The Efficacy of Post-Exposure Therapy Against Glanders in Mice

13 Burkholderia mallei, the causative agent of glanders, is a CDC Tier 1 Select Agent for 14 which there is no preventive vaccine and antibiotic therapy is difficult. In this study, we 15 show that a combination of vaccination using killed cellular vaccine and therapy using 16 moxifloxacin, azithromycin, or sulfamethoxazole / trimethoprim can protect BALB/c 17 mice from lethal infection even when given 5 days after infectious challenge. 18 Vaccination only, or antibiotic therapy only, was not efficacious. Although antibiotics 19 evaluated experimentally can protect when given before or 1 day after challenge, this 20 time course is not realistic in the cases of natural infection or biological attack, when the 21 patient seeks treatment after symptoms develop or after a biological attack has been 22 confirmed and the agent identified. Antibiotics can be efficacious after a prolonged 23 interval between exposure and treatment, but only if the animals were previously 24 vaccinated. 25 26