given antibiotics as a preventive measure and watched carefully.

• #3

  https://www.who.int/news-room/fact-sheets/detail/plague

  Antibiotic treatment is effective against plague bacteria, so early diagnosis and early treatment can save lives. […] Untreated pneumonic plague can be rapidly fatal, so early diagnosis and treatment is essential for survival and reduction of complications. Antibiotics and supportive therapy are effective against plague if patients are diagnosed in time. Pneumonic plague can be fatal within 18 to 24 hours of disease onset if left untreated, but common antibiotics for enterobacteria (gram negative rods) can effectively cure the disease if they are delivered early. […] Ensure correct treatment: Verify that patients are being given appropriate antibiotic treatment and that local supplies of antibiotics are adequate.

• #4 Plague: Recognition, Treatment, and Prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5744195/

  Plague is caused by Yersinia pestis and is not commonly encountered in clinics, although natural plague foci are widely distributed around the world. […] Therefore, this minireview briefly introduces the current understanding on Y. pestis and then focuses on practical aspects of plague, including clinical manifestations, diagnosis, treatment, and prevention, to alert clinicians about this notorious disease. […] Antibiotics, including streptomycin and gentamicin, are recommended to effectively treat the different types of plague. […] The keys to the successful treatment of plague are early recognition and timely administration of effective antibiotics. If the administration of effective antibiotics and antishock therapies are delayed by more than 24 h, it will usually be fatal for the patients.

• #5 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  The Centers for Disease Control and Prevention (CDC) published clinical practice guidelines on the treatment of plague in July 2021 in the Morbidity and Mortality Weekly Report. These are some of the highlights of the guidelines. […] Plague is treatable with antimicrobials and supportive care. Early recognition and administration of effective antimicrobials are key to saving lives. Persons exposed to Yersinia pestis can avoid illness if given effective antimicrobial prophylaxis. […] Aminoglycosides and fluoroquinolones are the mainstays of treatment for plague. Tetracyclines, chloramphenicol, and trimethoprim-sulfamethoxazole also might be suitable treatment, depending on the type of disease and the age and pregnancy status of the patient. Dual therapy with distinct classes of antimicrobials is recommended in the case of a bioterrorist attack with Y pestis engineered for resistance to treatment.

• #6 Plague: Recognition, Treatment, and Prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5744195/

  Plague is caused by Yersinia pestis and is not commonly encountered in clinics, although natural plague foci are widely distributed around the world. […] Therefore, this minireview briefly introduces the current understanding on Y. pestis and then focuses on practical aspects of plague, including clinical manifestations, diagnosis, treatment, and prevention, to alert clinicians about this notorious disease. […] Antibiotics, including streptomycin and gentamicin, are recommended to effectively treat the different types of plague. […] The keys to the successful treatment of plague are early recognition and timely administration of effective antibiotics. If the administration of effective antibiotics and antishock therapies are delayed by more than 24 h, it will usually be fatal for the patients.

• #7 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Begin appropriate therapy as soon as plague is suspected. […] Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors. […] The decision to initiate antibiotic therapy for plague should be made based on clinical signs and symptoms and a careful patient history. […] Gentamicin and fluoroquinolones are first-line treatments in the United States. […] Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs. […] The regimens listed below may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Recommended antibiotic treatment for plague […] Recommended antimicrobial treatment of adults and children with pneumonic or septicemic plague

• #8 Plague Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/plague

  Plague is treated with antibiotics. People with plague need to be treated right away. Treatment should be given if plague is suspected, even before test results come back. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. […] Antibiotics used to treat plague include: Ciprofloxacin, Doxycycline, Gentamicin, Levofloxacin, Moxifloxacin, Streptomycin. […] Oxygen, intravenous fluids, and respiratory support are usually also needed. […] People with pneumonic plague must be kept away from other patients and isolation procedures will be followed in the hospital. People who have had close contact with anyone infected by pneumonic plague should be given antibiotics as a preventive measure and watched carefully.

• #9 The Plague: Types, Causes, and Symptoms

  https://www.healthline.com/health/plague

  The plague is a life threatening condition that requires urgent care. If caught and treated early, its a treatable disease using antibiotics that are commonly available. […] Treatment usually involves: Strong and effective antibiotics such as gentamicin or ciprofloxacin, intravenous fluids, oxygen, and, sometimes, breathing support. […] Those with pneumonic plague must be isolated from other patients in order to avoid transmission. […] Treatment will continue for several weeks even after your fever breaks. […] Those in contact with someone with plague will be closely monitored, and possibly given antibiotics as a preventative measure. […] If diagnosed early, treatment for plague can be extremely successful with proper antibiotics. However, the main complication that may interfere with successful treatment is the timing of diagnosis and when treatment begins. […] Plague can be fatal if not treated quickly, so its important to visit the doctor as soon as symptoms appear.

• #10 Plague – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/plague/symptoms-causes/syc-20351291

  Plague usually can be treated with antibiotics. If not treated, the illness is often deadly. […] If treatment is not begun the first day, the disease progresses rapidly to failure of the lungs, shock and death. […] Most people with bubonic plague survive with prompt diagnosis and treatment. Death is more likely with septicemic plague because it is difficult to diagnose and worsens rapidly. Treatment may unintentionally be delayed. […] Pneumonic plague is severe and worsens rapidly. Risk of death is high if treatment doesn’t begin within 24 hours after symptoms start. […] No vaccine is available, but scientists are working to develop one. Antibiotics can help prevent infection if you were likely exposed to plague. […] People with pneumonic plague are isolated during treatment to prevent the spread of disease. Health care workers must wear protective masks, gowns, gloves and eyewear when they treat someone with pneumonic plague.

