{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:41:31Z","timestamp":1785372091482,"version":"3.55.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"6","funder":[{"DOI":"10.13039\/100000071","name":"NICHD","doi-asserted-by":"publisher","award":["R01 HD095547-01"],"award-info":[{"award-number":["R01 HD095547-01"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"NIAID","doi-asserted-by":"publisher","award":["R01 AI130185"],"award-info":[{"award-number":["R01 AI130185"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"NIAID","doi-asserted-by":"publisher","award":["R01 AI136803"],"award-info":[{"award-number":["R01 AI136803"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The high mortality of systemic anthrax is likely a consequence of the severe central nervous system inflammation that occurs in anthrax meningitis. Effective treatment of such infections requires, at a minimum, adequate cerebrospinal fluid (CSF) antimicrobial concentrations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We reviewed English medical literature and regulatory documents to extract information on serum and CSF exposures for antimicrobials with in vitro activity against Bacillus anthracis. Using CSF pharmacokinetic exposures and in vitro B. anthracis susceptibility data, we used population pharmacokinetic modeling and Monte Carlo simulations to determine whether a specific antimicrobial dosage would likely achieve effective CSF antimicrobial activity in patients with normal to inflamed meninges (ie, an intact to markedly disrupted blood\u2013brain barrier).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The probability of microbiologic success at achievable antimicrobial dosages was high (\u226595%) for ciprofloxacin, levofloxacin (500\u2005mg every 12 hours), meropenem, imipenem\/cilastatin, penicillin G, ampicillin, ampicillin\/sulbactam, doxycycline, and minocycline; acceptable (90%\u201395%) for piperacillin\/tazobactam and levofloxacin (750\u2005mg every 24\u2005hours); and low (&amp;lt;90%) for vancomycin, amikacin, clindamycin, and linezolid.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Prompt empiric antimicrobial therapy of patients with suspected or confirmed anthrax meningitis may reduce the high morbidity and mortality. Our data support using several \u03b2-lactam-, fluoroquinolone-, and tetracycline-class antimicrobials as first-line and alternative agents for treatment of patients with anthrax meningitis; all should achieve effective microbiologic exposures. Our data suggest antimicrobials that should not be relied on to treat suspected or documented anthrax meningitis. Furthermore, the protein synthesis inhibitors clindamycin and linezolid can decrease toxin production and may be useful components of combination therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae093","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T17:13:25Z","timestamp":1709054005000},"page":"1451-1457","source":"Crossref","is-referenced-by-count":8,"title":["Central Nervous System Antimicrobial Exposure and Proposed Dosing for Anthrax Meningitis"],"prefix":"10.1093","volume":"78","author":[{"given":"John S","family":"Bradley","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of California\u2013San Diego School of Medicine and Rady Children's Hospital , San Diego, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen B","family":"Bulitta","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy and Translational Research, College of 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M","family":"Hesse","sequence":"additional","affiliation":[{"name":"Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Chaney","sequence":"additional","affiliation":[{"name":"Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yon","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan L","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention , Atlanta, Georgia , 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