Pediatric Plague Medication

Updated: Aug 16, 2021
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
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Antibiotic agents

Class Summary

Patients suspected to have plague should be promptly treated. Prompt treatment with antimicrobials such as aminoglycosides, fluoroquinolones, or doxycycline greatly improves outcome. Streptomycin or gentamicin are preferred. Doxycycline is an effective alternative. Levofloxacin has been approved by the FDA for adults and children aged 6 months or older. New multidrug-resistant strains of Y pestis have been reported in Madagascar.


Aminoglycoside antibiotic is considered the drug of choice. Disadvantages include an intramuscular route of administration, resistant strains, and high toxicity.

Gentamicin (Garamycin)

Aminoglycoside used as an alternative to streptomycin and is equally effective.

Levofloxacin (Levaquin)

Levofloxacin is the L-isomer of the racemate, ofloxacin, a quinolone antimicrobial agent. The antibacterial activity of ofloxacin resides primarily in the L-isomer. It inhibits bacterial topoisomerase IV and DNA gyrase (topoisomerases type II), enzymes required for DNA replication, transcription, repair, and recombination. It is indicated for treatment and prophylaxis of plague, including pneumonic and septicemic plague, caused by Yersinia pestis in adults and pediatric patients, aged 6 months or older.

Tetracycline (Sumycin)

Frequently used for prophylaxis as well as treatment. Is usually substituted for streptomycin after a few days of therapy to minimize toxicity. Inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunits.

Doxycycline (Doxy, Vibramycin)

Used as an alternative for tetracycline. Inhibits protein synthesis and thus bacterial growth by binding to 30S and, possibly, 50S ribosomal subunits.

Chloramphenicol (Chloromycetin)

DOC for plague meningitis. The PO form is not available in the United States, but the IV formulation can be obtained. Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis.