Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis
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Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis, published by HL7 International - Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cpg-example-anthrax/ and changes regularly. See the Directory of published versions

ActivityDefinition: Moxifloxacin Request (Experimental)

Official URL: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/MoxifloxacinRequest Version: 1.1.0
Draft as of 2024-03-01 Computable Name: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request
Other Identifiers: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest

Usage:Age Range: 18 to ?, Clinical Venue: Outpatient environment, Clinical Focus: Contact with and (suspected) exposure to anthrax, Clinical Focus: Exposure to Bacillus anthracis (event), Clinical Focus: Asymptomatic (finding)

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).

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. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

Generated Narrative: ActivityDefinition

Resource ActivityDefinition "MoxifloxacinRequest"

url: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/MoxifloxacinRequest

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest

version: 1.1.0

name: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request

title: Moxifloxacin Request

status: draft

experimental: true

date: 2024-03-01 20:01:31+0000

publisher: HL7 International - Clinical Decision Support WG

contact: HL7 International - Clinical Decision Support WG: http://www.hl7.org/Special/committees/dss/index.cfm

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).

UseContexts

-CodeValue[x]
*Age Range (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code age = 'Age Range', stated as 'Age Range')18-?
*Clinical Venue (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code venue = 'Clinical Venue', stated as 'Clinical Venue')Outpatient environment (SNOMED CT#440655000)
*Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')Contact with and (suspected) exposure to anthrax (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z20.810)
*Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')Exposure to Bacillus anthracis (event) (SNOMED CT#170475009)
*Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')Asymptomatic (finding) (SNOMED CT#84387000)

jurisdiction: World (m49.htm#001)

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. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

kind: MedicationRequest

product: moxifloxacin HCl 400 MG Oral Tablet (RxNorm#311787)

quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code ORTAB = 'Oral Tablet')

Dosages

-TextAdditionalInstructionTimingRouteMethod
*One every day for 60 daysnone ()Once per 1 daysOral Route (SNOMED CT#26643006)Swallow - dosing instruction imperative (qualifier value) (SNOMED CT#421521009)