CDC Recommends Antibiotic Combination for Anthrax Care
The CDC yesterday issued guidelines for treating patients diagnosed with anthrax infection, recommending use of an antibiotic combination when the bacteria has been inhaled, the New York Times reports (Altman, New York Times, 10/26). According to the guidelines, published in the Morbidity and Mortality Weekly Report, inhalation anthrax patients should receive initial intravenous treatment with the antibiotics ciprofloxacin -- produced by Bayer under the brand name Cipro -- or doxycycline, plus at least one of seven other medications: rifampin, vancomycin, imipenem, chloramphenicol, penicillin and ampicillin, clindamycin or clarithromycin (MMWR, 10/26). Patients should be switched to oral therapy of ciprofloxacin or doxycycline alone when "clinically appropriate," with total treatment to last 60 days. The CDC also said cutaneous anthrax patients may still be treated with a single antibiotic but recommended 60 days of treatment, rather than seven to 10 days as previously suggested (New York Times, 10/26). The agency based its guidelines in part on lab tests of 11 anthrax samples isolated from the recent attacks in Florida, New York, New Jersey and Washington, finding that nearly all of the recommended drugs killed the bacteria in vitro. However, CDC officials cautioned that because the germs showed some resistance to penicillin, that drug should not be used alone to treat infections (Hensley/Regalado, Wall Street Journal, 10/26). Officials also "warned that there are no human studies to back up" the guidelines, the AP/Boston Globe reports. "This is the first bioterrorism-related anthrax attack in the United States, and the public health ramifications of this attack continue to evolve," the agency noted. The CDC acknowledged that some recommended drugs may have negative side effects in pregnant women (AP/Boston Globe, 10/26). The agency also "expressed concern" that widespread antibiotic use might increase bacterial drug resistance. But CDC epidemiologist Julie Gerberding concluded that the agency's "overriding concern" was preventing future anthrax cases and deaths (New York Times, 10/26).
Meanwhile, HHS Secretary Tommy Thompson said yesterday that flu vaccine delivery should be "expedite[d]" to stem fears this winter that flu cases might instead be anthrax infection, the AP/Minneapolis Star Tribune reports. Thompson plans to meet today and Monday with flu vaccine makers "to demand to know why production is delayed for a second year in a row." Before the anthrax scare, health officials had planned to reserve the first flu shots for those most at risk of illness, such as the elderly, leaving "plenty of time" to vaccinate the general population beginning in November. But Thompson said he is concerned that because the similarity of flu and anthrax symptoms may lead to a number of false anthrax reports, earlier vaccination is needed. He said, "I am going to have a stern discussion" with vaccine makers about speeding production. Thompson added that officials will start a "major public health campaign" to push flu shots once enough doses are available (Neergaard, AP/Minneapolis Star Tribune, 10/26).