United States’ regulatory approved pharmacotherapies for nuclear reactor explosions and anthrax-associated bioterrorism

Charles L. Bennett, Peter Georgantopoulos, Robert Peter Gale, Kevin Knopf, William J. Hrushesky, Chadi Nabhan, James O. Armitage

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Introduction: Nuclear reactor incidents and bioterrorism outbreaks are concerning public health disasters. Little is known about US Food and Drug Administration (FDA)-approved agents that can mitigate consequences of these events. We review FDA data supporting regulatory approvals of these agents. Areas covered: We reviewed pharmaceutical products approved to treat Hematopoietic Acute Radiation Syndrome (H-ARS) and to treat or prevent pulmonary infections following Bacillus anthracis (anthrax) exposure. Four drugs were approved for H-ARS: granulocyte-colony stimulating factor (G-CSF), granulocyte/macrophage colony stimulating factor, pegylated G-CSF, and romiplostim. For bioterrorism-associated anthrax, the FDA approved five antibiotics (doxycycline, penicillin-G, levofloxacin, moxifloxacin, and ciprofloxacin), two monoclonal antibodies (obiltoxaximab and raxibacumab), one polyclonal antitoxin (Anthrax Immune Globulin Intravenous) and two vaccines (Anthrax Vaccine Adsorbed and Anthrax Vaccine Adsorbed with an adjuvant). A national stockpile system ensures that communities have ready access to these agents. Our literature search was based on data included in drugs@FDA (2001–2023). Expert opinion: Two potential mass public health disasters are aerosolized anthrax dissemination and radiological incidents. Five agents authorized for anthrax emergencies only have FDA approval for this indication, five antibiotics have FDA approvals as antibiotics for common infections and for bacillus anthrax, and four agents have regulatory approvals for supportive care for cancer and for radiological incidents.

Original languageEnglish (US)
Pages (from-to)783-788
Number of pages6
JournalExpert Opinion on Drug Safety
Issue number9
StatePublished - 2023


  • Anthrax
  • animal rule
  • bioterrorism
  • hematopoietic acute radiation syndrome
  • stockpile

ASJC Scopus subject areas

  • Pharmacology (medical)


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