Huang, E., Pillai, S., Bower, W., et al. (2014). Antitoxin Treatment of Inhalation Anthrax: A Systematic Review. Health Security. 13(6):365-377.
The authors completed a systematic review (albeit with limited data) of human and animal studies on antitoxin treatment of inhalational anthrax. They found that early treatment with antimicrobial monotherapy or antimicrobial-antitoxin therapy were both associated with survival in animal studies. When treatment was delayed in animal studies, data suggested improved survivability for antimicrobial-antitoxin therapy compared to antimicrobial monotherapy. During large-scale anthrax incidents in which demand for antitoxin may exceed supply, the authors suggest that antitoxins be reserved for those who present with severe illness at onset but have a reasonable chance of survival and those who have not shown a clinical benefit from antimicrobials alone. The authors discussed numerous limitations to their study and emphasized the need for additional research.