Editing Anthrax (section)

== Treatment ==
[[File:Anthrax and Antibiotics - Anthrax is Deadly, Antibiotics Could Save Your Life.webm|thumb|Anthrax, and antibiotics]]
Anthrax cannot be spread from person to person, except in the rare case of skin exudates from cutaneous anthrax.<ref>{{Cite web|date=2019-01-09|title=How People Are Infected {{!}} Anthrax {{!}} CDC|url=https://www.cdc.gov/anthrax/basics/how-people-are-infected.html|access-date=2020-09-16|website=www.cdc.gov|language=en-us|archive-date=26 December 2016|archive-url=https://web.archive.org/web/20161226203338/https://www.cdc.gov/anthrax/basics/how-people-are-infected.html|url-status=live}}</ref> However, a person's clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with [[antimicrobial]] soap and water. Wastewater is treated with bleach or another antimicrobial agent.<ref>{{cite web |url=https://www.osha.gov/SLTC/etools/anthrax/decon.html |title=How should I decontaminate during response actions? |publisher=Occupational Safety & Health Administration |access-date=26 December 2016 |archive-url=https://web.archive.org/web/20161226204204/https://www.osha.gov/SLTC/etools/anthrax/decon.html |archive-date=26 December 2016 |url-status=dead }}</ref> Effective decontamination of articles can be accomplished by boiling them in water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though [[formaldehyde]] is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunize, treat, or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection.{{citation needed|date=May 2021}}

=== Antibiotics ===
Early antibiotic treatment of anthrax is essential; delay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as [[fluoroquinolone]]s ([[ciprofloxacin]]), [[doxycycline]], [[erythromycin]], [[vancomycin]], or [[penicillin]]. FDA-approved agents include ciprofloxacin, doxycycline, and penicillin.<ref name="urlCDC Anthrax Q & A: Treatment">{{cite web|url=http://emergency.cdc.gov/agent/anthrax/faq/treatment.asp|title=CDC Anthrax Q & A: Treatment|access-date=4 April 2011|url-status=dead|archive-url=https://web.archive.org/web/20110505191339/http://emergency.cdc.gov/agent/anthrax/faq/treatment.asp|archive-date=5 May 2011}}</ref> In possible cases of pulmonary anthrax, early [[prophylaxis|antibiotic prophylaxis]] treatment is crucial to prevent possible death. Many attempts have been made to develop new drugs against anthrax, but existing drugs are effective if treatment is started soon enough.<ref>{{cite journal | vauthors = Doganay M, Dinc G, Kutmanova A, Baillie L | title = Human Anthrax: Update of the Diagnosis and Treatment | journal = Diagnostics | volume = 13 | issue = 6 | page = 1056 | date = March 2023 | pmid = 36980364 | pmc = 10046981 | doi = 10.3390/diagnostics13061056 | doi-access = free }}</ref>

=== Monoclonal antibodies ===
In May 2009, [[Human Genome Sciences]] submitted a [[biologic license application]] (BLA, permission to market) for its new drug, [[raxibacumab]] (brand name ABthrax) intended for emergency treatment of inhaled anthrax.<ref>{{cite news |title=HGSI asks for FDA approval of anthrax drug ABthrax |agency=[[Associated Press]] |newspaper=Forbes |date=21 May 2009 |url=http://www.pharmpro.com/news/2009/05/hgsi-asks-fda-approval-anthrax-drug-abthrax |url-status=live |archive-url=https://web.archive.org/web/20141018235213/http://www.pharmpro.com/news/2009/05/hgsi-asks-fda-approval-anthrax-drug-abthrax |archive-date=18 October 2014 }}</ref> On 14 December 2012, the US Food and Drug Administration approved raxibacumab injection to treat inhalational anthrax. Raxibacumab is a [[monoclonal antibody]] that neutralizes toxins produced by ''B. anthracis''.<ref name="urlFDA approves raxibacumab to treat inhalational anthrax">{{cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm332341.htm|title=FDA approves raxibacumab to treat inhalational anthrax|website=[[Food and Drug Administration]]|access-date=14 December 2012|url-status=live|archive-url=https://web.archive.org/web/20121217061133/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm332341.htm|archive-date=17 December 2012}}</ref> In March 2016, FDA approved a second anthrax treatment using a monoclonal antibody which neutralizes the toxins produced by ''B. anthracis''. [[Obiltoxaximab]] is approved to treat inhalational anthrax in conjunction with appropriate [[antibacterial]] drugs, and for prevention when alternative therapies are not available or appropriate.<ref>{{cite web |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm491470.htm |title=FDA approves new treatment for inhalation anthrax |author=News Release |publisher=FDA |date=21 March 2016}}</ref>

=== Biologic for Drug-, Antibody- or Vaccine-resistant Anthrax ===
Treatment of multi-drug resistant, antibody- or vaccine-resistant Anthrax is also possible.  Legler, et al.<ref>{{cite journal | vauthors = Legler PM, Little SF, Senft J, Schokman R, Carra JH, Compton JR, Chabot D, Tobery S, Fetterer DP, Siegel JB, Baker D, Friedlander AM | title = Treatment of experimental anthrax with pegylated circularly permuted capsule depolymerase | journal = Science Translational Medicine | volume = 13 | issue = 623 | pages = eabh1682 | date = December 2021 | pmid = 34878819 | doi = 10.1126/scitranslmed.abh1682 }}</ref> showed that pegylated CapD (capsule depolymerase) could provide protection against 5 LD50 exposures to lethal Ames spores without the use of antibiotics, monoclonal antibodies, or vaccines.  The CapD enzyme removes the poly-D-glutamate (PDGA) capsular material from the bacteria, rendering it susceptible to the innate immune responses.  The unencapsulated bacteria can then be cleared.<ref>{{YouTube|id=QVSM2vaTFaE|title=Engineered enzyme against antibiotic resistant anthrax}}</ref>

[[File:CapD.jpg|thumb|center|400px|''B. anthracis'' Capsule Depolymerase (CapD) degrades the unusual PDGA capsule on the outer surface of the bacterium. The pegylated enzyme has been used in mice to protect against five LD50 challenges of lethal Ames spores.<ref name="pmid22257032">{{cite journal | vauthors = Hu X, Legler PM, Khavrutskii I, Scorpio A, Compton JR, Robertson KL, Friedlander AM, Wallqvist A | title = Probing the donor and acceptor substrate specificity of the γ-glutamyl transpeptidase | journal = Biochemistry | volume = 51 | issue = 6 | pages = 1199–1212 | date = February 2012 | pmid = 22257032 | doi = 10.1021/bi200987b }}</ref> The human enzyme (white surface) has been overlaid onto the bacterial CapD structure (PDB 3G9K,<ref name="Joachimiak">{{cite journal | vauthors = Wu R, Richter S, Zhang RG, Anderson VJ, Missiakas D, Joachimiak A | title = Crystal structure of Bacillus anthracis transpeptidase enzyme CapD | journal = The Journal of Biological Chemistry | volume = 284 | issue = 36 | pages = 24406–24414 | date = September 2009 | pmid = 19535342 | pmc = 2782033 | doi = 10.1074/jbc.M109.019034 | doi-access = free }}</ref> blue ribbon). In red is the substrate binding loop of HuGGT which CapD lacks. CapD binds polymers of D-glutamate. Original figure from Hu, Legler, et al.<ref name="pmid22257032" />]]