Anthrax is caused by the gram-positive Bacillus anthracis, which are toxin-producing, encapsulated, facultative anaerobic organisms. Anthrax, an often fatal disease of animals, is transmitted to humans by contact with infected animals or animal products. In humans, infection is typically acquired through the skin. Infection via inhalation is less common; infections affecting the oropharyngeal and gastrointestinal tracts and meninges are rare. For inhalation and gastrointestinal infections, nonspecific local symptoms are typically followed in several days by severe systemic illness, shock, and often death. Empiric treatment is with fluoroquinolones or doxycycline. A vaccine is available.
Etiology of Anthrax
Anthrax is an important disease in domestic animals, occurring in goats, cattle, sheep, and horses; it also occurs in wildlife, such as hippos, elephants, and Cape buffalo.
Anthrax is enzootic (a disease that is known to regularly affect animals in a particular area) but not endemic in the United States. Therefore, veterinarians recommend yearly vaccination of livestock in areas where animals have had anthrax in the past. Consequently, it is rare in humans in the United States (1). Anthrax occurs mainly in countries that do not prevent industrial or agricultural exposure to infected animals or animal products (eg, hides, carcasses, hair). (See also Anthrax in Animals.)
However, the potential use of anthrax as a biological weapon has increased fear of this pathogen. Spores have been prepared in a very finely powdered form and weaponized to be used as agents of warfare and bioterrorism (2); in the anthrax bioattacks of 2001, spores were spread in envelopes delivered via the United States Postal Service (3).
Anthrax is considered a notifiable disease. Immediate notification to the local health department should be done, and the local health department must then notify the Centers for Disease Control and Prevention (CDC) when the infection source is unknown, is suspected to be a bioterrorism exposure, or when the case involves severe illness resulting from naturally occurring anthrax (4).
Etiology references
1. Centers for Disease Control and Prevention (CDC): About Anthrax. April 2, 2025. Accessed April 22, 2025.
2. Bush LM, Abrams BH, Beall A, Johnson CC. Index case of fatal inhalational anthrax due to bioterrorism in the United States. N Engl J Med. 2001;345(22):1607-1610. doi:10.1056/NEJMoa012948
3. Centers for Disease Control and Prevention: Bioterrorism and Anthrax: The Threat. April 3, 2025. Accessed August 1, 2025.
4. CDC: Anthrax Case Definition, Reporting, and Surveillance. December 3, 2024. Accessed April 22, 2025.
Pathophysiology of Anthrax
Bacillus anthracis form spores when they are under conditions that are unfavorable for growth (eg, a dry environment). Spores resist destruction and can remain viable in soil, wool, and animal hair and hides for decades. Spores germinate and begin multiplying rapidly when they enter an environment rich in amino acids and glucose (eg, tissue, blood).
Human infection can be acquired by the following routes:
Cutaneous contact (most common)
Ingestion
Inhalation
Injection
Cutaneous infection is the most common form and accounts for > 95% of cases (1). It is usually acquired by contact with infected animals, spore-contaminated animal products or soil containing spores. Open wounds or abrasions increase susceptibility, but infection may occur even when skin is intact. Cutaneous anthrax is typically not contagious, but, in very rare instances, skin infection may be transmitted from person to person by direct contact or fomites (eg, towels, shared bedding).
Gastrointestinal (including oropharyngeal) infection (ingestion anthrax) may occur after ingestion of inadequately cooked meat containing the vegetative forms of the organism, usually when a disruption in the pharyngeal or intestinal mucosa facilitates invasion (1). Ingested anthrax can cause lesions from the oral cavity to the cecum. The released toxin causes hemorrhagic necrotic ulcers in the gastrointestinal lumen and mesenteric lymphadenitis, which may lead to intestinal hemorrhage, obstruction, or perforation. Gastrointestinal anthrax is not transmitted from person to person.
Pulmonary infection (inhalation anthrax), caused by inhaling spores, is almost always due to occupational exposure to contaminated animal products (eg, hides) and is often fatal. An act of overt or covert bioterrorism must be considered whenever inhalation anthrax is diagnosed or suspected. Inhalation anthrax is not transmitted from person to person.
Injection anthrax is rare. It is suspected to result from the recreational use of heroin contaminated with B. anthracis spores or in those who share needles. It leads to severe soft-tissue infections, including those complicated by sepsis and disseminated systemic infection. No cases have been reported in people who do not inject heroin.
