Oral Ciprofloxacin Bubonic Plague Treatment trial 

A new landmark clinical trial has demonstrated that a 10-day course of the oral antibiotic ciprofloxacin is just as effective as standard treatment for Bubonic plague, paving the way for simpler, more accessible care in outbreak-prone regions.

The study, conducted in rural Madagascar, compared two regimens: one using injectable aminoglycosides for three days followed by seven days of oral ciprofloxacin, and the other with ciprofloxacin alone for ten days. The results showed treatment failure rates of 9.0 % for oral monotherapy versus 8.1 % for the standard regimen—meeting the non-inferiority criterion. 

Bubonic plague, caused by the bacterium Yersinia pestis and spread via fleas carried by rodents, remains endemic in a handful of countries—including Madagascar—despite its historic reputation. The new trial enrolled 450 patients aged 2 to 72 years, of whom 222 had laboratory-confirmed infections. Mortality was approximately 4 % in both treatment arms. 

This oral-only regimen offers major advantages, especially in settings with limited hospital infrastructure or difficult access to injection-based treatment. Oral ciprofloxacin could reduce costs, simplify logistics and expand timely access to care during plague outbreaks. Regulatory bodies and international health agencies are likely to update treatment guidelines accordingly. The development is a significant step forward for plague control, improving both patient access to treatment and global outbreak management strategies.

Key Takeaways:

A 10-day oral ciprofloxacin regimen was found to be as effective as a combined injectable plus oral treatment for bubonic plague.

Oral therapy dramatically simplifies treatment delivery in resource-limited and remote settings where plague is endemic.

The findings are expected to influence future plague treatment guidelines and strengthen global health readiness against plague outbreaks.

Adapted From:

https://www.medscape.com/viewarticle/bubonic-plague-bowled-over-oral-antibiotics-2025a1000lvt?form=fpf

Link to original study

https://www.nejm.org/doi/10.1056/NEJMoa2413772