Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis
1.1.0 - ci-build
Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis
1.1.0 - ci-build
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
| Draft as of 2024-11-18 |
{
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"id" : "second-vaccinedose-antimicrobial-notpregnant-pd",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: PlanDefinition second-vaccinedose-antimicrobial-notpregnant-pd</b></p><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd\"> </a><a name=\"hcsecond-vaccinedose-antimicrobial-notpregnant-pd\"> </a><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd-en-US\"> </a><p><b>url</b>: <a href=\"PlanDefinition-second-vaccinedose-antimicrobial-notpregnant-pd.html\">PlanDefinition Second vaccine antimicrobial not pregnant</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet</p><p><b>version</b>: 1.1.0</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults</p><p><b>title</b>: Second vaccine antimicrobial not pregnant</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/plan-definition-type eca-rule}, {http://terminology.hl7.org/CodeSystem/plan-definition-type order-set}\">ECA Rule</span></p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-11-18 16:44:02+0000</p><p><b>publisher</b>: HL7 International - Clinical Decision Support WG</p><p><b>contact</b>: HL7 International - Clinical Decision Support WG: <a href=\"http://www.hl7.org/Special/committees/dss/index.cfm\">http://www.hl7.org/Special/committees/dss/index.cfm</a></p><p><b>description</b>: </p><div><p>Provides information for treating patients greater than or equal to 18 years old exposed to anthrax within the past 60 days, who do not have anthrax. It is divided into two parts: \\n- Part #1: For patients that may be symptomatic to flag the need to conduct a full diagnostic evaluation to rule out anthrax before proceeding with post-exposure prophylaxis (PEP) \\n- Part #2: For patients who are asymptomatic (not displaying signs and symptoms of anthrax), it provides recommended PEP regimen</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>jurisdiction</b>: <span title=\"Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}\">World</span></p><p><b>purpose</b>: </p><div><p>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.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --> (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>library</b>: <a href=\"Library-anthrax-post-exposure-prophylaxis-library.html\">Anthrax Post Exposure Prophylaxis (PEP) for Adults FHIRv400 Logic</a></p><blockquote><p><b>action</b></p><p><b>title</b>: Anthrax Post Exposure Prophylaxis 4</p><blockquote><p><b>trigger</b></p><p><b>type</b>: Data Added</p><blockquote><p><b>data</b></p><p><b>type</b>: Condition</p><blockquote><p><b>codeFilter</b></p><p><b>path</b>: code</p><p><b>code</b>: <a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-icd10CM.html#icd10CM-Z20.46810\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810</a>: Contact with and (suspected) exposure to anthrax, <a href=\"http://snomed.info/id/170475009\">SNOMED CT 170475009</a>: Exposure to Bacillus anthracis (event)</p></blockquote></blockquote></blockquote><blockquote><p><b>trigger</b></p><p><b>type</b>: Data Added</p><blockquote><p><b>data</b></p><p><b>type</b>: Observation</p><blockquote><p><b>codeFilter</b></p><p><b>path</b>: code</p><p><b>code</b>: <a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-icd10CM.html#icd10CM-Z20.46810\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810</a>: Contact with and (suspected) exposure to anthrax, <a href=\"http://snomed.info/id/170475009\">SNOMED CT 170475009</a>: Exposure to Bacillus anthracis (event), <a href=\"http://snomed.info/id/84387000\">SNOMED CT 84387000</a>: Asymptomatic (finding)</p></blockquote></blockquote></blockquote><blockquote><p><b>condition</b></p><p><b>kind</b>: Applicability</p><h3>Expressions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style=\"display: none\">*</td><td>CQL</td><td>GenerateOrderSet</td></tr></table></blockquote><p><b>groupingBehavior</b>: Logical Group</p><p><b>selectionBehavior</b>: Any</p><blockquote><p><b>action</b></p><p><b>title</b>: Antimicrobial medications for anthrax post-exposure prophylaxis</p><p><b>groupingBehavior</b>: Visual Group</p><p><b>selectionBehavior</b>: At Most One</p><blockquote><p><b>action</b></p><p><b>title</b>: First line antimicrobial medications for anthrax post-exposure prophylaxis</p><p><b>groupingBehavior</b>: Visual Group</p><p><b>selectionBehavior</b>: At Most One</p><h3>Actions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Definition[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-antimicrobial-notpregnant-pd/CiprofloxacinRequest\">ActivityDefinition Ciprofloxacin Request</a></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-antimicrobial-notpregnant-pd/DoxycyclineRequest\">ActivityDefinition Doxycycline Request</a></td></tr></table></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Second line antimicrobial medications for anthrax post-exposure prophylaxis</p><p><b>groupingBehavior</b>: Visual Group</p><p><b>selectionBehavior</b>: At Most One</p><h3>Actions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Definition[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-antimicrobial-notpregnant-pd/LevofloxacinRequest\">ActivityDefinition Levofloxacin Request</a></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-antimicrobial-notpregnant-pd/MoxifloxacinRequest\">ActivityDefinition Moxifloxacin Request</a></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></td><td><a href=\"#hcsecond-vaccinedose-antimicrobial-notpregnant-pd/ClindamycinRequest\">ActivityDefinition Clindamycin Request</a></td></tr></table></blockquote></blockquote><blockquote><p><b>action</b></p><p><b>title</b>: Anthrax Vaccination - 2nd dose</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/action-type create}\">Create</span></p><p><b>definition</b>: <a href=\"#hcsecond-vaccinedose-antimicrobial-notpregnant-pd/Inline-Vaccine-Request-8\">ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request</a></p></blockquote></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition #CiprofloxacinRequest</b></p><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/CiprofloxacinRequest\"> </a><a name=\"hcsecond-vaccinedose-antimicrobial-notpregnant-pd/CiprofloxacinRequest\"> </a><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/CiprofloxacinRequest-en-US\"> </a><p><b>url</b>: <a href=\"ActivityDefinition-CiprofloxacinRequest.html\">ActivityDefinition Ciprofloxacin Request</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request</p><p><b>title</b>: Ciprofloxacin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>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).