Welder's anthrax is a rare form that has been found in several people who were welders or metalworkers (2). It is usually contracted through inhalation and characterized by an occupational pneumonia caused by bacteria within the B. cereus group that produces the anthrax toxin.
After entering the body, spores germinate inside macrophages, which migrate to regional lymph nodes where the bacteria multiply. In inhalation anthrax, spores are deposited in alveolar spaces, where they are ingested by macrophages, which migrate to mediastinal lymph nodes, usually causing a hemorrhagic mediastinitis.
Bacteremia may occur in any form of anthrax and occurs in nearly all fatal cases; meningeal involvement is common.
Virulence factors
The virulence of B. anthracis is due to its:
Extracellular antiphagocytic capsule
Toxins (factors)
Rapid replication capability
The predominant toxins are edema toxin and lethal toxin. A cell-binding protein, called protective antigen (PA), binds to target cells and facilitates cellular entry of edema toxin and lethal toxin. Edema toxin causes massive local edema. Lethal toxin triggers a massive release of cytokines from macrophages, which is responsible for the sudden death common among people with anthrax infection. Lethal toxin is also thought to cause apoptosis of endothelial cells within the vascular system and to contribute to hemorrhage. The bacterium's antiphagocytic poly-D-gamma-glutamic acid capsule, encoded on the pX02 plasmid,helps to protect against phagocytosis.
In welder's anthrax, spores of some B cereus species contain pXO1 virulence genes, which are responsible for producing anthrax toxins.
The rapid replication of B. anthracis and B. cereus significantly contributes to their virulence. The high bacterial burden resulting from rapid multiplication can quickly overwhelm immune defenses in the host.
Pathophysiology references
1. Bower WA, Yu Y, Person MK, et al. CDC Guidelines for the Prevention and Treatment of Anthrax, 2023. MMWR Recomm Rep. 2023;72(6):1-47. Published 2023 Nov 17. doi:10.15585/mmwr.rr7206a1
2. de Perio MA, Hendricks KA, Dowell CH, et al. Welder's Anthrax: A Review of an Occupational Disease. Pathogens. 2022;11(4):402. doi:10.3390/pathogens11040402
Symptoms and Signs of Anthrax
Most patients with anthrax present within 1 to 7 days of exposure, but for inhalation anthrax, the incubation period can potentially be up to 60 days or more, if the exposed quantity of spores is very low.
Cutaneous anthrax begins as a painless, pruritic, reddish brown papule that forms 1 to 12 days after exposure to infective spores (1). The papule enlarges with a surrounding zone of brawny erythema and marked edema. Vesiculation and induration are present. Central ulceration follows, with serosanguineous exudation and formation of a black eschar (the malignant pustule). Local lymphadenopathy is common, occasionally with malaise, myalgia, headache, fever, nausea, and vomiting. It may take several weeks for the wound to heal and the edema to resolve.
CDC
CDC
Gastrointestinal (ingestion) anthrax ranges from asymptomatic to fatal. It usually develops 1 to 7 days after eating contaminated meat. Fever, nausea, vomiting, abdominal pain, and bloody diarrhea are common. Ascites may be present. Intestinal necrosis and septicemia with potentially lethal toxicity ensue. Oropharyngeal anthrax manifests as edematous lesions with central necrotic ulcers on the tonsils, posterior pharyngeal wall, or hard palate. Soft-tissue swelling in the neck is marked, and cervical lymph nodes are enlarged. Symptoms include hoarseness, sore throat, fever, and dysphagia. Airway obstruction may occur.
Inhalation anthrax has the most prolonged incubation period of all the subtypes of anthrax infections (up to 2 months). It begins insidiously as a flu-like illness, developing within a week of exposure. Within a few days, fever worsens, and chest pain and severe respiratory distress develop, followed by cyanosis, shock, and coma. Severe hemorrhagic necrotizing lymphadenitis develops and spreads to adjacent mediastinal structures. Serosanguineous transudation, pulmonary edema, and bloody pleural effusion occur. Typical bronchopneumonia does not occur. Hemorrhagic meningoencephalitis or symptoms of ingestion anthrax may develop.
Welder's anthrax is characterized by high fevers and pulmonary symptoms, including severe pneumonia marked by rapid respiratory distress, persistent cough, and chest pain. When significant parenchymal involvement occurs, patients may also have dyspnea and hypoxia, requiring mechanical ventilation. In severe cases, systemic infection and sepsis can develop, leading to fatalities.
