Americans are taking antibiotics into own hands, in case of anthrax

Officials vainly caution against stockpiling, random self-medication

October 13, 2001|By Jonathan Bor | Jonathan Bor,SUN STAFF

Though top health officials are urging people not to stockpile antibiotics, worried Americans are continuing to do just that.

Their fears that government supplies might not be mobilized for a large-scale attack is shared by some bioterrorism experts.

Reports of an anthrax case in New York yesterday, coming after news coverage about three people exposed in Florida, promise to exacerbate what has been a month-long run on pharmacies.

Some drugstores said they were being flooded with a wave of prescriptions for the antibiotic Cipro, a drug used for many common ailments such as urinary tract infections but also for anthrax.

"We ran out about a half-hour ago," Susan Chun of Northern Pharmacy in Baltimore said yesterday, just a few hours after the first reports of the New York case. "Everyone wants Cipro, and we can't fill it."

Yesterday, Health Secretary Tommy G. Thompson tried to reassure people that federal and local health agencies would be able to get antibiotics to anyone exposed to anthrax.

"People should not hoard antibiotics, including Cipro," he said at a news briefing. "We have enough for people who need it."

Public health experts warn that people who get their doctors to write prescriptions - and then take the drugs at the slightest sniffle - will needlessly subject themselves to dangerous side effects.

Perhaps more important, they could promote the growth of bacteria that do not respond to antibiotics. As a result, people who were never exposed to anthrax could suffer from other diseases that are impossible to treat.

To respond to large medical emergencies, the federal government stockpiles antibiotics and medical equipment in huge aluminum crates at eight storage facilities around the country. The packages are designed to be flown to any area of the continental United States within 12 hours. The closest cache to Baltimore is in Fort Indiantown Gap, Pa., northeast of Harrisburg.

Since the Sept. 11 terrorist attacks on the World Trade Center and Pentagon, some bioterrorism experts have voiced skepticism that drugs could be delivered to exposed people in time to do any good.

Dr. John Bartlett, chief of infectious diseases at the Johns Hopkins School of Medicine, said the system might work well in the event of a limited attack. But it might fail if large numbers of people are exposed to deadly bacteria.

"The health care system is not set up to give a million people prophylactic antibiotics," said Bartlett. "You can't have a line with a million people in it. Where are you going to do it?"

When the 50-ton shipment arrives, local health agencies will have to break down the packages, sort out the contents, read the instructions and decide who should be treated. Workers who can speak foreign languages will be needed to interview people about drug allergies and medical problems.

"Unless the locals have a plan to break that stockpile down and deliver it to the place where it's needed, it is not going to be effective," said Dr. Gregory Evans, director of the St. Louis University's Center for the Study of Bioterrorism and Emerging Infections.

"I know that the federal government has plans to bring physicians and other health care professionals into the area," he said. "I think this will take longer than required."

Many employees of American Media Inc., the Florida tabloid company that was the apparent target of an anthrax attack, were incensed that they didn't begin receiving antibiotics until Monday - three days after photo editor Robert Stevens died of anthrax.

Though the two workers who tested positive for anthrax were treated before they developed symptoms, some colleagues said that was a lucky accident rather than a public health success.

In Baltimore, Dr. Peter L. Beilenson, the health commissioner, said local hospitals have a three- or four-day supply of antibiotics. This, he said, should be enough to supply the public until a shipment from the federal stockpile arrived.

In an emergency, the city would use elementary schools and other buildings as triage centers. The National Guard and local law enforcement would keep order.

Judging from the run on pharmacies, many people are not assuaged by public health officials.

Dr. Howard Bellin, a New York plastic surgeon, said he has been writing Cipro prescriptions for patients, friends and family members since the Sept. 11 attacks.

"I told them to put the antibiotics away," he said. "When the government says we have a terrorist attack with anthrax, then start taking it. I don't think we're in imminent danger, but I think everyone should be protected."

Bartlett said he gave a few days' supply of Cipro to his two grown children in New York and told them to take the drugs only in the event of a known exposure. He isn't confident that they could get them from the New York public health system quickly enough in a large-scale emergency.

Many doctors staunchly oppose personal stockpiling. Dr. Neil Fishman, an infectious disease specialist at the University of Pennsylvania, said people will inevitably take them without reason. And this will worsen the already serious problem of antibiotic resistance.

People will needlessly subject themselves to side effects - diarrhea, skin rashes, fever and, in children, bone abnormalities, he said.

"It's silly," said Dr. Daniel Levy, an Owings Mills pediatrician. "Better to be handed antibiotics for a purpose than to have them just in case. There is more than an adequate supply in case of an epidemic."

While several other antibiotics, including amoxicillin and doxycycline, can be used to treat some strains of anthrax, they've been less in demand than Cipro, which is effective against many strains.

The clamor for Cipro is so high that the drug's manufacturer, Bayer, is reopening a plant in Germany to increase production.

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