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>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.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --> (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 309309}\">Ciprofloxacin 500 MG Oral Tablet</span></p><p><b>quantity</b>: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>PatientInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every 12 hours for 60 days</td><td><span title=\"Codes:\">CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine.</span>, <span title=\"Codes:\">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.</span>, <span title=\"Codes:\">Provide patient education on medications.</span></td><td>Take with full glass of water</td><td>Once per 12 hours</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition #DoxycyclineRequest</b></p><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/DoxycyclineRequest\"> </a><a name=\"hcsecond-vaccinedose-antimicrobial-notpregnant-pd/DoxycyclineRequest\"> </a><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/DoxycyclineRequest-en-US\"> </a><p><b>url</b>: <a href=\"ActivityDefinition-DoxycyclineRequest.html\">ActivityDefinition Doxycycline Request</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request</p><p><b>title</b>: Doxycycline Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>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).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>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.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --> (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 1650143}\">doxycycline hyclate 100 MG Oral Tablet</span></p><p><b>quantity</b>: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>PatientInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every 12 hours for 60 days</td><td><span title=\"Codes:\">CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, or any other drug that may interact and cause serious side effects, consider another antibiotic regimen.</span>, <span title=\"Codes:\">Provide patient education on medications.</span></td><td>Take with full glass of water</td><td>Once per 12 hours</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition #LevofloxacinRequest</b></p><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/LevofloxacinRequest\"> </a><a name=\"hcsecond-vaccinedose-antimicrobial-notpregnant-pd/LevofloxacinRequest\"> </a><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/LevofloxacinRequest-en-US\"> </a><p><b>url</b>: <a href=\"ActivityDefinition-LevofloxacinRequest.html\">ActivityDefinition Levofloxacin Request</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Levofloxacin_Request</p><p><b>title</b>: Levofloxacin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>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).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>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.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --> (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 311296}\">Levofloxacin 750 MG Oral Tablet</span></p><p><b>quantity</b>: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every day for 60 days</td><td><span title=\"Codes:\">none</span></td><td>Once per 1 days</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition #MoxifloxacinRequest</b></p><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/MoxifloxacinRequest\"> </a><a name=\"hcsecond-vaccinedose-antimicrobial-notpregnant-pd/MoxifloxacinRequest\"> </a><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/MoxifloxacinRequest-en-US\"> </a><p><b>url</b>: <a href=\"ActivityDefinition-MoxifloxacinRequest.html\">ActivityDefinition Moxifloxacin Request</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request</p><p><b>title</b>: Moxifloxacin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>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).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>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.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --> (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 311787}\">moxifloxacin HCl 400 MG Oral Tablet</span></p><p><b>quantity</b>: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>One every day for 60 days</td><td><span title=\"Codes:\">none</span></td><td>Once per 1 days</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition #ClindamycinRequest</b></p><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/ClindamycinRequest\"> </a><a name=\"hcsecond-vaccinedose-antimicrobial-notpregnant-pd/ClindamycinRequest\"> </a><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/ClindamycinRequest-en-US\"> </a><p><b>url</b>: <a href=\"ActivityDefinition-ClindamycinRequest.html\">ActivityDefinition Clindamycin Request</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Clindamycin_Request</p><p><b>title</b>: Clindamycin Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>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).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>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.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --> (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: MedicationRequest</p><p><b>product</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 284215}\">clindamycin HCl 300 MG Oral Capsule</span></p><p><b>quantity</b>: 360(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm)<span style=\"background: LightGoldenRodYellow\"> (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')</span></p><h3>Dosages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>AdditionalInstruction</b></td><td><b>Timing</b></td><td><b>Route</b></td><td><b>Method</b></td></tr><tr><td style=\"display: none\">*</td><td>Two tablets every 8 hours for 60 days</td><td><span title=\"Codes:\">none</span></td><td>2 per 8 hours</td><td><span title=\"Codes:{http://snomed.info/sct 26643006}\">Oral Route</span></td><td><span title=\"Codes:{http://snomed.info/sct 421521009}\">Swallow - dosing instruction imperative (qualifier value)</span></td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ActivityDefinition #Inline-Vaccine-Request-8</b></p><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/Inline-Vaccine-Request-8\"> </a><a name=\"hcsecond-vaccinedose-antimicrobial-notpregnant-pd/Inline-Vaccine-Request-8\"> </a><a name=\"second-vaccinedose-antimicrobial-notpregnant-pd/Inline-Vaccine-Request-8-en-US\"> </a><p><b>url</b>: <a href=\"http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-8\">http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-8</a></p><p><b>identifier</b>: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/VaccineRequest</p><p><b>name</b>: Anthrax_Post_Exposure_Prophylaxis_Adults_Vaccine_Request</p><p><b>title</b>: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request</p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>description</b>: </p><div><p>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).</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-age\">UsageContextType age</a>: Age Range</td><td>18-?</td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-venue\">UsageContextType venue</a>: Clinical Venue</td><td><span title=\"Codes:{http://snomed.info/sct 440655000}\">Outpatient environment</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm Z20.810}\">Contact with and (suspected) exposure to anthrax</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 170475009}\">Exposure to Bacillus anthracis (event)</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 84387000}\">Asymptomatic (finding)</span></td></tr></table><p><b>purpose</b>: </p><div><p>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.</p>\n</div><p><b>usage</b>: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.</p><p><b>approvalDate</b>: 2019-06-07</p><p><b>lastReviewDate</b>: 2019-06-07</p><p><b>effectivePeriod</b>: 2019-06-07 --> (ongoing)</p><p><b>topic</b>: <span title=\"Codes:\">Anthrax</span>, <span title=\"Codes:\">Emergency Medicine</span>, <span title=\"Codes:\">Post-Exposure Prophylaxis</span></p><p><b>author</b>: Alliance to Modernize Healthcare FFRDC: </p><p><b>endorser</b>: Centers for Disease Control and Prevention: </p><p><b>kind</b>: ImmunizationRecommendation</p><p><b>code</b>: <span title=\"Codes:{http://snomed.info/sct 49598002}, {http://snomed.info/sct 170339008}\">Anthrax vaccination</span></p><p><b>product</b>: <span title=\"Codes:{http://hl7.org/fhir/sid/cvx 24}\">Anthrax vaccine</span></p><blockquote><p><b>dosage</b></p><p><b>text</b>: 0.5mL</p><p><b>additionalInstruction</b>: <span title=\"Codes:\">Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs.</span></p><p><b>route</b>: <span title=\"Codes:{http://snomed.info/sct 34206005}\">Subcutaneous route</span></p><h3>DoseAndRates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Dose[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>0.5 mL<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM codemL = 'mL')</span></td></tr></table></blockquote></blockquote></div>"
},
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{
"resourceType" : "ActivityDefinition",
"id" : "CiprofloxacinRequest",
"url" : "http://cqframework.org/cpg-example-anthrax/ActivityDefinition/CiprofloxacinRequest",
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{
"value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest"
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"name" : "Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request",
"title" : "Ciprofloxacin Request",
"status" : "draft",
"experimental" : true,
"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).",
"useContext" : [
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"code" : "age",
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"display" : "Clinical Venue"
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"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
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"coding" : [
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],
"endorser" : [
{
"name" : "Centers for Disease Control and Prevention"
}
],
"kind" : "MedicationRequest",
"productCodeableConcept" : {
"coding" : [
{
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "284215",
"display" : "clindamycin HCl 300 MG Oral Capsule"
}
],
"text" : "clindamycin HCl 300 MG Oral Capsule"
},
"quantity" : {
"value" : 360,
"system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code" : "ORTAB"
},
"dosage" : [
{
"text" : "Two tablets every 8 hours for 60 days",
"additionalInstruction" : [
{
"text" : "none"
}
],
"timing" : {
"repeat" : {
"frequency" : 2,
"period" : 8,
"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" : "Inline-Vaccine-Request-8",
"url" : "http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-8",
"identifier" : [
{
"value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/VaccineRequest"
}
],
"name" : "Anthrax_Post_Exposure_Prophylaxis_Adults_Vaccine_Request",
"title" : "Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request",
"status" : "draft",
"experimental" : true,
"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).",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "age",
"display" : "Age Range"
},
"valueRange" : {
"low" : {
"value" : 18
}
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "venue",
"display" : "Clinical Venue"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "440655000",
"display" : "Outpatient environment"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "Z20.810",
"display" : "Contact with and (suspected) exposure to anthrax"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "170475009",
"display" : "Exposure to Bacillus anthracis (event)"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "84387000",
"display" : "Asymptomatic (finding)"
}
]
}
}
],
"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" : {
"start" : "2019-06-07"
},
"topic" : [
{
"text" : "Anthrax"
},
{
"text" : "Emergency Medicine"
},
{
"text" : "Post-Exposure Prophylaxis"
}
],
"author" : [
{
"name" : "Alliance to Modernize Healthcare FFRDC"
}
],
"endorser" : [
{
"name" : "Centers for Disease Control and Prevention"
}
],
"kind" : "ImmunizationRecommendation",
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "49598002",
"display" : "Anthrax vaccination"
},
{
"system" : "http://snomed.info/sct",
"code" : "170339008",
"display" : "Second anthrax vaccination"
}
]
},
"productCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/cvx",
"code" : "24",
"display" : "Anthrax vaccine"
}
]
},
"dosage" : [
{
"text" : "0.5mL",
"additionalInstruction" : [
{
"text" : "Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs."
}
],
"route" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "34206005",
"display" : "Subcutaneous route"
}
]
},
"doseAndRate" : [
{
"doseQuantity" : {
"value" : 0.5,
"unit" : "mL",
"system" : "http://unitsofmeasure.org",
"code" : "mL"
}
}
]
}
]
}
],
"url" : "http://cqframework.org/cpg-example-anthrax/PlanDefinition/second-vaccinedose-antimicrobial-notpregnant-pd",
"identifier" : [
{
"value" : "Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet"
}
],
"version" : "1.1.0",
"name" : "Anthrax_Post_Exposure_Prophylaxis_Adults",
"title" : "Second vaccine antimicrobial not pregnant",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "eca-rule",
"display" : "ECA Rule"
},
{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "order-set",
"display" : "Order Set"
}
]
},
"status" : "draft",
"experimental" : true,
"date" : "2024-11-18T16:44:02+00:00",
"publisher" : "HL7 International - Clinical Decision Support WG",
"contact" : [
{
"name" : "HL7 International - Clinical Decision Support WG",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/dss/index.cfm"
}
]
}
],
"description" : "Provides information for treating patients greater than or equal to 18 years old exposed to anthrax within the past 60 days, who do not have anthrax. It is divided into two parts: \\n- Part #1: For patients that may be symptomatic to flag the need to conduct a full diagnostic evaluation to rule out anthrax before proceeding with post-exposure prophylaxis (PEP) \\n- Part #2: For patients who are asymptomatic (not displaying signs and symptoms of anthrax), it provides recommended PEP regimen",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "age",
"display" : "Age Range"
},
"valueRange" : {
"low" : {
"value" : 18
}
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "venue",
"display" : "Clinical Venue"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "440655000",
"display" : "Outpatient environment"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "Z20.810",
"display" : "Contact with and (suspected) exposure to anthrax"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "170475009",
"display" : "Exposure to Bacillus anthracis (event)"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "84387000",
"display" : "Asymptomatic (finding)"
}
]
}
}
],
"jurisdiction" : [
{
"coding" : [
{
"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001",
"display" : "World"
}
]
}
],
"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" : {
"start" : "2019-06-07"
},
"topic" : [
{
"text" : "Anthrax"
},
{
"text" : "Emergency Medicine"
},
{
"text" : "Post-Exposure Prophylaxis"
}
],
"author" : [
{
"name" : "Alliance to Modernize Healthcare FFRDC"
}
],
"endorser" : [
{
"name" : "Centers for Disease Control and Prevention"
}
],
"library" : [
🔗 "http://cqframework.org/cpg-example-anthrax/Library/anthrax-post-exposure-prophylaxis-library"
],
"action" : [
{
"title" : "Anthrax Post Exposure Prophylaxis 4",
"trigger" : [
{
"type" : "data-added",
"data" : [
{
"type" : "Condition",
"codeFilter" : [
{
"path" : "code",
"code" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "Z20.810",
"display" : "Contact with and (suspected) 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" : "Contact with and (suspected) 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"
}
}
],
"groupingBehavior" : "logical-group",
"selectionBehavior" : "any",
"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"
}
]
}
]
},
{
"title" : "Anthrax Vaccination - 2nd dose",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/action-type",
"code" : "create",
"display" : "Create"
}
]
},
"definitionCanonical" : "#Inline-Vaccine-Request-8"
}
]
}
]
}