Symptoms and signs reference
1. Stevens DL, Bisno AL, Chambers HF, et al: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 59(2):e10-e52, 2014. doi:10.1093/cid/ciu444
Diagnosis of Anthrax
Gram stain and culture
Direct fluorescent antibody (DFA) test
Polymerase chain reaction (PCR) assay
Anthrax lethal factor toxin testing
Sometimes tests for localized infection such as imaging (chest radiographs or CT for inhalation anthrax) or lumbar puncture (for meningeal anthrax)
Occupational and exposure history is important. Anthrax should be considered in the differential diagnosis in travelers with unexplained fevers or new skin lesions who are returning from anthrax-endemic areas.
Cultures and Gram stain of samples from clinically identified sites, including cutaneous or mucosal lesions, blood, pleural fluid, cerebrospinal fluid, ascites, or stool, should be performed. Sputum examination and Gram stain are unlikely to identify inhalation anthrax because airspace disease is frequently absent.
A PCR test and immunohistochemical methods (eg, DFA) can aid in making a more rapid diagnosis.
Anthrax lethal factor testing involves the detection and quantification of the lethal factor (LF) toxin produced by Bacillus anthracis, typically through mass spectrometry-based assays that measure either its quantity or function (ie, the enzymatic activity of the toxin). LF toxin evaluation is highly specific and a rapid diagnostic tool (1).
An enzyme-linked immunosorbent assay (ELISA) can detect antibody in serum, but confirmation requires a 4-fold change in antibody titer from acute to convalescent specimens.
Nasal swab testing for spores in people potentially exposed to inhalation anthrax is not recommended because the negative predictive value is unknown. Although a positive nasal swab culture indicates exposure, a negative nasal swab does not mean that exposure has not occurred.
Gram-positive bacilli that are characteristic of B. anthracis are shown.
Pearls & Pitfalls
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Chest radiography (or CT) should be performed if pulmonary symptoms are present. It typically shows widening of the mediastinum (because of enlarged hemorrhagic lymph nodes) and pleural effusion. Pneumonic infiltrates are uncommon.
Typical findings of inhalation anthrax on chest radiograph include a widened mediastinum caused by hemorrhagic necrotizing mediastinal lymphadenitis and bilateral pleural effusions. Pneumonic infiltrates are uncommon.
Lumbar puncture should be performed if patients have meningeal signs or a change in mental status. If a lumbar puncture cannot be performed, central nervous system imaging by CT with contrast or MRI with contrast should be done instead to document meningeal enhancement characteristics of meningitis and identify hemorrhagic parenchymal lesions characteristic of anthrax meningoencephalitis.
The state or local health department should be informed of any possible case of anthrax and will assist in diagnostic testing (2). Samples must be handled, packaged, and shipped appropriately to avoid inadvertent anthrax exposure.
Diagnosis references
1. Boyer AE, Quinn CP, Woolfitt AR, et al. Detection and quantification of anthrax lethal factor in serum by mass spectrometry. Anal Chem 2007;79(22):8463-8470. doi:10.1021/ac701741s
2. Centers for Disease Control and Prevention: Health Department Directories. May 15, 2024. Accessed July 15, 2025.
Treatment of Anthrax
Antibiotics
Other medications
Pleural fluid drainage
If the treatment of anthrax is delayed (usually because the diagnosis is missed), the risk of death is increased. Empiric antibiotic treatment needs to be initiated immediately and antibiotic susceptibility results followed up to adjust the choice of agent if needed. Glucocorticoids, monoclonal antibodies, and IVIG are adjunctive treatments that may improve clinical outcomes.
Antibiotics
Cutaneous anthrax
Cutaneous anthrax without significant edema, systemic symptoms, or concern for meningitis is treated with a single antibiotic for 7 to 10 days. If there is risk of inhalation exposure, antibiotics need to be continued for 60 days to complete post-exposure prophylaxis (1). The following are first-line empiric agents:
Ciprofloxacin Ciprofloxacin
Levofloxacin Levofloxacin
MinocyclineMinocycline
Doxycycline Doxycycline
Amoxicillin or penicillin V may be used if the strain is susceptible to penicillin. Amoxicillin or penicillin V may be used if the strain is susceptible to penicillin.
Mortality is rare with treatment, but the lesion will progress through the eschar phase.
