Anthrax cures like Cipro could be health hazard

PITTSBURGH (AP) -- After anthrax was found at NBC, Tom Brokaw held up a prescription bottle during a newscast and declared: "In Cipro we trust." On Capitol Hill, politicians lined up for the small white pills after a scare there. The word on everyone's lips: Cipro.

Few people had even heard of Cipro a month ago. Now, Bayer Corp. is more than tripling its production of the drug, the only antibiotic approved by the Food and Drug Administration to fight anthrax.

Even with production running 24 hours a day, seven days a week, Sen. Charles Schumer, D-N.Y., said he is worried about a shortage.

On Tuesday, Schumer asked the U.S. Department of Health and Human Services to allow the government to purchase a generic form of the antibiotic directly from manufacturers. Bayer holds the patent for the drug until 2003.

Bayer has promised the government it will be able to deliver 200 million Cipro tablets in the next three months.

By Charles Ornstein

Los Angeles Times

Anthrax anxiety has spawned a massive public health experiment -- one that is unplanned, uncontrolled and perhaps unstoppable.

Never before have so many healthy people been given private stashes of antibiotics to use at their whim.

The trouble, say medical experts, is that indiscriminate prescription of Cipro and other powerful antibiotics could prove horribly counterproductive. It could ultimately render these last-defense drugs helpless against serious bacterial infections, allowing them to flourish and spread to others.

Even those who don't take Cipro could develop infections resistant to it.

But in a nation with powerful faith in the ability of drugs to treat any ill, patients are besieging doctors with requests for Cipro and other powerful just-in-case antibiotics. Unsolicited e-mails from online pharmacies fan their fears.

"With the threat of anthrax upon us, we are now offering Cipro to help build your immune system to fight the anthrax virus!" a mass e-mail proclaims.

Even trusted figures such as NBC News anchor Tom Brokaw are lending encouragement. "In Cipro we trust," he said Monday night at the close of his newscast. His personal assistant contracted cutaneous anthrax -- on her skin -- when she handled a contaminated letter addressed to Brokaw.

Many doctors are bending to patients' pressure, to the dismay of some colleagues. "Patients are getting angry," said Dr. Samuel Fink, a Tarzana internist who has drawn fire for saying no even to family members. "They're calling and they're demanding 60 days of Cipro for themselves, their wives and their dogs."

At the very least, the run on Cipro will aggravate a growing problem with antibiotic resistance that was flagged as a serious danger years before the terrorist attacks.

Many Americans use antibiotics inappropriately, taking them for shorter periods than prescribed or for viral infections instead of bacterial infections. They don't kill viruses.

Over time, this misuse leads to development of hardier bacteria and more virulent infections.

With antibiotics in their personal medical cabinets, patients will be tempted to use the pills, unsupervised, when they are scared or they develop flu-like symptoms that mirror the initial signs of anthrax.

"These pills are not going to sit on the shelves. They're going to be used, especially if you spent $250 on them," said Dr. Stuart Levy, a professor of medicine at Tufts University and president of the Alliance for the Prudent Use of Antibiotics. "It's a mistake to stockpile."

Dr. Jane Spiegel, a Santa Monica, Calif., internist, agreed.

"What we're going to see is a public health nightmare in the making," she said. "When you have ready availability of antibiotics, people are going to have their runny nose or a little cough, and they're going to say, 'I'll just take a few of these Cipro and it'll help me out.'

"If that happens, we're going to have massive resistance. We won't have anything left in our armamentarium. That's our big gun."

The U.S. Food and Drug Administration has strongly recommended that physicians not prescribe Cipro for individual patients to have on hand for possible use against anthrax precisely because of fears about development of drug-resistant organisms.

The reason Cipro is so popular is that it is the only drug approved by the FDA for treatment of inhalation anthrax (although a few other antibiotics work too). The infection is more than 90 percent fatal if not treated early.

Health experts have repeatedly told the public that the federal government has enough antibiotics for 2 million people in case of a major anthrax attack, and doses for 10million more are requested. But such assurances are doing little to calm patients' nerves or cause doctors to say no.

Demand for Cipro has become so intense that drug wholesalers are now rationing supplies, and some pharmacies in Southern California are limiting patients to a fraction of what is recommended in the event of a confirmed anthrax infection.