What is anthrax and how is it transmitted?

Anthrax is a disease caused by an infection from the spore-forming bacterium Bacillus anthracis. It most commonly occurs in animals (sheep, goats, cattle), but can occur in humans if exposed to infected animals or the spores of the bacteria. This has been considered one of the agents or weapons for a bioterrorist attack. Direct contact to the spores through contaminated powders in mail has become the main concern for human infections since the terrorist attacks on the United States. The inhaled form of Anthrax is the most deadly and initial symptoms are similar to having a common cold. Anthrax can also cause a less serious skin infection if abraded or cut skin is exposed to the spores. Fortunately, it takes a dose of at least 8,000 spores to infect a human with inhalation, the disease in not contagious (It is not transmitted from person to person), and is treatable if antibiotics given early after exposure. Therefore, the people at greatest risk are those who directly handle and inhale contaminated powders.

What is the approved treatment for Anthrax?

Anthrax can be treated by any of three types of antibiotics. These include fluoroquinolones (ciprofloxacin-Cipro(r)), tetracyclines, and penicillins. Patients who have inhaled the spores must be treated before they have symptoms of the disease for the best prognosis. Ciprofloxacin has been widely publicized for the prevention of pulmonary disease, due in part to the Centers for Disease Control and Prevention recommendations. Consequently, significant public demand for ciprofloxacin has created the potential for depleting pharmacy stocks.

Should patients ask their physicians to write a prescription for cirpofloxacin or other antibiotics to treat Anthrax?

No. The widespread prescribing of these antibiotics could lead to the development of drug-resistant bacteria and reduce the effectiveness of these antibiotics to treat other serious infections. Considering that the recommended duration of Anthrax prophylaxis is 60 days, this potential for development of resistance is great. In addition, the antibiotics used to treat Anthrax may be associated with serious side effects and significant drug interactions.

If we have a major attack with Anthrax, how can we obtain enough antibiotics to respond?

The government has created the National Pharmaceutical Stockpile Program. They can ship large stockpiles of antibiotics to any area of the country within 12 hours following notification of an attack.

Where can I get more information on Bioterrorism?

There are several local, state and federal governmental agencies and other private groups that provide updated information on the internet. Two useful links for pharmacists include: www.bt.cdc.gov (The CDC Bioterrorism Preparedness and Response Program-includes link to the National Pharmaceutical Stockpile Program and the Health Alert Network that serves as an early warning system and share guidelines on how to respond to a threat-eg. Receiving a suspicious package or unknown powder) and www.hopkins-biodefense.org (The Johns Hopkins University Center for Civilian Biodefense Studies - includes link to the JAMA Consensus Statements on Medical Management of bioterrorism agents).

This information was provided courtesy of:
School of Pharmacy, University of California San Francisco
Mary Anne Koda-Kimble Pharm.D., Dean
California Poison Control System, UCSF School of Pharmacy
Stuart E. Heard, Pharm.D., Executive Director