Pregnant or lactating women and children should still receive a first-line treatment agent, even if these agents are otherwise generally contraindicated. Because of the critical need to use the most effective antimicrobial agents, the usual avoidance of quinolones and tetracyclines in children and pregnancy is supplanted. Once the susceptibility profile of the anthrax strain is determined and clinical improvement has been demonstrated, alterations of the regimen can be made to decrease possible toxicity. The descending order of preference is doxycycline, ciprofloxacin, and levofloxacin, and minocycline.Pregnant or lactating women and children should still receive a first-line treatment agent, even if these agents are otherwise generally contraindicated. Because of the critical need to use the most effective antimicrobial agents, the usual avoidance of quinolones and tetracyclines in children and pregnancy is supplanted. Once the susceptibility profile of the anthrax strain is determined and clinical improvement has been demonstrated, alterations of the regimen can be made to decrease possible toxicity. The descending order of preference is doxycycline, ciprofloxacin, and levofloxacin, and minocycline.
Inhalation and other forms of anthrax
Inhalation and other forms of anthrax, including cutaneous anthrax with significant edema or systemic symptoms, require initial therapy with 3 antibiotics. Antibiotic therapy should include ≥ 2 antibiotics from different antibiotic classes with bactericidal activity, and ≥ 1 should be a protein or RNA synthesis inhibitor, which may block toxin production. If the B. anthracis strain is susceptible to penicillin, penicillin G is considered equivalent to a fluoroquinolone. strain is susceptible to penicillin, penicillin G is considered equivalent to a fluoroquinolone.
Treatment should be given intravenously for ≥ 2 weeks or until the patient is clinically stable, whichever is longer. Once IV combination therapy is completed, therapy should be continued with a single oral antibiotic given for 60 days to prevent relapse resulting from ungerminated spores in the lungs.
Appropriate first-line antibiotics with bactericidal activity include:
A fluoroquinolone (ciprofloxacin or levofloxacin)A fluoroquinolone (ciprofloxacin or levofloxacin)
A carbapenem (meropenem or imipenem/cilastatin)A carbapenem (meropenem or imipenem/cilastatin)
For penicillin-susceptible strains, penicillin G or ampicillin For penicillin-susceptible strains, penicillin G or ampicillin
Appropriate first-line antibiotics that inhibit protein synthesis include minocycline, doxycycline, or clindamycin.Appropriate first-line antibiotics that inhibit protein synthesis include minocycline, doxycycline, or clindamycin.
The recommended RNA synthesis inhibitor is rifampin.The recommended RNA synthesis inhibitor is rifampin.
If meningitis is suspected, meropenem should be used with other antibiotics because it has good central nervous system penetration. If meropenem is not available, imipenem/cilastatin is an equivalent alternative.
Other medications
Glucocorticoids may be useful for meningitis and severe mediastinal edema but have not been evaluated adequately.
Raxibacumab and obiltoxaximab are monoclonal antibodies that work by preventing binding of the protective antigen (PA) component of the anthrax toxin to its receptors in host cells, thereby blocking the toxin’s deleterious effects and should be used when available in combination with antibiotics to treat inhalation anthrax (Raxibacumab and obiltoxaximab are monoclonal antibodies that work by preventing binding of the protective antigen (PA) component of the anthrax toxin to its receptors in host cells, thereby blocking the toxin’s deleterious effects and should be used when available in combination with antibiotics to treat inhalation anthrax (2). These monoclonal antibodies have shown efficacy in animal models of inhalation anthrax, particularly when given early.
Intravenous anthrax human immune globulin prepared from the plasma of donors who have been vaccinated against anthrax can be used in combination with antibiotics to treat inhalation anthrax if monoclonal antibodies are not available.
Drug resistance
Drug resistance is a concern. Although normally sensitive to penicillin, B. anthracis manifests inducible beta-lactamases (1), so single-drug therapy with a penicillin or a cephalosporin is generally not recommended.
Pleural fluid drainage
Patients with inhalation anthrax require supportive care and sometimes mechanical ventilation. Prompt and continuous pleural fluid drainage by chest tube is critical.