• #11 Plague – Controls | Occupational Safety and Health Administration

  http://www.osha.gov/plague/controls

  There are a variety of controls that should be implemented in order to protect workers from exposure to plague. […] National infection control guidelines prescribe specific precautions to be taken when treating patients with known or suspected plague. These precautions include „Standard”, „Droplet” and „Airborne” Precautions, under certain circumstances. Patient isolation and similar precautions may also be necessary. […] Similar infection control precautions, as listed previously for live individuals, should be implemented for the post-mortem care of plague patients. These precautions apply to all workers performing post-mortem procedures on plague patients, including healthcare workers, morticians, forensic personnel, or others. […] The risk of re-aerosolization of plague bacteria from contaminated persons is considered low. In situations where there may have been gross exposure to plague, personal decontamination can be performed by removing contaminated clothing and washing exposed skin with soap and water.

• #12 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  The Centers for Disease Control and Prevention (CDC) published clinical practice guidelines on the treatment of plague in July 2021 in the Morbidity and Mortality Weekly Report. These are some of the highlights of the guidelines. […] Plague is treatable with antimicrobials and supportive care. Early recognition and administration of effective antimicrobials are key to saving lives. Persons exposed to Yersinia pestis can avoid illness if given effective antimicrobial prophylaxis. […] Aminoglycosides and fluoroquinolones are the mainstays of treatment for plague. Tetracyclines, chloramphenicol, and trimethoprim-sulfamethoxazole also might be suitable treatment, depending on the type of disease and the age and pregnancy status of the patient. Dual therapy with distinct classes of antimicrobials is recommended in the case of a bioterrorist attack with Y pestis engineered for resistance to treatment.

• #13 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Begin appropriate therapy as soon as plague is suspected. […] Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors. […] The decision to initiate antibiotic therapy for plague should be made based on clinical signs and symptoms and a careful patient history. […] Gentamicin and fluoroquinolones are first-line treatments in the United States. […] Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs. […] The regimens listed below may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Recommended antibiotic treatment for plague […] Recommended antimicrobial treatment of adults and children with pneumonic or septicemic plague

• #14 Plague Medication: Antibiotics

  https://emedicine.medscape.com/article/235627-medication

  Untreated plague can progress to a fulminant illness with a high risk of mortality. Thus, early and appropriate antibiotic treatment is essential. […] Historically, streptomycin (15 mg/kg, up to 1 g intramuscularly every 12 h) has been the drug of choice; however, in the United States, supplies of streptomycin are scarce. […] An in vitro comparison and a murine model demonstrated that gentamicin (5 mg/kg intravenously or intramuscularly once daily) is comparable to or superior than streptomycin. Gentamicin has been used successfully in the treatment of human plague, is inexpensive, and can be dosed once daily. […] Doxycycline (as dosed for anthrax) is a recommended alternative in patients who cannot take aminoglycosides or in the event of a mass casualty scenario, making parenteral therapy unachievable.

• #15 Plague and Other Yersinia Infections – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/plague-and-other-yersinia-infections

  Treatment is with streptomycin or gentamicin; alternatives are a fluoroquinolone or doxycycline. […] In septicemic or pneumonic plague, treatment must begin within 24 hours with 1 of the following if renal function is normal: Streptomycin 1 g IV or IM 2 times a day. […] Gentamicin 5 mg/kg IM or IV once a day (or 2 mg/kg loading dose followed by 1.7 mg/kg every 8 hours). […] The antibiotic is given for 10 days or until 3 days after temperature has returned to normal. Doxycycline 200-mg loading dose IV or orally, then 100 mg IV or orally every 12 hours for 14 days is an alternative. […] Chloramphenicol is preferred for patients with infection of tissue spaces into which other antibiotics pass poorly (eg, plague meningitis, endophthalmitis). […] For bubonic or pharyngeal plague, doxycycline can be used as well as the antibiotics used to treat septicemic or pneumonic plague.

• #16 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  FDA-approved antimicrobials for plague include streptomycin, ciprofloxacin, levofloxacin, moxifloxacin, and doxycycline. Although not approved for plague, gentamicin, chloramphenicol, and trimethoprim-sulfamethoxazole are considered effective. […] Patients initially treated with parenteral antimicrobials can be transitioned to oral administration when they are improving clinically. […] All clinical forms of plague require 10-14 days of treatment in total. The duration of treatment can be extended for those with continuing fever or other worrisome signs or symptoms. […] Treatment recommendations for those who are elderly or immunocompromised are the same as those for adults; however, these patients may experience decreased glomerular filtration rate or polypharmacy, and clinicians should adjust treatment as necessary.

• #17 Plague Medication: Antibiotics

  https://emedicine.medscape.com/article/235627-medication

  Because chloramphenicol attains high CSF concentrations, it has been used to treat meningeal plague, although no studies have been conducted for substantiation. Chloramphenicol may be challenging to obtain. […] Studies in murine models have shown that fluoroquinolones demonstrate efficacy similar to that of the aminoglycosides. Fluoroquinolones are a reasonable alternative therapy. […] The FDA has approved levofloxacin and moxifloxacin for the treatment of plague. These also have been approved for use as prophylaxis following exposure to Yersinia pestis. […] Trimethoprim-sulfamethoxazole has been used to treat bubonic plague; however, it is not considered first-line therapy. […] Beta-lactam antibiotics and macrolides should not be used. […] Patients with advanced plague have a presentation of typical gram-negative sepsis and need antibiotic treatment for 10-14 days, along with other supportive measures.

