This page is part of the Clinical Guidelines (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions
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All Rights Reserved.", "library": [ "Library/Anthrax_Post_Exposure_Prophylaxis_FHIRv400_Library" ], "action": [ { "title": "Anthrax Post Exposure Prophylaxis", "groupingBehavior": "logical-group", "selectionBehavior": "any", "trigger": [ { "type": "data-added", "data": [ { "type": "Condition", "codeFilter": [ { "path": "code", "code": [ { "system": "http://hl7.org/fhir/sid/icd-10-cm", "code": "Z20.810", "display": "Exposure to Anthrax" }, { "system": "http://snomed.info/sct", "code": "170475009", "display": "Exposure to Bacillus anthracis (event)" } ] } ] } ] }, { "type": "data-added", "data": [ { "type": "Observation", "codeFilter": [ { "path": "code", "code": [ { "system": "http://hl7.org/fhir/sid/icd-10-cm", "code": "Z20.810", "display": "Exposure to Anthrax" }, { "system": "http://snomed.info/sct", "code": "170475009", "display": "Exposure to Bacillus anthracis (event)" }, { "system": "http://snomed.info/sct", "code": "84387000", "display": "Asymptomatic (finding)" } ] } ] } ] } ], "condition": [ { "kind": "applicability", "expression": { "language": "text/cql", "expression": "GenerateOrderSet" } } ], "action": [ { "title": "Antimicrobial medications for anthrax post-exposure prophylaxis", "groupingBehavior": "visual-group", "selectionBehavior": "at-most-one", "action": [ { "title": "First line antimicrobial medications for anthrax post-exposure prophylaxis", "groupingBehavior": "visual-group", "selectionBehavior": "at-most-one", "action": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/action-type", "code": "create", "display": "Create" } ] }, "definitionCanonical": "#CiprofloxacinRequest" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/action-type", "code": "create", "display": "Create" } ] }, "definitionCanonical": "#DoxycyclineRequest" } ] }, { "title": "Second line antimicrobial medications for anthrax post-exposure prophylaxis", "groupingBehavior": "visual-group", "selectionBehavior": "at-most-one", "action": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/action-type", "code": "create", "display": "Create" } ] }, "definitionCanonical": "#LevofloxacinRequest" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/action-type", "code": "create", "display": "Create" } ] }, "definitionCanonical": "#MoxifloxacinRequest" }, { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/action-type", "code": "create", "display": "Create" } ] }, "definitionCanonical": "#ClindamycinRequest" } ] } ] } ] } ], "contained": [ { "resourceType": "ActivityDefinition", "id": "CiprofloxacinRequest", "url": "https://cds.ahrq.gov/cdsconnect/artifact/anthrax-post-exposure-prophylaxis", "identifier": [ { "value": "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest" } ], "version": "1.1.0", "name": "Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request", "title": "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request", "status": "draft", "experimental": true, "date": "2019-06-07", "publisher": "Centers for Disease Control and Prevention", "description": "In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). 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All Rights Reserved.", "kind": "MedicationRequest", "productCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "309309", "display": "Ciprofloxacin 500 MG Oral Tablet" } ], "text": "Ciprofloxacin 500 MG Oral Tablet" }, "quantity": { "value": 120, "system": "http://hl7.org/fhir/v3/orderableDrugForm", "code": "ORTAB" }, "dosage": [ { "text": "One every 12 hours for 60 days", "additionalInstruction": [ { "text": "CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine." }, { "text": "CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, theophylline, drugs that prolong QT interval, duloxetine (Cymbalta), zolpidem (Ambien), clozapine or any other drug that may interact and cause serious side effects, consider another antibiotic regimen." }, { "text": "Provide patient education on medications." } ], "patientInstruction": "Take with full glass of water", "timing": { "repeat": { "frequency": 1, "period": 12, "periodUnit": "h" } }, "route": { "coding": [ { "system": "http://snomed.info/sct", "code": "26643006", "display": "Oral Route" } ] }, "method": { "coding": [ { "system": "http://snomed.info/sct", "code": "421521009", "display": "Swallow - dosing instruction imperative (qualifier value)" } ] } } ] }, { "resourceType": "ActivityDefinition", "id": "DoxycyclineRequest", "url": "https://cds.ahrq.gov/cdsconnect/artifact/anthrax-post-exposure-prophylaxis", "identifier": [ { "value": "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest" } ], "version": "1.1.0", "name": "Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request", "title": "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request", "status": "draft", "experimental": true, "date": "2019-06-07", "publisher": "Centers for Disease Control and Prevention", "description": "In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). 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After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). 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After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).", "purpose": "Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. 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All Rights Reserved.", "kind": "MedicationRequest", "productCodeableConcept": { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "311787", "display": "moxifloxacin HCl 400 MG Oral Tablet" } ], "text": "moxifloxacin HCl 400 MG Oral Tablet" }, "quantity": { "value": 60, "system": "http://hl7.org/fhir/v3/orderableDrugForm", "code": "ORTAB" }, "dosage": [ { "text": "One every day for 60 days", "additionalInstruction": [ { "text": "none" } ], "timing": { "repeat": { "frequency": 1, "period": 1, "periodUnit": "d" } }, "route": { "coding": [ { "system": "http://snomed.info/sct", "code": "26643006", "display": "Oral Route" } ] }, "method": { "coding": [ { "system": "http://snomed.info/sct", "code": "421521009", "display": "Swallow - dosing instruction imperative (qualifier value)" } ] } } ] }, { "resourceType": "ActivityDefinition", "id": "ClindamycinRequest", "url": "https://cds.ahrq.gov/cdsconnect/artifact/anthrax-post-exposure-prophylaxis", "identifier": [ { "value": "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest" } ], "version": "1.1.0", "name": "Anthrax_Post_Exposure_Prophylaxis_Adults_Clindamycin_Request", "title": "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request", "status": "draft", "experimental": true, "date": "2019-06-07", "publisher": "Centers for Disease Control and Prevention", "description": "In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).", "purpose": "Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. 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