Treatment references
1. Bower WA, Yu Y, Person MK, et al. CDC Guidelines for the Prevention and Treatment of Anthrax, 2023 [published correction appears in MMWR Morb Mortal Wkly Rep. 2024 Aug 08;73(31):689. doi: 10.15585/mmwr.mm7331a4]. MMWR Recomm Rep 2023;72(6):1-47. Published 2023 Nov 17. doi:10.15585/mmwr.rr7206a1
2. Slay RM, Cook R, Hendricks K, Boucher D, Merchlinsky M. Pre- and Postlicensure Animal Efficacy Studies Comparing Anthrax Antitoxins. Clin Infect Dis. 2022;75(Suppl 3):S441-S450. doi:10.1093/cid/ciac593
Prognosis for Anthrax
Case fatality approximate rates in untreated anthrax vary depending on infection type (1, 2, 3, 4):
Inhalation and meningeal anthrax: 90%
Cutaneous anthrax: 20%
Gastrointestinal anthrax: 40%
Oropharyngeal anthrax: 12 to 50%
Injection anthrax: 30%
Welder's anthrax: > 50%
With early diagnosis, treatment, and intensive support, including mechanical ventilation, fluids, and vasopressors, mortality of inhalation anthrax may be reduced. Mortality in welders is high due to the chronic lung injury associated with sustained exposure to metal fumes and high temperatures.
Prognosis references
1. Person MK, Cook R, Bradley JS, et al: Systematic review of hospital treatment outcomes for naturally acquired and bioterrorism-related anthrax, 1880-2018. Clin Infect Dis 75(Suppl 3):S392–S401, 2022. doi: 10.1093/cid/ciac536
2. U.S. Food and Drug Administration: Vaccines: Anthrax. July 21, 2023. Accessed July 15, 2025.
3. Grunow R, Verbeek L, Jacob D, et al: Injection anthrax--a new outbreak in heroin users. Dtsch Arztebl Int 109(49):843–848, 2012. doi:10.3238/arztebl.2012.0843
4. Dawson P, Schrodt CA, Feldmann K, et al: Notes from the Field: Fatal Anthrax Pneumonia in Welders and Other Metalworkers Caused by Bacillus cereus Group Bacteria Containing Anthrax Toxin Genes - U.S. Gulf Coast States, 1994-2020. MMWR Morb Mortal Wkly Rep 70(41):1453–1454, 2021. doi:10.15585/mmwr.mm7041a4
Prevention of Anthrax
Cutaneous anthrax may result in acquired immunity; subsequent infections are rarely reported and tend to be milder, implying some degree of acquired immunity. Inhalation anthrax may provide some protection against future anthrax infection in patients who survive (1) but this idea is supported mostly by anecdotal evidence that humoral immunity develops, which is based on the observation that reinfections are less severe.
An anthrax vaccine (AVA)anthrax vaccine (AVA), composed of a cell-free culture filtrate containing protective antigen protein, is available for preexposure prophylaxis in adults between ages 18 and 65 years at high risk (eg, military personnel, veterinarians, laboratory technicians, employees of textile mills processing imported goat hair, employees handling animals or animal products, travel to certain parts of the world, and welding or metal work). The vaccine contains no dead or live bacteria and is administered with a 5-dose intramuscular series (0.5 mL) at 0 and 4-weeks, followed by subsequent injections at 6, 12, and 18 months, as well as yearly boosters. A separate veterinary vaccine is also available.
Repeated annual preexposure vaccination is required to ensure protection. The anthrax vaccine is reportedly effective for people who complete the primary series and maintain the booster vaccinations (Repeated annual preexposure vaccination is required to ensure protection. The anthrax vaccine is reportedly effective for people who complete the primary series and maintain the booster vaccinations (2). Local reactions from vaccine can occur. Pregnant women should not be vaccinated against anthrax unless the potential benefits of vaccination have been determined to outweigh the potential risk to the fetus. Persons with serious or severe allergic reaction to the anthrax vaccine should not be administered the vaccine prior to exposure. People in the United States who anticipate exposure to anthrax may find information about vaccine availability from their local state health department (). Local reactions from vaccine can occur. Pregnant women should not be vaccinated against anthrax unless the potential benefits of vaccination have been determined to outweigh the potential risk to the fetus. Persons with serious or severe allergic reaction to the anthrax vaccine should not be administered the vaccine prior to exposure. People in the United States who anticipate exposure to anthrax may find information about vaccine availability from their local state health department (3).
Postexposure prophylaxis
Postexposure measures include:
Antibiotics
Vaccination
Monoclonal antibodies
Asymptomatic people (including pregnant patients and children) exposed to inhaled anthrax require prophylaxis with oral antibiotic, given for 60 days. Doxycycline, ciprofloxacin, or levofloxacin are first-line empiric choices and should be adjusted based on the patient's antibiotic susceptibility testing results and pregnancy status (Asymptomatic people (including pregnant patients and children) exposed to inhaled anthrax require prophylaxis with oral antibiotic, given for 60 days. Doxycycline, ciprofloxacin, or levofloxacin are first-line empiric choices and should be adjusted based on the patient's antibiotic susceptibility testing results and pregnancy status (4). The potential risks of quinolones and tetracyclines in children and pregnant patients are outweighed by their benefits. Amoxicillin or penicillin V potassium can be used only if the patient's isolate is known to be penicillin-susceptible. Alternative antibiotics include minocycline, moxifloxacin, and clindamycin. ). The potential risks of quinolones and tetracyclines in children and pregnant patients are outweighed by their benefits. Amoxicillin or penicillin V potassium can be used only if the patient's isolate is known to be penicillin-susceptible. Alternative antibiotics include minocycline, moxifloxacin, and clindamycin.
