Pediatric Plague Treatment & Management

Updated: Jan 18, 2016
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
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Treatment

Medical Care

Plague is a treatable disease, but clinicians must have a high index of suspicion and initiate appropriate antibiotics at the earliest possible time. [21] Initial evaluation of patients with plague may begin on an emergent outpatient basis. However, hospitalization is generally required to initiate therapy. Isolation of hospitalized patients varies based on the type of disease. Standard precautions are indicated for cases of bubonic plague. Droplet precautions are indicated for patients with pneumonic plague and for all patients until pneumonia has been excluded and treatment initiated. In patients with pneumonic plague, isolation should be continued until 48 hours of appropriate antibiotic treatment has been administered. Aggressive supportive medical care as necessary to stabilize and maintain the patient's hemodynamic and respiratory status.

Currently recommended antibiotic treatment for plague is summarized in the tables below. Gentamicin and fluoroquinolones are typically first-line treatments in the United States. Duration of treatment is 10 to 14 days, or until 2 days after fever subsides. Oral therapy may be substituted once the patient improves.

 

  Recommended antibiotic treatment for plague in adults (Source: CDC, Atlanta, GA) [22]

Table. (Open Table in a new window)

Antibiotic Dose Route of Administration
Streptomycin 1 g twice daily IM
Gentamicin 5 mg/kg once daily, or 2 mg/kg loading dose followed by 1.7 mg/kg every 8 hours IM or IV
Levofloxacin 500 mg once daily IV or po
Ciprofloxacin

400 mg every 8-12 hours

IV

500-750 mg twice daily po
Doxycycline 100 mg twice daily or 200 mg once daily IV or po
Moxifloxacin 400 mg once daily IV or po
Chloramphenicol 25 mg/kg every 6 hours IV

 

Recommended antibiotic treatment for plague in Children* (Source: CDC, Atlanta, GA) [22]

Table. (Open Table in a new window)

Antibiotic Dose Route of Administration
Streptomycin 15 mg/kg twice daily (maximum 2 g/day) IM
Gentamicin 2.5 mg/kg/dose every 8 hours IM or IV
Levofloxacin 10 mg/kg/dose (maximum 500 mg/dose) IV or po
Ciprofloxacin

15 mg/kg/dose every 12 hours (maximum 400 mg/dose)

IV

20 mg/kg/dose every 12 hours (maximum 500 mg/dose) po
Doxycycline

Weight < 45 kg: 2.2 mg/kg twice daily (maximum 100 mg/dose)

Weight ≥ 45 kg: same as adult dose

IV or po
Chloramphenicol (for children > 2 years) 25 mg/kg every 6 h (maximum daily dose, 4 g) IV

* All recommended antibiotics for plague have relative contraindications for use in children and; however, use is justified in life-threatening situations.

Additionally, updated 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). [23]

 

Provide supportive medical care as necessary to stabilize and maintain the patient's hemodynamic and respiratory status.

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). [23]

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Surgical Care

Incision and drainage of buboes may be indicated. Material drained from the buboes is infectious until patient is appropriately treated.

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Consultations

Consultations may include the following:

  • Infectious disease specialist

  • Intensive care specialist, if hemodynamic or respiratory instability is present

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Diet

No special diet is required.

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Activity

No specific activity restrictions are required.

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Prevention

Persons engaging in outdoor activities in areas where plague is endemic should wear long pants when possible and use insect repellent on clothing and skin. Persons also should avoid direct contact with ill or dead animals and never feed squirrels, chipmunks, or other rodents. In addition, pet owners should regularly use flea control products on their pets and consult a veterinarian if their pet is ill. Rodent habitat can be reduced around the home by removing brush, clutter, and potential rodent food sources such as garbage or pet food.

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