Plague Treatment & Management

Updated: Aug 15, 2017
  • Author: Venkat R Minnaganti, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Medical Care

Updated (2014) 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). [24]


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

Presumptive therapy consists of a 7-day course of oral doxycycline and ciprofloxacin.

Chloramphenicol may be used as an alternative.

Levofloxacin may be prescribed as a 10-14 day regimen for either treatment or postexposure prophylaxis.

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. [27]


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