• #18 Plague and Other Yersinia Infections – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/plague-and-other-yersinia-infections

  Treatment is with streptomycin or gentamicin; alternatives are a fluoroquinolone or doxycycline. […] In septicemic or pneumonic plague, treatment must begin within 24 hours with 1 of the following if renal function is normal: Streptomycin 1 g IV or IM 2 times a day. […] Gentamicin 5 mg/kg IM or IV once a day (or 2 mg/kg loading dose followed by 1.7 mg/kg every 8 hours). […] The antibiotic is given for 10 days or until 3 days after temperature has returned to normal. Doxycycline 200-mg loading dose IV or orally, then 100 mg IV or orally every 12 hours for 14 days is an alternative. […] Chloramphenicol is preferred for patients with infection of tissue spaces into which other antibiotics pass poorly (eg, plague meningitis, endophthalmitis). […] For bubonic or pharyngeal plague, doxycycline can be used as well as the antibiotics used to treat septicemic or pneumonic plague.

• #19 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  FDA-approved antimicrobials for plague include streptomycin, ciprofloxacin, levofloxacin, moxifloxacin, and doxycycline. Although not approved for plague, gentamicin, chloramphenicol, and trimethoprim-sulfamethoxazole are considered effective. […] Patients initially treated with parenteral antimicrobials can be transitioned to oral administration when they are improving clinically. […] All clinical forms of plague require 10-14 days of treatment in total. The duration of treatment can be extended for those with continuing fever or other worrisome signs or symptoms. […] Treatment recommendations for those who are elderly or immunocompromised are the same as those for adults; however, these patients may experience decreased glomerular filtration rate or polypharmacy, and clinicians should adjust treatment as necessary.

• #20 Plague Medication: Antibiotics

  https://emedicine.medscape.com/article/235627-medication

  Untreated plague can progress to a fulminant illness with a high risk of mortality. Thus, early and appropriate antibiotic treatment is essential. […] Historically, streptomycin (15 mg/kg, up to 1 g intramuscularly every 12 h) has been the drug of choice; however, in the United States, supplies of streptomycin are scarce. […] An in vitro comparison and a murine model demonstrated that gentamicin (5 mg/kg intravenously or intramuscularly once daily) is comparable to or superior than streptomycin. Gentamicin has been used successfully in the treatment of human plague, is inexpensive, and can be dosed once daily. […] Doxycycline (as dosed for anthrax) is a recommended alternative in patients who cannot take aminoglycosides or in the event of a mass casualty scenario, making parenteral therapy unachievable.

• #21 Antibiotics for treating plague: a systematic review (executive summary) – WHO guidelines for plague management: revised recommendations for the use of rapid diagnostic tests, fluoroquinolones for case management and personal protective equipment for prev

  https://www.ncbi.nlm.nih.gov/books/NBK571125/

  WHO guidelines for plague management: revised recommendations for the use of rapid diagnostic tests, fluoroquinolones for case management and personal protective equipment for prevention of post-mortem transmission. […] Plague is a serious disease and always constitutes a medical emergency, therefore, prompt and appropriate treatment can be life saving. The three main forms of plague have different case-fatality rates: bubonic plague is usually transmitted by fleas, and accounts for 80-95% of all cases, with a case-fatality rate of 10-20%; pneumonic plague is usually transmitted between humans, and is less common, but causes outbreaks with a case-fatality rate that is close to 100% if left untreated and more than 50% even when adequately treated with antimicrobials; and systemic plague accounts for 10-20% of cases and can be primary or secondary to bubonic and pneumonic plague.

• #22 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #23 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #24 Plague and Other Yersinia Infections – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/plague-and-other-yersinia-infections

  Treatment is with streptomycin or gentamicin; alternatives are a fluoroquinolone or doxycycline. […] In septicemic or pneumonic plague, treatment must begin within 24 hours with 1 of the following if renal function is normal: Streptomycin 1 g IV or IM 2 times a day. […] Gentamicin 5 mg/kg IM or IV once a day (or 2 mg/kg loading dose followed by 1.7 mg/kg every 8 hours). […] The antibiotic is given for 10 days or until 3 days after temperature has returned to normal. Doxycycline 200-mg loading dose IV or orally, then 100 mg IV or orally every 12 hours for 14 days is an alternative. […] Chloramphenicol is preferred for patients with infection of tissue spaces into which other antibiotics pass poorly (eg, plague meningitis, endophthalmitis). […] For bubonic or pharyngeal plague, doxycycline can be used as well as the antibiotics used to treat septicemic or pneumonic plague.

• #25 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #26 Antibiotics for treating plague: a systematic review (executive summary) – WHO guidelines for plague management: revised recommendations for the use of rapid diagnostic tests, fluoroquinolones for case management and personal protective equipment for prev

  https://www.ncbi.nlm.nih.gov/books/NBK571125/

  WHO guidelines for plague management: revised recommendations for the use of rapid diagnostic tests, fluoroquinolones for case management and personal protective equipment for prevention of post-mortem transmission. […] Plague is a serious disease and always constitutes a medical emergency, therefore, prompt and appropriate treatment can be life saving. The three main forms of plague have different case-fatality rates: bubonic plague is usually transmitted by fleas, and accounts for 80-95% of all cases, with a case-fatality rate of 10-20%; pneumonic plague is usually transmitted between humans, and is less common, but causes outbreaks with a case-fatality rate that is close to 100% if left untreated and more than 50% even when adequately treated with antimicrobials; and systemic plague accounts for 10-20% of cases and can be primary or secondary to bubonic and pneumonic plague.

