ANNAPOLIS – Andrew Goldstein’s brother lives in Boca Raton, Fla., not far from the American Media Inc. building where the first case of anthrax was reported earlier this month.
Worried that his brother could be exposed to anthrax, the Annapolis-based gynecologist sent his brother a prescription for Cipro, the potent antibiotic approved by the Food and Drug Administration last year for treating anthrax.
“I told him not to get it filled until they confirmed the anthrax wasn’t isolated (to AMI),” said Goldstein. His brother didn’t and won’t now that the AMI building has been sealed off, Goldstein said.
Overuse of Cipro and “just-in-case” prescriptions are unnecessary precautions, health officials say, and may be harmful in the long run.
But fears of the disease are increasing with the number of reports of its discovery.
One man died and three others have been sickened by anthrax in both Florida and New York, where two television networks were affected. On Wednesday, the House of Representatives closed to allow anthrax testing after mail sent to Senate Majority Leader Tom Daschle’s office tested positive for the substance. So far, 31 people have been exposed to the anthrax in Daschle’s office.
The Department of Health and Mental Hygiene issued a statement to doctors and Maryland residents this week warning “widespread use of antibiotics without indications can cause resistance to them.”
MedChi, the Maryland physicians’ society, echoed the health department’s warning with an advisory sent to doctors earlier this week.
“We’re telling physicians not to overdispense Cipro because pathogens can build up an immunity” to the drug, MedChi spokesman Russel Kujan said.
Bacteria reproduce and tend to undergo significant genetic changes faster than larger organisms. Such changes allow certain strains to adapt to and resist antibiotics to which they’re constantly exposed, experts say.
Not only does unnecessarily prescribing Cipro increase the possibility of creating antibiotic-resistant varieties of anthrax and other pathogens, the drug itself is so powerful it can cause harmful side effects in people.
According to online information from the FDA and Bayer, Cipro’s manufacturer, Cipro can cause diarrhea, vomiting, stomach pain and headaches. To treat anthrax, Cipro must be taken for two months.
The FDA has approved the use of Cipro for only 14 conditions, including some urinary and respiratory tract infections. Anthrax joined the list July 2000.
Goldstein understands the drug’s power.
“Most of the anthrax that’s out there is penicillin-sensitive,” he said. “Using Cipro would be like killing a fly with a Howitzer.”
Penicillin and Doxycycline, milder-strength antibiotics, are also used to treat anthrax.
The Maryland Board of Physician Quality Assurance can discipline doctors who “grossly overutilize health care services” or fail to meet peer standards for delivering care, but overprescription of medications is not an issue generally brought before the board.
Doctors have been offering Cipro prescriptions to patients nationwide, officials say, often to help allay anxieties about anthrax.
The surgeon general has issued a recommendation for doctors not to prescribe Cipro or other antibiotics unless a patient has been exposed to a pathogen.
“We’ve certainly heard a lot of anecdotal reports of doctors prescribing it without a diagnosis or clear symptoms or probable exposure,” said Damon Thompson, spokesman for the office of the surgeon general.
But prescribing Cipro and other antibiotics without a diagnosis “doesn’t necessarily put the patients first,” Thompson said. “It could do more harm than good. We suggest that they not do that.”