Viable spores have been detected in the lungs after aerosol exposure. Because people exposed to aerosolized B. anthracis spores are presumed to be at risk of inhalation anthrax due to ungerminated spores remaining in their lungs after the initial exposure, antibiotic therapy is continued for 60 days to clear germinating organisms.
The Centers for Disease Control and Prevention (CDC) recommend that the anthrax vaccine be administered along with appropriate antibiotic prophylaxis to patients exposed to anthrax spores (The Centers for Disease Control and Prevention (CDC) recommend that the anthrax vaccine be administered along with appropriate antibiotic prophylaxis to patients exposed to anthrax spores (5). The CDC recommends a 3-dose subcutaneous vaccine series at 0, 2, and 4 weeks with concomitant antimicrobial therapy for at least 60 days. During an emergency (eg, a bioterrorism attack), the only people who should not be given the vaccine after exposure are those who have had a serious allergic reaction to a previous dose of the anthrax vaccine (be given the vaccine after exposure are those who have had a serious allergic reaction to a previous dose of the anthrax vaccine (6).
Raxibacumab and obiltoxaximab are antitoxin monoclonal antibodies indicated for prophylaxis of inhalation anthrax when alternative therapies are not available or are not appropriate. Raxibacumab and obiltoxaximab are antitoxin monoclonal antibodies indicated for prophylaxis of inhalation anthrax when alternative therapies are not available or are not appropriate.
Prevention references
1. Quinn CP, Dull PM, Semenova V, et al. Immune responses to Bacillus anthracis protective antigen in patients with bioterrorism-related cutaneous or inhalation anthrax. J Infect Dis. 2004;190(7):1228-1236. doi:10.1086/423937
2. Bower WA, Schiffer J, Atmar RL, et al. Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2019. . Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2019.MMWR Recomm Rep. 2019;68(4):1-14. Published 2019 Dec 13. doi:10.15585/mmwr.rr6804a1
3. Centers for Disease Control and Prevention: Health Department Directories. May 15, 2024. Accessed July 15, 2025.
4. Bower WA, Yu Y, Person MK, et al. CDC Guidelines for the Prevention and Treatment of Anthrax, 2023 [published correction appears in MMWR Morb Mortal Wkly Rep. 2024 Aug 08;73(31):689. doi: 10.15585/mmwr.mm7331a4]. MMWR Recomm Rep 2023;72(6):1-47. Published 2023 Nov 17. doi:10.15585/mmwr.rr7206a1
5. Centers for Disease Control and Prevention: Vaccines and Immunizations: Anthrax Vaccine VIS. January 8, 2020. Accessed July 15, 2025.: Vaccines and Immunizations: Anthrax Vaccine VIS. January 8, 2020. Accessed July 15, 2025.
6. Centers for Disease Control and Prevention: Anthrax: Prevention. April 16, 2025. Accessed July 15, 2025.
Key Points
Anthrax is typically acquired from infected animals but has been used as a biological weapon.
Potent toxins, including edema toxin and lethal toxin, are responsible for the most severe manifestations.
The main clinical forms of anthrax are cutaneous (most common), ingestion, inhalation, and meningeal (most lethal).
Ingestion and inhalation anthrax are not transmitted from person to person.
Treat with an appropriate antibiotic regimen and sometimes a monoclonal antibody or anthrax human immune globulin that binds to the protective antigen component of B. anthracis toxin.
Give postexposure prophylaxis with ciprofloxacin, levofloxacin, moxifloxacin, doxycycline, minocycline, or clindamycin; anthrax vaccine; and sometimes monoclonal antibodies to people exposed to inhalation anthrax.Give postexposure prophylaxis with ciprofloxacin, levofloxacin, moxifloxacin, doxycycline, minocycline, or clindamycin; anthrax vaccine; and sometimes monoclonal antibodies to people exposed to inhalation anthrax.
Drugs Mentioned In This Article