• #27 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  For naturally occurring pneumonic plague, the CDC recommends levofloxacin or moxifloxacin. […] Ciprofloxacin now is a first-line agent instead of an alternative agent. Levofloxacin and moxifloxacin (recommended for naturally-occurring plague) have been added as first-line or alternative agents for treatment and prophylaxis. […] Institute dual therapy with 2 distinct antimicrobial classes for patients with severe septicemic or pneumonic disease, and narrow therapy to a single antimicrobial after the patient improves clinically. […] Moxifloxacin and levofloxacin have robust activity against Yersinia pestis and excellent CNS penetration; therefore, they should be effective for plague meningitis. […] Because plague has a high case-fatality rate, the CDC recommends antimicrobial treatment and prophylaxis for affected pregnant individuals even if antimicrobial treatment carries risk to the fetus.

• #28 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #29 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  For naturally occurring pneumonic plague, the CDC recommends levofloxacin or moxifloxacin. […] Ciprofloxacin now is a first-line agent instead of an alternative agent. Levofloxacin and moxifloxacin (recommended for naturally-occurring plague) have been added as first-line or alternative agents for treatment and prophylaxis. […] Institute dual therapy with 2 distinct antimicrobial classes for patients with severe septicemic or pneumonic disease, and narrow therapy to a single antimicrobial after the patient improves clinically. […] Moxifloxacin and levofloxacin have robust activity against Yersinia pestis and excellent CNS penetration; therefore, they should be effective for plague meningitis. […] Because plague has a high case-fatality rate, the CDC recommends antimicrobial treatment and prophylaxis for affected pregnant individuals even if antimicrobial treatment carries risk to the fetus.

• #30 Plague Disease (Black Death): Symptoms, Types, Causes, Treatment

  https://www.emedicinehealth.com/plague/article_em.htm

  What Is the Treatment for Plague? […] If doctors suspect a patient may have the plague, healthcare professionals will take precautions when dealing with the patient and will wear goggles, gloves, gowns, and masks. […] Patients are isolated and precautions are taken not to infect others. Some patients may need help breathing and are given oxygen. They are kept away from others for two to three days after antibiotic treatment has started or until the infection is cleared. […] Most patients experience some degree of septic shock (low blood pressure), and specialists monitor this closely in an intensive care unit. […] Medical management of the plague can involve several medications. Antibiotics must be given early in the infection to maximize the chance of the antibiotics killing Y. pestis bacteria. These antibiotics might include streptomycin sulfate in combination with tetracycline and other antibiotics.

• #31 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #32 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #33 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  For naturally occurring pneumonic plague, the CDC recommends levofloxacin or moxifloxacin. […] Ciprofloxacin now is a first-line agent instead of an alternative agent. Levofloxacin and moxifloxacin (recommended for naturally-occurring plague) have been added as first-line or alternative agents for treatment and prophylaxis. […] Institute dual therapy with 2 distinct antimicrobial classes for patients with severe septicemic or pneumonic disease, and narrow therapy to a single antimicrobial after the patient improves clinically. […] Moxifloxacin and levofloxacin have robust activity against Yersinia pestis and excellent CNS penetration; therefore, they should be effective for plague meningitis. […] Because plague has a high case-fatality rate, the CDC recommends antimicrobial treatment and prophylaxis for affected pregnant individuals even if antimicrobial treatment carries risk to the fetus.

• #34 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  Antimicrobial safety profiles can help the clinician select the antimicrobial treatment that maximizes benefit to the pregnant patient while minimizing potential risk. […] Gentamicin is preferred over streptomycin because streptomycin has been shown to have the greater risk for irreversible fetal ototoxicity. […] Because plague has a high case-fatality rate, the CDC recommends antimicrobial treatment and prophylaxis for affected pregnant individuals even if antimicrobial treatment carries risk to the fetus.

• #35 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  Antimicrobial safety profiles can help the clinician select the antimicrobial treatment that maximizes benefit to the pregnant patient while minimizing potential risk. […] Gentamicin is preferred over streptomycin because streptomycin has been shown to have the greater risk for irreversible fetal ototoxicity. […] Because plague has a high case-fatality rate, the CDC recommends antimicrobial treatment and prophylaxis for affected pregnant individuals even if antimicrobial treatment carries risk to the fetus.

• #36 Plague Info for Providers | Larimer County

  https://www.larimer.gov/health/communicable-disease/animal-borne-diseases/plague-info-providers

  The regimens listed below are guidelines only and may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Gentamicin is pregnancy category C but has been used safely and effectively for treatment of plague in pregnant women. […] Doxycycline and ciprofloxacin are pregnancy categories D and C, respectively. These agents should be administered only if gentamicin is not available.

• #37 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  FDA-approved antimicrobials for plague include streptomycin, ciprofloxacin, levofloxacin, moxifloxacin, and doxycycline. Although not approved for plague, gentamicin, chloramphenicol, and trimethoprim-sulfamethoxazole are considered effective. […] Patients initially treated with parenteral antimicrobials can be transitioned to oral administration when they are improving clinically. […] All clinical forms of plague require 10-14 days of treatment in total. The duration of treatment can be extended for those with continuing fever or other worrisome signs or symptoms. […] Treatment recommendations for those who are elderly or immunocompromised are the same as those for adults; however, these patients may experience decreased glomerular filtration rate or polypharmacy, and clinicians should adjust treatment as necessary.

