Doctors say panic is risk to patients with cystic fibrosis

Overuse of drug Cipro could dilute helpfulness on lung-clogging disease

War On Terrorism Anthrax Scare

October 21, 2001|By Jonathan Bor | Jonathan Bor,SUN STAFF

Infections are the constant enemy of a child with cystic fibrosis. But one stands above the rest - threatening to clog the lungs, trigger furious coughing and make breathing impossible.

Fortunately, an antibiotic in use since the 1980s has enabled children to survive many bouts of the infection, which goes by the name Pseudomonas aeruginoa.

The drug is Cipro.

Now, doctors say, overuse of Cipro by Americans frightened about anthrax could cripple the drug's ability to help patients - including those with cystic fibrosis - who desperately need for it to work.

They worry that widespread and needless use of Cipro could give rise to bacteria that are genetically resistant to treatment. The resistant germs could sicken previously healthy people but could also spread to fragile patients who depend on an arsenal of effective drugs.

"It's a real concern," said Dr. Pamela Zeitlin, a cystic fibrosis researcher at the Johns Hopkins School of Medicine. "It's dangerous to start using antibiotics when you don't need them."

The problem of antibiotic overuse is nothing new. For years, doctors have seen various antibiotics become useless against pneumonia, childhood ear infections and dangerous infectious that strike patients in hospital intensive care units.

Dr. Argun Srinivasan, a Hopkins infectious disease specialist, says Cipro is extremely useful against many different types of bacteria that travel around hospitals and cause intestinal, respiratory and blood infections.

"These are drugs that we generally reserve for serious infections," he said. Once Cipro loses its effectiveness against these bugs, doctors will have fewer drugs at their disposal.

This week, Surgeon General David Satcher urged doctors to stop writing Cipro prescriptions for patients who are worried about anthrax but haven't been exposed.

"We do not believe that the treatment for anxiety in patients is to give them prescriptions," Satcher said.

He said the drug should be prescribed only for people who have tested positive for an anthrax exposure. He and other doctors have noted that other antibiotics can be used to treat an exposed patient.

Doctors have also warned that some people taking Cipro will also suffer side effects. The most common are nausea, vomiting, diarrhea and loss of appetite.

Each year, organisms that are resistant to antibiotics cause or contribute to the deaths of about 70,000 hospitalized people in the United States, according to the Center for Adaptation Genetics and Drug Resistance at Tufts University.

The principle of antibiotic resistance is well-known to doctors.

In any population of bacteria, there are many germs that are susceptible to an antibiotic and a small number of mutants that happen to be resistant.

"If you take antibiotics once in a while, fine," said Srinivasan. "The more you expose bacteria to antibiotics, the greater the likelihood that one of these mutants will become successful in growing."

Cipro is known as a broad-spectrum antibiotic because it is effective against many types of bacteria. This poses a particular concern for doctors, who say its overuse could encourage the growth - and spread - of a variety of resistant organisms.

The drug has prolonged the lives of thousands of children with cystic fibrosis, Zeitlin said.

A disease that afflicts 30,000 Americans, cystic fibrosis causes an abnormal buildup of thick mucus in the lungs. The condition causes chronic lung congestion and predisposes children to life-threatening infections.

The most serious infection, said Zeitlin, is Pseudomonas. Children feel tired, cough violently and can become so short of breath they need to placed on oxygen.

Cipro is technically not approved for children because of studies suggesting that it might interfere with bone growth. But pediatricians treating fatal diseases such as cystic fibrosis have legally used it "off-label" - deciding that its benefits outweigh its potential risks. Cipro, which is taken as a pill, usually clears up a Pseudomonas infection within two weeks. But it is not a cure. A child will suffer repeated bouts, eventually with a Cipro-resistant strain.

When that happens, doctors switch to other antibiotics, which must be taken intravenously and which eventually lose their effectiveness, too. Most cystic fibrosis victims die of a drug-resistant Pseudomonas strain.

The median life span of patients with cystic fibrosis is 31, but Zeitlin warns that victims could die much younger if Cipro is no longer useful as a first line of defense. "It's a big fear," she said. "We have to try not to overuse the antibiotics."

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