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Anthrax in children is difficult to detect and treat

Difficulties in diagnosing anthrax may lead to dangerous delays in caring for children infected with this often-deadly disease, according to a new report from the Agency for Healthcare Research and Quality (AHRQ). Treating pediatric anthrax is also a special challenge because most currently recommended therapies have not been widely used to treat children with the disease. The anthrax report was requested and funded by the Health Resources and Services Administration of the Department of Health and Human Services.

Since anthrax exposure occurs rarely in the United States and most of the recent cases have been naturally occurring, clinicians may not have first-hand knowledge of the disease and might have difficulty diagnosing it. In addition, symptoms of pediatric anthrax can be easily confused with those of more common illnesses; for example, inhalational anthrax has symptoms similar to influenza. Also, there is little evidence about the effectiveness in children of interventions currently recommended for adults.

The researchers found very little published evidence of the efficacy of treating children who have anthrax with newer antibiotics such as ciprofloxacin. They also found no reports of anthrax vaccine given to children. The report calls for more current research on the effectiveness in children of non-antibiotic therapies that have been used with considerable success in the past, such as anthrax antiserum and drainage of fluid from the lung cavity.

For the new AHRQ report, investigators analyzed 62 pediatric cases obtained through an extensive review of the scientific literature. Because case reports of pediatric anthrax are relatively rare, investigators examined cases from as early as 1900 in an effort to maximize the available evidence. More than 50 percent involved children between the ages of 14 and 18; data on younger children, especially those under age 2, were more limited. There were only two cases of inhalational anthrax, the most deadly form of the disease.

Editor's Note: The AHRQ report, Pediatric Anthrax: Implications for Bioterrorism Preparedness was prepared by AHRQ's Evidence-based Practice Center at Stanford University and the University of California, San Francisco. Copies of the report can be found at the Agency's Web site at http://www.ahrq.gov/clinic/tp/pedanthtp.htm. Print copies of the report (AHRQ Publication No. 06-E013) are also available through the AHRQ Publications Clearinghouse.

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