• #38 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Begin appropriate therapy as soon as plague is suspected. […] Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors. […] The decision to initiate antibiotic therapy for plague should be made based on clinical signs and symptoms and a careful patient history. […] Gentamicin and fluoroquinolones are first-line treatments in the United States. […] Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs. […] The regimens listed below may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Recommended antibiotic treatment for plague […] Recommended antimicrobial treatment of adults and children with pneumonic or septicemic plague

• #39 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Begin appropriate therapy as soon as plague is suspected. […] Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors. […] The decision to initiate antibiotic therapy for plague should be made based on clinical signs and symptoms and a careful patient history. […] Gentamicin and fluoroquinolones are first-line treatments in the United States. […] Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs. […] The regimens listed below may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Recommended antibiotic treatment for plague […] Recommended antimicrobial treatment of adults and children with pneumonic or septicemic plague

• #40 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  FDA-approved antimicrobials for plague include streptomycin, ciprofloxacin, levofloxacin, moxifloxacin, and doxycycline. Although not approved for plague, gentamicin, chloramphenicol, and trimethoprim-sulfamethoxazole are considered effective. […] Patients initially treated with parenteral antimicrobials can be transitioned to oral administration when they are improving clinically. […] All clinical forms of plague require 10-14 days of treatment in total. The duration of treatment can be extended for those with continuing fever or other worrisome signs or symptoms. […] Treatment recommendations for those who are elderly or immunocompromised are the same as those for adults; however, these patients may experience decreased glomerular filtration rate or polypharmacy, and clinicians should adjust treatment as necessary.

• #41 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  FDA-approved antimicrobials for plague include streptomycin, ciprofloxacin, levofloxacin, moxifloxacin, and doxycycline. Although not approved for plague, gentamicin, chloramphenicol, and trimethoprim-sulfamethoxazole are considered effective. […] Patients initially treated with parenteral antimicrobials can be transitioned to oral administration when they are improving clinically. […] All clinical forms of plague require 10-14 days of treatment in total. The duration of treatment can be extended for those with continuing fever or other worrisome signs or symptoms. […] Treatment recommendations for those who are elderly or immunocompromised are the same as those for adults; however, these patients may experience decreased glomerular filtration rate or polypharmacy, and clinicians should adjust treatment as necessary.

• #42 Evaluating Oral Ciprofloxacin for Treatment of Plague

  https://www.contagionlive.com/view/evaluating-oral-ciprofloxacin-for-treatment-of-plague

  According to the authors, all five patients recovered from their fevers within just two days of treatment. […] Fluoroquinolones have properties that make them particularly suitable for treatment of plague, the authors state, including bactericidal activity, good oral bioavailability, excellent tissue penetration, and an established safety record. […] Laboratory studies and animal studies have also suggested that, with respect to the ability to kill Yersinia pestis, ciprofloxacin is as effective as streptomycin and more effective than doxycycline. […] These results add to the growing body of evidence supporting broader use of oral ciprofloxacin for treating plague in people, especially in resource-poor areas where intravenous treatment is limited, Dr. Apangu and colleagues conclude. […] Despite previous warnings from the FDA on the use of fluoroquinolones, in certain situations, the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.

• #43 Plague Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/plague

  Plague is treated with antibiotics. People with plague need to be treated right away. Treatment should be given if plague is suspected, even before test results come back. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. […] Antibiotics used to treat plague include: Ciprofloxacin, Doxycycline, Gentamicin, Levofloxacin, Moxifloxacin, Streptomycin. […] Oxygen, intravenous fluids, and respiratory support are usually also needed. […] People with pneumonic plague must be kept away from other patients and isolation procedures will be followed in the hospital. People who have had close contact with anyone infected by pneumonic plague should be given antibiotics as a preventive measure and watched carefully.

• #44 Plague Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/plague

  Plague is treated with antibiotics. People with plague need to be treated right away. Treatment should be given if plague is suspected, even before test results come back. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. […] Antibiotics used to treat plague include: Ciprofloxacin, Doxycycline, Gentamicin, Levofloxacin, Moxifloxacin, Streptomycin. […] Oxygen, intravenous fluids, and respiratory support are usually also needed. […] People with pneumonic plague must be kept away from other patients and isolation procedures will be followed in the hospital. People who have had close contact with anyone infected by pneumonic plague should be given antibiotics as a preventive measure and watched carefully.

• #45 Plague Disease (Black Death): Symptoms, Types, Causes, Treatment

  https://www.emedicinehealth.com/plague/article_em.htm

  What Is the Treatment for Plague? […] If doctors suspect a patient may have the plague, healthcare professionals will take precautions when dealing with the patient and will wear goggles, gloves, gowns, and masks. […] Patients are isolated and precautions are taken not to infect others. Some patients may need help breathing and are given oxygen. They are kept away from others for two to three days after antibiotic treatment has started or until the infection is cleared. […] Most patients experience some degree of septic shock (low blood pressure), and specialists monitor this closely in an intensive care unit. […] Medical management of the plague can involve several medications. Antibiotics must be given early in the infection to maximize the chance of the antibiotics killing Y. pestis bacteria. These antibiotics might include streptomycin sulfate in combination with tetracycline and other antibiotics.

• #46 GUIDELINE for Plague due to Yersinia pestis — ABCD cats & vets

  https://www.abcdcatsvets.org/guideline-for-plague-due-to-yersinia-pestis/

  Plague is a severe bacterial disease of humans and other mammals caused by Yersinia pestis. […] Diagnosis is based on cytological, cultural, and PCR techniques. […] Gentamycin is the first line antibiotic, sometimes used in combination with fluoroquinolones. […] Doxycycline is given for prevention in cats with known contact with infected animals. […] Different treatment protocols have been used in humans to treat the plague but only a small, randomized trial with gentamycin and doxycycline has been performed. […] Gentamycin is the drug of choice, sometimes in combination with fluoroquinolones; doxycycline is used in less severe cases (bubonic form) or for prevention in cats with known contact with infected animals. […] In case of bubonic form, drainage of abscesses improves the prognosis.

