ACP American College of Physicians - Internal Medicine - Doctors for Adults

Clinical Information

• PIER - Decision Support
• Guidelines
• Journals & Publications
• Additional Resources
  • Bedside Diagnosis
  • Bioterrorism
  • Lyme Disease Initiative
  • End of Life Care

Bioterrorism and Antibiotics - What You Should Know

Dear Patient:

Because of the terrible events of September 11th and the latest cases of anthrax, many patients have expressed concern about bioterrorism. Patients have asked whether they should be taking antibiotics now as a preventive measure to protect themselves against such diseases.

Please be aware that infectious disease experts at the nation's leading public health agency, Centers for Disease Control and Prevention (CDC), recommend that physicians NOT prescribe antibiotics as a preventive measure or so patients can stockpile these medicines.

There are extremely compelling reasons for this advice.

1. The CDC and other state and local health care agencies are working in a concerted way to detect, diagnose, respond to and prevent illnesses caused by bioterrorism. The CDC has an ample supply of medications, and it is prepared to reach the public within hours of the event. This plan was implemented following the September 11th attack and worked extremely well.
2. Many different biological or chemical agents could be used in a bioterrorism attack. Therefore, the course of treatment will be different and specific to each agent. Anticipating which medications to keep on hand is therefore practically impossible.
3. Unnecessary use of antibiotics is not recommended because there are serious side effects. Many antibiotics are absolutely not to be taken by children, teens and pregnant or nursing women. Indiscriminate use or stockpiling also diminishes existing supplies of antibiotics that will be needed if there is widespread infection or the need to treat other infectious diseases.
4. Most crucial, overuse and misuse of antibiotics through self-medication can create bacteria resistant to treatment. So, if you get sick and need the medicine, it may not work. To avoid this serious problem, antibiotic use must be necessary and specific.

Specifically Regarding Anthrax: Anthrax is an infectious disease but it is not contagious; it cannot be spread from one human to another.

Symptoms: Symptoms vary but occur within 7 days after exposure. Initial symptoms of "inhalation" anthrax may resemble influenza and progress to severe breathing problems. "Intestinal" anthrax may cause nausea, vomiting, abdominal pain and fever. "Cutaneous" anthrax, appears on the skin with recognizable lesions identifiable by a physician. Treatments: The antibiotic ciprofloxacin is currently the most publicized antibiotic used to treat persons exposed to anthrax, but the FDA has approved three types antibiotics for treatment of anthrax: fluoroquinolones (which include ciprofloxacin and others), penicillins and tetracyclines (including doxycycline).

Officials are treating people who have been in or near anthrax-exposed areas with antibiotics and are successfully preventing progression of the disease.

For more information, please refer to the following websites: CDC Bioterrorism website: www.bt.cdc.gov

The American College of Physicians - American Society of Internal Medicine offers the following web-based resources:

Bioterrorism Resource Center
http://www.acponline.org/bioterro/index.html

Quick Facts about Anthrax
http://www.acponline.org/bioterro/anthrax_facts.htm

Emerging Antibiotic Resistance
http://www.acponline.org/ear/

Trust your physician: Your personal physician is your first line of defense when you have any questions or concerns about your health. If medications are necessary, your physician will prescribe the most effective treatment needed to keep you and your family well. In these times, it is important to remain calm. You should know that many organizations, such as the CDC, the American Medical Association, the American College of Physicians American Society of Internal Medicine, and others, are working hard to keep the public well informed and safe in these difficult and uncertain times.

Sincerely,

Herbert S. Waxman, MD
Senior Vice President, Education
American College of Physicians-American Society of Internal Medicine
Philadelphia PA