Prophylaxis after exposure to Coxiella burnetii.
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).
Moodie
Claire E
CE
Centers for Disease Control and Prevention, Atlanta, Georgia, USA. claire_moodie@hotmail.com
Thompson
Herbert A
HA
Meltzer
Martin I
MI
Swerdlow
David L
DL
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology; D023482:Bioterrorism / Q000517:prevention & control; D002648:Child; D016997:Coxiella burnetii / Q000472:pathogenicity*; D003663:Decision Trees; D004318:Doxycycline / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006349:Heart Valve Diseases / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D007231:Infant, Newborn; D008297:Male; D008954:Models, Biological; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011778:Q Fever / Q000517:prevention & control* / Q000635:transmission; D018570:Risk Assessment; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline