Systematic Review: A Century of Inhalational Anthrax Cases

Data Synthesis: The authors found 106 reports of 82 cases of inhalational anthrax. Mortality was statistically significantly lower for patients receiving antibiotics or anthrax antiserum during the prodromal phase of disease, multidrug antibiotic regimens, or pleural fluid drainage. Patients in the 2001 U.S. attack were less likely to die than historical anthrax case-patients (45% vs. 92%; P 0.001) and were more likely to receive antibiotics during the prodromal phase (64% vs. 13%; P 0.001), multidrug regimens (91% vs. 50%; P 0.027), or pleural fluid drainage (73% vs. 11%; P 0.001). Patients who progressed to the fulminant phase had a mortality rate of 97% (regardless of the treatment they received), and all patients with anthrax meningoencephalitis died.