Posted on 10/06/2001 2:29:02 AM PDT by JohnHuang2
Doctors want direction in preventing infection
At issue: prescribing antibiotics as a precautionBY PAUL BRINKLEY-ROGERS
pbrinkley-rogers@herald.com
The federal government needs to issue new guidelines to doctors who are getting calls from worried patients wanting to know how to protect themselves against anthrax, health officials said Friday.
Anthrax can be treated with antibiotics, but advisories from the federal government's Centers for Disease Control and Prevention (CDC) say nothing about prescribing penicillin, Cipro and doxycycline to protect against an anthrax infection. The center instead recommends that the drugs should only be given when the virulent disease is detected.
Dr. Landis Crockett, head of disease control for the Florida Department of Health in Tallahassee, said he thinks new guidelines are probably needed, but he cautioned against extended use of antibiotics, saying it could harm people.
``In regard to issuing antibiotics,'' Crockett said, ``I would be in favor if we knew who we should issue them to and when and where we should use them. . . . We also should know if [taking antibiotics] creates more benefits than harm.''
Dr. Jim James, director of the Miami-Dade County Health Department, said his agency had been receiving calls from the public about anthrax and that ``medical professionals'' had also been making inquiries.
DRUG CAUTION
While he said he, too, was not opposed to doctors prescribing preventives, James also cautioned about prolonged use of antibiotics.
``If you make a recommendation to take [medication],'' he said, ``you've got to define what you are protecting against.'' Should the drug be taken for two weeks, one month, or longer, he asked. ``You may take antibiotics for a year and do yourself real harm,'' he said, by creating resistant infections.
NO REAL THREAT
``I personally would not recommend prophylaxis [preventive] antibiotics unless we had a real threat,'' he said. ``This is still an isolated case in Palm Beach. The significance of it is that it is a rare occurrence.''
Doctors say that prompt treatment with antibiotics can defeat anthrax, especially if the disease is detected within three days after infection. Pulmonary anthrax is harder to treat and more deadly than the more usual strains of the disease which enter the body through breaks or cuts in the skin. If untreated, the disease is fatal.
At least one physician's group -- the American Council on Science and Health (ACSH) -- said that Americans should remain calm.
The public health group, directed by more than 350 leading scientists and doctors, said, ``The prophylactic use of powerful antibiotics for any mild illness, without any evidence of a widespread threat, will cause much more harm than it may prevent.''
Elizabeth Whelan, ACSH president, said, ``Until clear evidence of other cases is demonstrated, Americans would be wise to remain calm and not assume that danger lurks from terrorists using `germ warfare.' Such panic is not in anyone's interests, and will interfere with public health efforts to identify the real source of this infection.''
DRUGS REQUESTED
Several South Florida doctors said patients requested prescriptions to help prevent anthrax.
Dr. Lew Samules of North Miami Beach, for example, said 12 of his 25 patients on Friday afternoon asked him questions about the disease, and that several requested that he write a prescription.
``It was like as the day wore on more and more people began worrying. I did not write any prescriptions because I don't believe there is a threat. . . . I just told everybody that I would start writing them the moment that threat is real.''
CIPRO SUPPLY
At least one doctor said he is not taking any chances.
Dr. Jerry Horn, a Miami ophthalmologist, said he is hearing from other physicians ``anecdotally that people are trying to be prepared'' by asking for antibiotics.
Horn said his wife picked up a supply of Cipro as a precaution, and that he intends to put his whole family on the drug ``as soon as we initiate action'' against Osama bin Laden and the Taliban. ``I'll be putting them on it for two months,'' he said. ``I believe the Florida case is a calling card.''
He said that state and federal officials are not being sufficiently proactive.
``I have just spent the month researching this,'' he said. ``The last time we had a case of inhaled anthrax was 40 years ago? This just doesn't happen.
``It is not enough for the CDC to recommend treatment in 12 hours'' after infection. ``I don't think that's enough.''
SURGICAL MASKS
He said that health officials could also recommend surgical masks as protection. However, anthrax spores cannot be seen, smelled or tasted so the problem, Horn acknowledged, is knowing when to wear a mask.
``A 50-cent surgical mask filters down to one-tenth of a micron,'' he said. Anthrax spores measure from two to six microns. ``Even a cheap mask -- say 25 cents -- protects down to six-tenths of a micron.''
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