Plague Treatment & Management

Updated: Aug 13, 2021
  • Author: Venkat R Minnaganti, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Medical Care

Guidelines on the diagnosis and treatment of bubonic plague have been published by the Infectious Diseases Society of America (IDSA) (see Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America). [30, 33]


All patients with suspected plague and signs of pneumonia should be placed in strict respiratory isolation for 48-72 hours after antibiotic therapy is initiated and kept there until pneumonia has been ruled out or until sputum culture have shown negative findings.

Report patients thought to have plague to the local health department and to the WHO.

Alert laboratory personnel to the possibility of the diagnosis of plague. All fluid specimens must be handled with care to prevent aerosolization of the infected fluids. Gowns, gloves, and masks should be worn at all times, and strict infection control is of utmost importance.

Supportive therapy

Hemodynamic monitoring and ventilatory support are performed as appropriate.

Management of sepsis associated with plague requires aggressive intravenous hydration. Norepinephrine and other vasopressors may be required to manage hypotension and to improve hemodynamic status.

Postexposure prophylaxis and treatment guidelines

Both the prevention of symptomatic plague and treatment of plague have been recently reviewed. [1]  In adults, first line treatment is usually streptomycin or gentamicin plus doxycycline with ciprofloxacin, levofloxacin, moxifloxacin or chloramphenicol as secondary choices. In children, streptomycin or gentamicin are the primary choices for treatment with doxycycline, ciprofloxacin or chloramphenicol as secondary choices. Consultation with an infectious diseases specialist for either prophylaxis or treatment antibiotic choices is strongly recommended.  

Presumptive therapy (post-exposure prophylaxis) consists of a 7-day course of oral doxycycline and ciprofloxacin as first line treatment in adults. Treatment of an established case is usually for 10-14 days. 

In a community experiencing a pneumonic plague epidemic, individuals with a temperature of 38.5°C or higher or newly onset cough should promptly receive parenteral antimicrobial therapy. [34]


Surgical Care

Enlarging or fluctuant buboes require incision and drainage.



The following specialists may be consulted:

  • Infectious disease specialist

  • Pulmonary and critical care specialist

  • General surgeon

  • Neurologist