Oral ciprofloxacin effective against modern plague

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Takeaway

  • Data support use of oral ciprofloxacin for human plague, especially in rural, resource-poor areas.

Why this matters

  • In vitro, and now in vivo, evidence demonstrate ciprofloxacin has comparable and/or superior bactericidal activity, respectively, against intracellular Yersinia pestis vs streptomycin and doxycycline/gentamicin, giving clinicians another option to treat modern plague.

Key results

  • 5 patients enrolled: 4, bubonic plague, confirmed by Y pestis isolated from bubo aspirate or blood cultures; 1, pneumonic plague, characterized by hemoptysis, patchy bilateral infiltrates on chest radiograph, confirmed by Y pestis in sputum.
  • In addition to ciprofloxacin, all patients (3 admitted, 2 outpatient) also received adjunctive acetaminophen; 2 received a bolus of normal saline.
  • 5/5 became afebrile ≤2 d and were discharged and/or returned to normal activity at day 14.
  • Patient with pneum...