there is now considerable recent experience with the use of these antibiotics for selected serious pediatric infections Furthermore, the risk of morbidity and mortality from these biologic agent–induced diseases far outweighs the minor risks (tendinopathy with fluoroquinolones, dental staining with tetracyclines) associated with short-term pediatric use of these medications In fact, ciprofloxacin, levofloxacin, and doxycycline have lower risk of these adverse effects and are approved by the U.S Food and Drug Administration (FDA) for use in children for the treatment and prophylaxis of anthrax and plague following inhalational exposure (i.e., in the context of terrorism) TABLE 132.1 CHARACTERISTICS OF CHEMICAL AND BIOLOGIC ATTACKS Chemical weapons attack (differences in comparison to “routine” hazardous materials incidents) Biologic weapons attack (differences in comparison to natural infectious disease epidemics) Intent to cause mass casualties Intent to cause mass casualties More toxic substances More virulent agents Initial substance identification delayed Rare, nonendemic diseases, delayed diagnosis Greater risk to EMS first responders Greater risk to physicians and other first receivers Overwhelming numbers of patients Overwhelming numbers of patients Many “worried well” Many “worried well” Mass hysteria, panic Mass hysteria, panic Discovery of chemical dispersal device Discovery of biologic agent dispersal device Time frame may or may not be More compressed time frame of compressed outbreak High attack rates near release site Very high infection rates, morbidity, mortality Dead and dying animals More respiratory forms of disease than in natural forms Multiple epidemics at once Reduced rate of infection in sheltered persons Infected, dying animals EMS, emergency medical services Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr Biological and chemical terrorism J Pediatr 2002;141:311–326 Copyright © 2002 Elsevier With permission TABLE 132.2 PEDIATRIC VULNERABILITIES TO BIOLOGIC AND CHEMICAL TERRORISM Realm Potential vulnerability Potential response Physiologic Increased respiratory exposure (higher minute ventilation, time spent “closer to the ground”) Early warning, sheltering a (gas masks for the general population are not advised at present due to risk of poor fit, suffocation) Protective clothing, earlier decontamination a Developmental Increased dermal exposure (thinner, more permeable skin; larger body surface area/mass ratio) Increased risk of dehydration, shock with toxin-induced vomiting, diarrhea (decreased fluid reserves, larger body surface area/mass ratio) Increased risk of hypothermia during decontamination (larger body surface area/mass ratio) More fulminant disease (possible), immunologic immaturity, more permeable blood–brain barrier Differing disease manifestations Relative antibiotic contraindications Less capacity to understand and follow complex instructions, escape attack site, take appropriate evasive actions Recognition, aggressive fluid therapy Warm water decontamination Pediatric-specific research for early diagnosis and treatment of biologic and chemical weapons victims a Education Research trials in children Increased public education, especially of parents, teachers, and caregivers ... Multiple epidemics at once Reduced rate of infection in sheltered persons Infected, dying animals EMS, emergency medical services Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr Biological and chemical... chemical terrorism J Pediatr 2002;141:311–326 Copyright © 2002 Elsevier With permission TABLE 132.2 PEDIATRIC VULNERABILITIES TO BIOLOGIC AND CHEMICAL TERRORISM Realm Potential vulnerability Potential... take appropriate evasive actions Recognition, aggressive fluid therapy Warm water decontamination Pediatric- specific research for early diagnosis and treatment of biologic and chemical weapons victims