Don't take Cipro lightly

October 21, 2001|By Edward Roeder

WASHINGTON — "In Cipro we trust" -- NBC anchor Tom Brokaw

WASHINGTON -- As thousands of congressional aides and visitors were given nasal swab tests for anthrax last week after an envelope containing anthrax was opened in a Senate office, the attending Capitol physician announced, "If we screen you, we treat you."

This means a course of the antibiotic Ciprofloxacin, commonly called, sought and today hoarded under the brand name Cipro. But thousands of doses of Cipro will lead to hundreds of serious and unnecessary harmful side effects. Cipro works. So does amputation. For anthrax, less drastic treatment is more appropriate.

People are crossing the border to get supplies of Cipro in Mexico, no prescription required. The Internet is full of ads for Cipro, appealing to fear. Cipro's maker, Bayer AG, announced a 25 percent to 30 percent production increase, more likely to simply allow the company to reap greater profits from the current panic than to increase stockpiles by at least an order of magnitude (which could prepare us for a crisis, but glut the market once the crisis passes).

Cipro ain't aspirin. Casual use of Cipro is dangerous and self-defeating. The drug's serious side effects, if widely known, might deter unnecessary use. So might repetition of the perils of improperly using a last-line-of-defense antibiotic.

Cipro is a very powerful systemic drug. This means it is untargeted, not aimed at one specific disease. In a person or a population, it can effectively kill many strains of beneficial bacteria, essential rivals to the harmful ones.

According to the Physician's Desk Reference, 2,799 patients took Cipro during clinical investigations. "Adverse events that were considered likely to be drug related occurred in 7.3 percent of patients treated, possibly related in 9.2 percent" (together, one-sixth of all recipients), the PDR reports. Another 3 percent had serious problems considered only remotely related.

The most frequently reported adverse events, drug related or not, were nausea (5.2 percent), diarrhea (2.3 percent) and vomiting (2 percent). Beyond that, more than one in 100 Cipro recipients had problems ranging from vaginitis to internal bleeding to headaches, rashes and eye problems.

Less common ills comprised a horror list ranging from intestinal perforations to jaundice to central nervous system disorders. This last included convulsive seizures, paranoia, hallucinations, dizziness, confusion, depression, manic reaction and toxic psychosis. In technical terms, Cipro can make you nuts.

Others experienced a broad range of often fatal heart and lung afflictions, including cardiovascular collapse, cardiopulmonary arrest and arrhythmia.

Precautions about taking Cipro and adverse reactions to it fill more than a page and a half of fine print in the PDR. If you're not yet scared, beware. It even caused lameness in immature dogs by producing crippling lesions on developing cartilage. This bodes ill for anyone taking the drug who is not fully grown. Even in a clinical trial of 214 people given just a single dose of Cipro, more than 5 percent had serious adverse medical events.

Sending an envelope bearing white powder has to be seen as a felony, not a prank, even when it's just powdered milk. A mock anthrax attack brings real harm because each false alarm causes hundreds to be defensively dosed with Cipro. The record suggests that 165 people will have serious problems, many of them multiple reactions, for every 1,000 taking the drug.

Hoarding Cipro will increase the shortage. Dispensing or taking it unnecessarily will cause countless ill effects.

Cipro is effective against all forms of anthrax, including exotic new strains developed for biological warfare. But none of those new strains has shown up in the recent scares. All of the cases found have been old-fashioned anthrax, which can be killed by penicillin or, for those who have an allergy, by several variants of tetracycline -- far less harmful (and less costly) drugs than Cipro.

The skin form of anthrax is quite treatable, and responds well to antibiotics even after the appearance of telltale black lesions. But for persons who contract the inhaled form of anthrax and don't get prompt treatment, anthrax is almost always fatal.

Abusing antibiotics for decades has rendered them ineffective against new strains of resistant diseases. If Cipro is similarly used improperly, someday soon it won't work, either. Every patient getting the drug needlessly, and every physician prescribing it inappropriately, hastens that day.

Edward Roeder is a Washington-based reporter.

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