Table 1

 Summary of the characteristics and management guidelines for category A biological weapons

AgentIncubation periodSyndromes and key featuresProvider precautionsTreatment recommendations
*Other antimicrobial agents include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin.
**Smallpox vaccine is not recommended in children less than 12 months old.
Anthrax1–60 daysInhalational: fever, respiratoryStandard universalInhalational: IV ciprofloxacin 20–30 mg/kg/day
distress with a widenedprecautionsBID (max 500 mg/dose) or doxycycline
mediastinum, no rhinorrhea4.4–5 mg/kg/day BID (max 100 mg/dose)
Cutaneous: painlessand 1–2 additional antimicrobials*
swelling necrotic ulcerCutaneous: ciprofloxacin or doxycyclyne
(doses as above)
Botulinum12–36 hAcute afebrile symmetricStandard universalSupportive care (respiratory) and passive
descending flaccid paralysis,precautionsimmunisation with equine antitoxin
multiple cranial nerve palsies
Haemorrhagic2–21 daysFever with progressivePatient isolation,Supportive care (attention to fluids
fever viruseshaemorrhagic diathesis,airborne/contactand electrolytes) and ribavirin 30 mg/kg
hypotensionprecautions, personalPO then 15 mg/kg/day BID
protective equipment
Plague2–4 daysPneumonic: fever, respiratoryPatient isolation, airborneStreptomycin 15 mg/kg IM q12h (max 2 g)
distress with haemoptysisprecautions, personalor gentamicin 2.5 mg/kg IV q8h
Bubonic: fever and acuteprotective equipmentAlternate: doxycyclyne, ciprofloxacin,
swollen tender lymph nodechloramphenicol
Smallpox10–12 daysFever with vesicular rashPatient isolation,Vaccinia immune globulin 0.6 mg/kg IM,
concentrated on face andairborne/contactvaccina vaccine, cedofivir plus
extremities (all lesions ofprecautions, personalprobenacid**
same age)protective equipment
Tularaemia3–5 daysFever withStandard universalStreptomycin or gentamicin
pleuropneumonitisprecautionsAlternate: doxycyline,
chloramphenicol, ciprofloxacin