Is plague curable?
Yes. "Plague can be cured with antibiotics, but treatment must be given quickly," says CDC. Before antibiotics, 66 to 93 percent of patients died. In US data from the antibiotic era, 9 percent of patients who received at least one dose of an effective antibiotic died, compared with 52 percent of those who received none or the wrong drug.
Antibiotics
Treatment lasts 10 to 14 days, longer if fever persists. First-line drugs for adults (CDC, 2021):
- Pneumonic or septicemic plague: ciprofloxacin, levofloxacin, moxifloxacin, gentamicin, streptomycin.
- Bubonic plague: ciprofloxacin, levofloxacin, moxifloxacin, doxycycline, gentamicin, streptomycin.
- Plague meningitis: chloramphenicol plus moxifloxacin or levofloxacin.
In 2021 WHO added fluoroquinolones to its first-line list, partly because streptomycin and chloramphenicol are becoming scarce. In 2025 a randomised trial in Madagascar showed that 10 days of oral ciprofloxacin alone was as effective for bubonic plague as injected aminoglycosides followed by ciprofloxacin (treatment failure 9.0 vs 8.1 percent), the first conclusive trial of plague treatment.
Why timing matters
Untreated pneumonic plague can kill within 18 to 24 hours of the first symptoms. WHO says recovery rates are high when it is detected and treated within 24 hours, and CDC advises antibiotics within 24 hours of symptom onset. Doctors are told to begin as soon as plague is suspected and "never delay or withhold treatment" while waiting for laboratory results.
Prophylaxis for contacts
Preventive antibiotics are given for 7 days to people who had close (under 2 metres), unprotected contact with a pneumonic plague patient, to lab workers accidentally exposed, and to people who handled infected animals. Options include ciprofloxacin, levofloxacin, moxifloxacin, doxycycline and, per WHO, sulfamethoxazole-trimethoprim. Household members of bubonic plague patients also receive them, WHO says.
Health workers who used standard and droplet precautions do not need prophylaxis and can be placed on a fever watch. Stockpiling antibiotics without an exposure, as some Irkutsk residents reportedly did in October 2026, is not recommended.
Vaccines
- WHO does not recommend vaccination except for high-risk groups such as laboratory personnel and health workers.
- United States: "A plague vaccine is no longer available in the United States."
- European Union: no approved plague vaccine; antibiotics are used as prophylaxis.
- Russia and Kazakhstan: the live EV76-NIIEG vaccine is given yearly to anti-plague laboratory staff and residents of enzootic areas; 90,822 people in the Altai Republic were vaccinated in five years. In April 2024 Russia also licensed a molecular rF1+rV vaccine.
- China: EV76 is licensed for use where plague is endemic.
- Pipeline: more than 21 preclinical candidates and several in clinical trials, including rF1V vaccines (US, China) and Oxford's ChAdOx1 plague vaccine.
Older vaccines never showed sufficient protection against pneumonic plague, which is why none is used for the general public.
Antibiotic resistance
Naturally occurring resistance of Y. pestis to the drugs used for plague is rare worldwide and has not been reported in the US. All 33 isolates cultured during Madagascar's 2017 epidemic were sensitive to every recommended antibiotic.
Quick answers
Is plague curable?
Yes. Plague is cured with common antibiotics such as ciprofloxacin, doxycycline, gentamicin or streptomycin, given for 10 to 14 days. Treatment must start quickly, ideally within 24 hours of the first symptoms for pneumonic plague.
Can I get a plague vaccine?
Not in Europe or the US. A plague vaccine is no longer available in the United States and none is approved in the EU. WHO recommends vaccination only for high-risk groups. Russia, Kazakhstan and China use a live vaccine for anti-plague staff and residents of enzootic areas.
Should I take antibiotics to prevent plague?
Only on medical advice after a real exposure, such as close contact with a pneumonic plague patient. Preventive antibiotics are given for 7 days. Stockpiling or self-medicating without exposure is not recommended.
Reference information, not medical advice. With symptoms after a possible exposure, call your local emergency number.