• #47 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Recommended antimicrobial treatment of adults and children with bubonic or pharyngeal plague […] Recommended antimicrobial treatment of pregnant women with pneumonic, bubonic, septicemic, or pharyngeal plague […] Post-exposure prophylaxis is indicated for persons with known exposure to plague, such as close ( 6 ft), sustained contact with a patient or animal with pneumonic plague or direct contact with infected body fluids or tissues. […] Prophylaxis with a single antimicrobial agent is recommended for potentially exposed persons following a case of naturally acquired infection or intentional release of Y. pestis.

• #48 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #49 Plague | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html

  Bubonic plague is the most common form, usually resulting from the bite of an infected flea. Without prompt treatment, the bacteria may be disseminated by haematogenous route, producing a more severe form (see below) with a high mortality rate. […] Start empiric antibiotic treatment for 10 to 14 days as soon as plague is suspected, before results of diagnosis tests are available. […] A combination of 2 antibiotics from different classes is recommended in severe disease, plague meningitis, and pregnant women. […] If mild disease: gentamicin IM or IV or ciprofloxacin PO or IV. […] If severe disease: gentamicin + ciprofloxacin or, if not available, gentamicin + doxycycline. […] After clinical improvement, change to ciprofloxacin or doxycycline PO. […] Bubonic, pneumonic, and septicaemic plague: gentamicin IM or IV + ciprofloxacin PO or IV. […] Plague meningitis: chloramphenicol IV + ciprofloxacin PO or IV. […] In the event of contact with a pneumonic plague patient or direct contact with infected body fluids or tissues of any plague patient: doxycycline PO for 7 days or ciprofloxacin PO for 7 days.

• #50 Plague and Other Yersinia Infections – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/plague-and-other-yersinia-infections

  Treat with streptomycin or gentamicin; acceptable alternatives include doxycycline, ciprofloxacin, levofloxacin, and chloramphenicol. […] Monitor close contacts carefully, treat them prophylactically with doxycycline, ciprofloxacin, or levofloxacin, and treat children with TMP/SMX; plague vaccine is no longer available in the United States.

• #51 Controlling Spread of Plague | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/plague/controlling

  Droplet Precautions are indicated when caring for patients with plague until pneumonia is excluded and appropriate antibiotic therapy has been initiated. […] In patients with pneumonic plague, Droplet Precautions should be maintained for 72 hours after starting treatment. […] Cases with pneumonic plague are considered infectious throughout their symptomatic illness and for 72 hours following initiation of antibiotic treatment. […] People who have been in household or face-to-face contact with a case with pneumonic plague during the infectious period should be educated regarding signs and symptoms and recommended prophylaxis, and referred to their healthcare provider for antibiotic prophylaxis. […] If contacts of a pneumonic plague case are unable to receive antibiotic prophylaxis, they should be placed under a strict quarantine for a 7-day period. […] Additionally, a Y. pestis vaccine is recommended for persons whose occupations put them at high risk for exposure to Y. pestis or plague-infected rodents. […] Also, vaccine may be considered for persons traveling to, or residing in, areas with epizootic or epidemic plague.

• #52 Plague Prevention and Therapy: Perspectives on Current and Future Strategies

  https://www.mdpi.com/2227-9059/9/10/1421

  If diagnosed accurately and early after infection, human plague cases can be controlled by the appropriate administration of antimicrobial drugs, including aminoglycoside, tetracyclines, fluroquinolones, and sulfonamides. […] The emergence of multidrug-resistant (MDR) strains of bacterial pathogens, including Y. pestis, is one of the most critical issues facing public health due to the difficulty in treatment, the high cost associated with medical care (particularly in developing countries) and increased mortality rates associated with the drug-resistant phenotypes. […] An effective and safe plague vaccine is important from a public health perspective but also in context of national biodefense strategies. […] The first plague vaccines, developed late in the 19th century, consisted of killed whole cells of Y. pestis.

• #53 Plague Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/235627-guidelines

  The Centers for Disease Control and Prevention (CDC) published clinical practice guidelines on the treatment of plague in July 2021 in the Morbidity and Mortality Weekly Report. These are some of the highlights of the guidelines. […] Plague is treatable with antimicrobials and supportive care. Early recognition and administration of effective antimicrobials are key to saving lives. Persons exposed to Yersinia pestis can avoid illness if given effective antimicrobial prophylaxis. […] Aminoglycosides and fluoroquinolones are the mainstays of treatment for plague. Tetracyclines, chloramphenicol, and trimethoprim-sulfamethoxazole also might be suitable treatment, depending on the type of disease and the age and pregnancy status of the patient. Dual therapy with distinct classes of antimicrobials is recommended in the case of a bioterrorist attack with Y pestis engineered for resistance to treatment.

• #54 Antibiotic Therapy of Plague: A Review

  https://www.mdpi.com/2218-273X/11/5/724

  Antibiotic therapy is essential for countering plague, a deadly disease caused by the bacterium Yersinia pestis. […] Several classes of antibiotics (e.g., tetracyclines, fluoroquinolones, aminoglycosides, sulfonamides, chloramphenicol, rifamycin, and β-lactams) are active in vitro against the majority of Y. pestis strains and have demonstrated efficacy in various animal models. […] Only monotherapy is currently recommended; combination therapy has not shown any benefits in preclinical studies or case reports. […] Concerns about the emergence of multidrug-resistant strains of Y. pestis have led to the development of new classes of antibiotics and other therapeutics (e.g., LpxC inhibitors, cationic peptides, antivirulence drugs, predatory bacteria, phages, immunotherapy, host-directed therapy, and nutritional immunity).

