Plague is treated with antibiotics, and they work. The medicines are ordinary ones, in use for decades. What is not ordinary is how little time there is to start them.
Which medicines. Named here so that you recognise them, not so that you take them:
- gentamicin or streptomycin, given by injection;
- ciprofloxacin, levofloxacin or moxifloxacin;
- doxycycline, mainly for bubonic plague;
- chloramphenicol, when the infection has reached the lining of the brain.
The usual course is 10 to 14 days. The choice, the dose and the route are decided by the doctor, and they differ for children and in pregnancy.
Where. In hospital. Besides antibiotics, a person with severe plague may need fluids into a vein, oxygen and help with breathing.
Isolation.
- Pneumonic plague: the patient is isolated, and everyone entering the room takes precautions against droplets. With effective antibiotics the patient is usually no longer contagious after 48 hours.
- Bubonic plague without a cough: no isolation; ordinary care with gloves and hand-washing, and care with anything that has touched pus.
Why hours matter.
- For pneumonic plague the World Health Organization says recovery rates are high when treatment begins within 24 hours of the first symptoms. Its manual adds that death usually follows if effective treatment is not started within 24 to 36 hours.
- Even so, treatment is never withheld because it seems late. Come at any stage.
- Across published cases of bubonic plague, about 66 % of untreated patients died, against about 13 % of those treated.
Recovery. Most people begin to feel better within a week or two of starting treatment. The swollen nodes can take several weeks to go down. Take every dose of the course, to the end, even once you feel well.
What it can do, and what it can leave behind. The complications clinicians list are these:
- tissue death — gangrene — of fingers, toes or the nose, which can end in the loss of a finger, a toe or a limb;
- meningitis;
- respiratory failure;
- failure of other organs;
- afterwards, a long convalescence.
They develop quickly, and they belong to plague that was treated late. The way to avoid them is the same as the way to survive: treatment on the first day.
Pregnancy and children. The same urgency applies; the medicines are chosen and dosed for the patient. In the reported cases, untreated plague in pregnancy was fatal for about two thirds of the women. In a review of 658 patients, 40 % were under 18.
Resistance. Rare. One strain resistant to several antibiotics has been described; the World Health Organization notes that drug resistance has not been a problem in treating patients with plague.
Source. WHO, Manual for plague surveillance, diagnosis, prevention and control (2024), section 6, https://www.who.int/publications/i/item/9789240090422 ; Nelson C. A. et al., "Antimicrobial treatment and prophylaxis of plague", MMWR Recommendations and Reports 70(RR-3), 2021, https://www.cdc.gov/mmwr/volumes/70/rr/rr7003a1.htm ; Médecins Sans Frontières, Clinical guidelines: Plague, https://medicalguidelines.msf.org/en/viewport/CG/english/plague-16689935.html ; Cleveland Clinic, Plague, https://my.clevelandclinic.org/health/diseases/17782-plague
What this is not. Reading, not a prescription. The names of medicines are given for recognition only. Antibiotics for plague are prescribed and supervised by a doctor.