Nuclear War. Painted by Itzhak Brook in 1957
Initial care of medical casualties with moderate and severe radiation exposure should include early institution of measures to reduce pathogen acquisition from the environment, with emphasis on food with low microbial content, clean water supplies, frequent hand washing (or wearing of gloves), and air filtration. ( Bland SA. Mass casualty management for radiological and nuclear incidents. J R Army Med Corps. 2004;150 (3 Suppl 1):27)
Prophylactic use of selective gut decontamination with antibiotics that suppress aerobes but preserve ordinarily commensal anaerobes is recommended. Antibiotic prophylaxis should be considered only in afebrile patients who are at the highest risk for infection because of exposure to a high dose of radiation over 1.5 Gy. The quinolones (e.g., ciprofloxacin, levofloxacin) are used for selective decontamination. However, the use of pefloxacin for selective decontamination or therapy of post-irradiation sepsis is not recommended because its use in irradiated mice increases their mortality rate due to suppression of granulocyte-macrophage progenitor cells. ( Patchen et al. Adverse effects of pefloxacin in irradiated C3H/HeN mice: correction with glucan therapy. Antimicrob Agents Chemother; 37:1882, 1993).
The disadvantage of using quinolones for selective decontamination is that they are absorbed and distributed throughout the body. This may generate systemic side effects and promote antimicrobial resistance. ( Ng et al. Fluoroquinolone prophylaxis against febrile neutropenia in areas with high fluoroquinolone resistance--an Asian perspective. J Formos Med Assoc. 2010 ;109:624).