• #55 Antibiotic Therapy of Plague: A Review

  https://www.mdpi.com/2218-273X/11/5/724

  Antibiotic therapy is essential for countering plague, a deadly disease caused by the bacterium Yersinia pestis. […] Several classes of antibiotics (e.g., tetracyclines, fluoroquinolones, aminoglycosides, sulfonamides, chloramphenicol, rifamycin, and β-lactams) are active in vitro against the majority of Y. pestis strains and have demonstrated efficacy in various animal models. […] Only monotherapy is currently recommended; combination therapy has not shown any benefits in preclinical studies or case reports. […] Concerns about the emergence of multidrug-resistant strains of Y. pestis have led to the development of new classes of antibiotics and other therapeutics (e.g., LpxC inhibitors, cationic peptides, antivirulence drugs, predatory bacteria, phages, immunotherapy, host-directed therapy, and nutritional immunity).

• #56 Antibiotic Therapy of Plague: A Review

  https://www.mdpi.com/2218-273X/11/5/724

  Antibiotic therapy is essential for countering plague, a deadly disease caused by the bacterium Yersinia pestis. […] Several classes of antibiotics (e.g., tetracyclines, fluoroquinolones, aminoglycosides, sulfonamides, chloramphenicol, rifamycin, and β-lactams) are active in vitro against the majority of Y. pestis strains and have demonstrated efficacy in various animal models. […] Only monotherapy is currently recommended; combination therapy has not shown any benefits in preclinical studies or case reports. […] Concerns about the emergence of multidrug-resistant strains of Y. pestis have led to the development of new classes of antibiotics and other therapeutics (e.g., LpxC inhibitors, cationic peptides, antivirulence drugs, predatory bacteria, phages, immunotherapy, host-directed therapy, and nutritional immunity).

• #57 Antibiotic Therapy of Plague: A Review

  https://www.mdpi.com/2218-273X/11/5/724

  Antibiotic therapy is essential for countering plague, a deadly disease caused by the bacterium Yersinia pestis. […] Several classes of antibiotics (e.g., tetracyclines, fluoroquinolones, aminoglycosides, sulfonamides, chloramphenicol, rifamycin, and β-lactams) are active in vitro against the majority of Y. pestis strains and have demonstrated efficacy in various animal models. […] Only monotherapy is currently recommended; combination therapy has not shown any benefits in preclinical studies or case reports. […] Concerns about the emergence of multidrug-resistant strains of Y. pestis have led to the development of new classes of antibiotics and other therapeutics (e.g., LpxC inhibitors, cationic peptides, antivirulence drugs, predatory bacteria, phages, immunotherapy, host-directed therapy, and nutritional immunity).

• #58 Plague: Recognition, Treatment, and Prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5744195/

  Streptomycin and gentamicin are recommended for adult patients, including immunocompromised patients and pregnant women. […] For the treatment of primary pneumonic plague, we have successful experience using the combination of streptomycin and ciprofloxacin. […] In addition to antibiotic administration, supportive therapy for severe symptoms, such as shock, should not be neglected. […] Other therapies have been reported, including immunotherapy, phage therapy, bacteriocin therapy, and application of virulence factor inhibitors; however, they are not routinely used in clinics.

• #59 Plague Prevention and Therapy: Perspectives on Current and Future Strategies

  https://www.mdpi.com/2227-9059/9/10/1421

  Live attenuated Y. pestis vaccines, such as the EV strain (derived and attenuated in the 1920s by serial passaging a virulent Y. pestis parent strain isolated from a patient identified as EV), have been in use in various parts of the world for decades. […] While there has been progress in vaccine development, the need remains for other reliably protective and readily deployable countermeasures against plague.

• #60 Plague: Types, History, Causes & Prevention

  https://my.clevelandclinic.org/health/diseases/17782-plague

  Plague needs to be treated with antibiotics right away. Your healthcare provider will give medication to you either through your veins (IV) or in a pill to take. Depending on your symptoms and risk, you may start antibiotics even before your provider has your test results. […] You take antibiotics by mouth or through your veins to treat plague. Your healthcare provider might prescribe one or more of these antibiotics: Ciprofloxacin, Levofloxacin, Moxifloxacin, Doxycycline, Gentamicin, Streptomycin, Chloramphenicol, Trimethoprim-sulfamethoxazole. […] Immediate treatment with antibiotics will help you survive the plague. With quick treatment, about 90% of people with all forms of plague survive. […] Without treatment, plague is nearly always fatal. With treatment, there’s a 5 to 15% mortality (death) rate for bubonic plague and around a 50% mortality rate for pneumonic and septicemic plague.

• #61 Plague Disease (Black Death): Symptoms, Types, Causes, Treatment

  https://www.emedicinehealth.com/plague/article_em.htm

  Well, or asymptomatic contacts of people with the plague are followed up closely and may be given prophylactic antibiotics as a precaution against disease development. […] […] […] What Is the Prognosis for the Plague? […] Patients with plague may develop meningitis (infection and swelling of the brain), septic shock (dangerously low blood pressure with decreased function of the kidneys, brain, or other organs due to a serious system-wide blood infection), tissue death and bleeding, and swelling around the heart. All may lead to death. […] The death rate is about 13% for those treated for bubonic plague. […] A person with primary or secondary septicemic plague (infection in the bloodstream with associated shock symptoms) has an approximate 40% death rate, even when treated.

