Last Updated

11 Jun 2003

Source: Baltimore Sun, November 9, 2001.

5,000 of 32,000 on antibiotics need 60-day course, CDC says

New anthrax guidelines aim to limit number of needless prescriptions

Associated Press, Baltimore Sun

WASHINGTON - About 32,000 people have been prescribed antibiotics in the anthrax crisis, including 5,000 who really needed them and thus must take the pills a full 60 days, health officials said yesterday.

Medical authorities said in new guidelines that merely finding traces of anthrax clinging to surfaces does not warrant closing buildings or prescribing antibiotics.

President Bush went to Atlanta yesterday to tour the Centers for Disease Control and Prevention, where scientists are working around the clock to deal with the anthrax that has killed four people and sickened 13 others.

Postmaster General John Potter asked Congress for $5 billion to offset the toll of the attacks by mail. He said the government should pay for safety equipment and other recovery.

"They should be considered costs of homeland security," Potter told a Senate Appropriations subcommittee.

In the most stunning picture yet of how far anthrax has reached, the CDC disclosed that 32,000 Americans have taken antibiotics for at least several days while scientists raced to tell who was truly exposed to the germs. Of them, 5,000 were found at risk for anthrax infection and told to take antibiotics for a full 60 days.

Cipro, the main drug prescribed, can cause some severe side effects. But a quick study of 490 Floridians taking it and other antibiotics found 20 percent reported only minor side effects. The Food and Drug Administration plans the unprecedented step of contacting all 32,000 antibiotic recipients to better count side effects - and ensure that people don't have relapses after ending their medication.

In addition, 300 post offices and other buildings have been tested for anthrax, the CDC said.

Most heavily contaminated are the Hart Senate Office Building, where an anthrax-tainted letter to Majority Leader Tom Daschle was opened, and Washington's Brentwood central post office, which processed that letter.

Officials say the majority of other buildings have had no or very little contamination.

"We will never remove every spore" in a building cleanup, Dr. James Baker Jr., a University of Michigan bioterror expert, told Congress.

As for Hart, "you will not sterilize that building no matter what you do," he said.

Simply finding anthrax clinging to surfaces is not enough to close buildings or prescribe protective antibiotics, the CDC guidelines say. Anthrax is deadliest when it is in the air, not when the sticky spores have settled to the ground.

"We've learned that the cases of anthrax have occurred in environments that are very heavily contaminated, and that we don't see cases in environments where there is not significant contamination," said CDC anthrax specialist Dr. Julie Gerberding.

The guidelines aim to limit the number of unnecessary antibiotic prescriptions. People need protective antibiotics if there is evidence they were in "a breathing zone" of anthrax, Gerberding said - such as a postal facility known to have processed a tainted letter or a building where someone caught inhalation anthrax.

Antibiotics should not be used to prevent the milder skin form of anthrax, or for people who routinely handle mail in absence of a credible threat, the guidelines say.

Some agencies deemed at high risk of a bioterror attack may continue regular air or building tests in hopes of catching any future anthrax release. But air testing remains experimental, and no one knows how effective random building tests will be, Gerberding said.

Cutaneous, or skin, anthrax is easily diagnosed and treated - look for a rash or bump that resembles a spider bite, with a dark center.

Potentially deadly inhalation anthrax must be caught early, yet initial symptoms are hard to distinguish from flu or other respiratory viruses. The CDC issued its most definitive symptom list to date to help:

Anthrax does not usually cause a runny nose; only one of the 10 people with inhalation anthrax had one.

Most inhalation anthrax patients had a fever, chills, fatigue, a dry cough, shortness of breath, chest discomfort, and nausea or vomiting.

All had abnormal chest X-rays. Regular pneumonia will show up on X-ray, too, while flu or other viruses will not.