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Experts Caution Against Hoarding Bioterrorism Drugs

Efforts to stash Cipro and other antibiotics to stave off anthrax may be futile, they say

FRIDAY, Oct. 5, 2001 (HealthDayNews) -- People frantically trying to stock up on antibiotics in fear of a bioterrorism attack might be doing so in vain.

Americans' panic may be understandable, experts say, but their actions -- aside from soothing their fears -- are probably futile.

Since the Sept. 11 attacks on the World Trade Center towers, pharmacies in New York City have reported a run on the prescription antibiotic Cipro (ciprofloxacin) to treat anthrax, a deadly disease that people fear terrorists might spread by releasing bacteria into the air.

Beyond New York, and throughout the country, fearful Americans also have stockpiled bottled water and bought gas masks and other emergency provisions.

"If people believe that getting gas masks or stashes of Cipro are going to provide some benefit, then I think they're mistaken," says pharmacist and toxicologist Bruce Anderson, director of the Maryland Poison Center in Baltimore.

"They're focusing on things that are exceptionally unlikely," he adds. "And meanwhile, they're getting in the car and driving to the Army surplus store, and that increases their likelihood of ending up dead [in a car accident] 1,000 times more than getting attacked by a terrorist."

The need for such things is unlikely, Anderson and other experts say, in part because of the difficulty of mounting a biological attack.

Other types of attack seem more probable, says chemical warfare specialist Michael Wartell, who is chairman of the Defense Intelligence Agency Advisory Board and chancellor of Indiana University-Purdue University Fort Wayne.

"While there certainly exists a threat of biological attack, the probability of that kind of thing happening is much lower than [for] the kind of explosions that we just saw," Wartell says. "If you can do the type of damage that was done using our own planes as bombs, and realizing the difficulty of putting together a biological attack, then I don't understand the widespread anxiety about that."

But even the experts acknowledge some basis for people's fears.

"I do understand [the anxiety] in terms of the fear of breathing something in and getting sick," Wartell says. "Yes, that's a very frightening prospect."

And they agree that the particulars on anthrax, and how terrorists might use the bacteria, probably elevate the fear factor. For many, the fears were compounded amid news reports that one of the named hijackers, Mohammed Atta, had made several inquiries into crop dusters.

Anthrax infection, a rare disease, is usually contracted after contact with infected animals or contaminated animal hides or hairs. But since the mid-1900s, a handful of countries and unknown numbers of terrorist groups have found ways to turn the already dangerous bacteria into a deadly biological weapon.

If released into the air, according to the Center for Civilian Biodefense Studies at Johns Hopkins University, an aerosol cloud of anthrax would be colorless, odorless, invisible and undetectable and would affect people indoors as well as those outside.

A hypothetical attack on Washington, D.C., involving the release of 100 kilograms of aerosolized anthrax, would be akin to a hydrogen bomb, the center says, adding that projected death estimates from such an attack would range between 130,000 and 3 million people.

After the accidental release of anthrax spores at a Russian military facility in 1979, 68 of the 79 people who'd inhaled the bacteria died.

And in the first case in the United States in 25 years, a 63-year-old Florida man died today from pulmonary (inhaled) anthrax, but state and federal health officials maintain the man's case cannot be linked to any terrorist act.

Antibiotics, including penicillin and doxycyline, exist to treat anthrax infection. "But there are concerns that the anthrax that is used for weapons purposes may have been altered, so that [these drugs] might not work," Anderson says.

But Bayer Corp.'s Cipro -- used in the United States since 1987 to treat a range of problems, from lower respiratory tract infections and gonorrhea to bone infections and typhoid fever -- was approved in August 2000 by the Food and Drug Administration for use specifically against inhaled anthrax. Bayer sought the approval at the urging of the Centers for Disease Control and Prevention, the company said at an approval hearing.

Dosage recommendations say adults who've been exposed should take 500 milligrams orally twice a day for 60 days.

But that, too, may not be as simple as it sounds.

"Anthrax is not something you can smell or taste or detect, so you don't know that you've been exposed," Anderson says. "So how do you know when you need to treat yourself? And it doesn't work unless you get it into yourself very, very quickly -- within the first day or two after you've been exposed."

"So the practical reality is that, for it to work, you'd have to take Cipro every single day of your life for the rest of your life," he says. "That's expensive, and very impractical."

It also could lead to other problems, Anderson adds.

Like all drugs, Cipro has side effects, he says, including problems with bone and cartilage development. The FDA, in fact, acknowledged in its announcement approving the drug for inhaled anthrax treatment that only the lethal nature of the use of anthrax as a biological agent prompted the agency to override concerns about the drug's long-term safety.

In addition, there could be the problem of Cipro becoming resistant to organisms it normally would fight because of continuing, long-term use, Anderson says.

"People [who've stocked up] are going to have this stuff around, and if they start getting a cold, a viral infection, they'll start to dose themselves," he says, "and that will increase the likelihood of developing resistance."

Taking this antibiotic as a preventive -- or even keeping it in your medicine cabinet just in case -- "doesn't make any sense," Anderson says. "It's not very good use of dollars or of medicine."

Biological terrorism is "very expensive, very difficult and has a relatively low likelihood," he adds. "That doesn't mean we shouldn't conduct research, or do things to try to prevent terrorist actions from taking place. But for most ordinary folks walking around, the likelihood of an attack by a biological weapon is fairly low."

Should that happen, however, federal government officials contend that quick response by federal agencies could contain any epidemic.

"We're prepared to take care of any contingency, any consequence that develops from a biological attack," U.S. Health and Human Services Secretary Tommy Thompson said this week in an interview on the CBS program "60 Minutes."

"I don't think the American public should go out and stockpile antibiotics," Thompson added. "We have enough to treat 2 million people for 60 days."

Still, many people have opted to make their own preparations, hoarding antibiotics, water, and the like.

"In a lot of ways," Wartell says, "succumbing to this kind of fear plays into the hands of the folks who would like to terrorize us -- and I think that's a shame."

What To Do

A vaccine for anthrax has existed since 1970 but, apparently because of limited supplies, has been restricted almost entirely to use by military personnel. Since September 1998, the military has mandated that all its members be vaccinated against anthrax.

To find out more about anthrax, visit the Centers for Disease Control and Prevention.

To learn more about bioterrorism preparedness and defense, check out information from the Center for Civilian Biodefense Studies.

SOURCES: Interviews with Bruce Anderson, Pharm.D., director, Maryland Poison Institute, and associate professor, University of Maryland School of Pharmacy, Baltimore; Michael Wartell, Ph.D., chancellor and professor of chemistry, Indiana University-Purdue University Fort Wayne, Fort Wayne, Ind., and chairman, Defense Intelligence Agency Advisory Board; Food and Drug Administration; White House Web sites; Bayer Corp. photo
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