• #62 Plague – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/plague/symptoms-causes/syc-20351291

  Plague usually can be treated with antibiotics. If not treated, the illness is often deadly. […] If treatment is not begun the first day, the disease progresses rapidly to failure of the lungs, shock and death. […] Most people with bubonic plague survive with prompt diagnosis and treatment. Death is more likely with septicemic plague because it is difficult to diagnose and worsens rapidly. Treatment may unintentionally be delayed. […] Pneumonic plague is severe and worsens rapidly. Risk of death is high if treatment doesn’t begin within 24 hours after symptoms start. […] No vaccine is available, but scientists are working to develop one. Antibiotics can help prevent infection if you were likely exposed to plague. […] People with pneumonic plague are isolated during treatment to prevent the spread of disease. Health care workers must wear protective masks, gowns, gloves and eyewear when they treat someone with pneumonic plague.

• #63

  https://www.who.int/news-room/fact-sheets/detail/plague

  Antibiotic treatment is effective against plague bacteria, so early diagnosis and early treatment can save lives. […] Untreated pneumonic plague can be rapidly fatal, so early diagnosis and treatment is essential for survival and reduction of complications. Antibiotics and supportive therapy are effective against plague if patients are diagnosed in time. Pneumonic plague can be fatal within 18 to 24 hours of disease onset if left untreated, but common antibiotics for enterobacteria (gram negative rods) can effectively cure the disease if they are delivered early. […] Ensure correct treatment: Verify that patients are being given appropriate antibiotic treatment and that local supplies of antibiotics are adequate.

• #64 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Begin appropriate therapy as soon as plague is suspected. […] Patients can be treated with intravenous or oral antimicrobials, depending on severity of illness and other clinical factors. […] The decision to initiate antibiotic therapy for plague should be made based on clinical signs and symptoms and a careful patient history. […] Gentamicin and fluoroquinolones are first-line treatments in the United States. […] Duration of treatment is 10 to 14 days, but treatment can be extended for patients with ongoing fever or other concerning signs. […] The regimens listed below may need to be adjusted depending on a patient’s age, medical history, underlying health conditions, or allergies. […] Recommended antibiotic treatment for plague […] Recommended antimicrobial treatment of adults and children with pneumonic or septicemic plague

• #65 Plague – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/plague/symptoms-causes/syc-20351291

  Plague usually can be treated with antibiotics. If not treated, the illness is often deadly. […] If treatment is not begun the first day, the disease progresses rapidly to failure of the lungs, shock and death. […] Most people with bubonic plague survive with prompt diagnosis and treatment. Death is more likely with septicemic plague because it is difficult to diagnose and worsens rapidly. Treatment may unintentionally be delayed. […] Pneumonic plague is severe and worsens rapidly. Risk of death is high if treatment doesn’t begin within 24 hours after symptoms start. […] No vaccine is available, but scientists are working to develop one. Antibiotics can help prevent infection if you were likely exposed to plague. […] People with pneumonic plague are isolated during treatment to prevent the spread of disease. Health care workers must wear protective masks, gowns, gloves and eyewear when they treat someone with pneumonic plague.

• #66 Clinical Care of Plague | Plague | CDC

  https://www.cdc.gov/plague/hcp/clinical-care/index.html

  Recommended antimicrobial treatment of adults and children with bubonic or pharyngeal plague […] Recommended antimicrobial treatment of pregnant women with pneumonic, bubonic, septicemic, or pharyngeal plague […] Post-exposure prophylaxis is indicated for persons with known exposure to plague, such as close ( 6 ft), sustained contact with a patient or animal with pneumonic plague or direct contact with infected body fluids or tissues. […] Prophylaxis with a single antimicrobial agent is recommended for potentially exposed persons following a case of naturally acquired infection or intentional release of Y. pestis.

• #67 Plague Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/plague

  Plague is treated with antibiotics. People with plague need to be treated right away. Treatment should be given if plague is suspected, even before test results come back. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. […] Antibiotics used to treat plague include: Ciprofloxacin, Doxycycline, Gentamicin, Levofloxacin, Moxifloxacin, Streptomycin. […] Oxygen, intravenous fluids, and respiratory support are usually also needed. […] People with pneumonic plague must be kept away from other patients and isolation procedures will be followed in the hospital. People who have had close contact with anyone infected by pneumonic plague should be given antibiotics as a preventive measure and watched carefully.

• #68 Plague in Cats – Causes, Treatment and Associated Conditions – Vetster

  https://vetster.com/en/conditions/cat/plague

  Plague is a potentially life-threatening bacterial infection caused by the Yersinia pestis bacteria which can affect different species, including cats and humans. […] Affected cats are isolated and treated with antibiotics. […] Due to the high mortality rate and zoonotic potential, immediate medical attention and isolation for cats suspected of infection with Y. pestis are paramount. […] While highly deadly when left untreated, plague is easily managed with antibiotic treatment. […] Treatment options include: Isolation, Flea removal, Antibiotic treatment (10 to 21 days), IV fluids, Vomiting and diarrhea medication, Supplemental oxygen. […] Plague is a reportable disease; as such veterinary staff is required to report cases to public health authorities to ensure proper prevention and contact tracing. […] Prognosis for plague varies from guarded to extremely poor and is dependent on which form develops and the timing of treatment. […] Typical Treatment: Isolation, Flea removal, Antibiotic treatment, IV fluids, Vomiting and diarrhea medication, Supplemental oxygen.

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