What is a first-line option for post-exposure prophylaxis after suspected inhalational anthrax exposure?

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Post-exposure prophylaxis for suspected inhalational anthrax must use antibiotics that can prevent germinating spores from causing illness, and the duration must span the entire incubation window. Inhalational anthrax can take up to about 60 days to develop after exposure, so preventive therapy is continued for 60 days to cover the full potential period of illness. The recommended first-line options for this purpose are ciprofloxacin or doxycycline given for 60 days; these drugs have reliable activity against Bacillus anthracis and are endorsed by public health guidelines for post-exposure prophylaxis, providing protection throughout the risk period. Shorter courses, such as amoxicillin for 14 days, azithromycin for 5 days, or cefdinir for 7 days, do not cover the full incubation period and therefore are not appropriate as first-line post-exposure prophylaxis for suspected inhalational anthrax.