- WASHINGTON (Reuters) - Thousands
of people who may have been exposed to anthrax are now getting antibiotics
-- just in case -- but U.S. health officials stressed on Thursday that
most Americans do not need the drugs.
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- They said the antibiotics were being given to protect
people, mostly postal workers, who may have breathed in or touched anthrax
spores, and to cover them while tests were done to narrow down precisely
who was most at risk of exposure.
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- Doctors must do that because it is impossible to tell
for sure who is actually infected before the person becomes sick -- and
in the case of inhaled anthrax, by then it may be too late to treat, said
Dr. Jeffrey Koplan, head of the U.S. Centers for Disease Control and Prevention.
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- ``A lot of folks are on antibiotics in different places
now and they are on them for different reasons,'' Koplan told reporters
in a telephone briefing. ``At the moment at different sites around the
country, particularly among postal workers, there are probably several
thousand people taking antibiotics.''
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- The goal is to balance the risk from anthrax against
the risk of taking unnecessary antibiotics.
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- So as the government hands out drugs in little plastic
bags to postal workers, people working in the U.S. Capitol and those in
media office buildings where tainted envelopes were received, it is asking
the vast majority of Americans to refrain from stocking up on antibiotics.
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- ``Widespread, unnecessary use of antibiotics can only
do harm,'' Health and Human Services Secretary Tommy Thompson said. ''Antibiotics
can have side effects, including a few serious side effects in the case
of the more powerful products. Furthermore, antibiotics can become less
effective against disease if they are used inappropriately.''
-
- So how can health officials be telling people on the
one hand not to take antibiotics unless they really are sick, and on the
other giving them freely to people who have not even been tested for anthrax?
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- 'DAMNED IF YOU DO AND DAMNED IF YOU DON'T'
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- ``It's a case of damned if you do and damned if you don't,''
Koplan said. Inhaled anthrax is so deadly that anyone at risk must be given
antibiotics right away -- as the deaths of two postal workers in Washington
this week illustrated.
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- The CDC is, therefore, giving the drugs first, then later
narrowing down who really needs them.
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- The agency does that by sampling floors, surfaces and
people's noses for the anthrax spores. They can find a pattern that tells
them what areas were exposed.
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- ``We expect that as environmental sample data become
available, we will learn that most of these people do not need to take
antibiotic prophylaxis (prevention),'' the CDC's Dr. Julie Gerberding told
reporters.
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- ``However, we are also concerned about unnecessary exposure
to antibiotics. We may provide people a few days' treatment while we sort
it out.''
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- There is no way to tell whether an individual is about
to get an infection, doctors say. Having a spore in the nose means a person
was exposed, but that spore may never get to the lungs, and there may not
be enough of them to start an infection -- it takes several thousand spores
to make a person sick.
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- A clean swab does not mean there is no spore in a person's
nose -- the swab may have simply missed it. Gerberding added that by the
time anthrax or its toxin shows up in the blood, that patient is already
sick.
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- The CDC uses epidemiology -- studying patterns of disease
and the physical pattern of where spores are found -- to figure out who
is at most risk of infection.
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- ``If you have been near a powder, you will need antibiotics,''
Gerberding said.
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- ``If there are five of us sitting in a room three doors
away from someone exposed, and one of us got positive nasal swabs, what
it indicates is anthrax got in the room and all five of us would go on
antibiotics,'' Koplan said.
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- SERIOUS SIDE EFFECTS
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- The side effects of antibiotics were serious, so people
cleared of risk should stop taking them, Koplan said.
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- Ciprofloxacin, the first drug usually used for anthrax
exposure, can cause diarrhea, abnormal liver enzyme function, headaches,
dizziness, seizures, and, in a very few cases, a strange weakening of the
ligaments.
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- Antibiotics kill off the ``good'' bacteria that help
digestion and that physically block disease-causing invaders from the body.
The more often bacteria are exposed to antibiotics, the more likely they
are to mutate into drug-resistant forms that cannot be easily treated.
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- The numbers of people now getting ciprofloxacin, doxycycline,
penicillin and other drugs are not high enough to affect the overall trend
-- long documented -- of bacteria gradually becoming resistant to antibiotics.
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- ``You don't worry at all about antibiotic resistance,''
Dr. Tony Fauci, head of the National Institute of Allergies and Infectious
Diseases, told reporters.
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- ``The concern is if everybody starts stocking up on Cipro
and tens of hundreds of thousands of people throughout the country ...
in Detroit or North Carolina or wherever start popping Cipro or any antibiotic.''
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