November 16, 2001

The events of Sept. 11 have left an indelible mark on people throughout the country and also have left many doubting their own personal safety and security. The daily reports of the threat of bioterrorism and of anthrax infections in particular make many individuals feel vulnerable. Leaders at the MGH – including experts from MGH Pharmacy and Infection Control – are encouraging employees to keep these risks in perspective.

According to the Centers for Disease Control and Prevention (CDC), there have been 22 confirmed cases of anthrax exposure in the United States during the past two months. The people exposed lived or worked in New York City, New Jersey, Washington and Florida. More than 300 buildings have been tested for the presence of anthrax, and more than 32,000 people have been placed on antibiotics – usually Ciprofloxacin, also called Cipro – as a precautionary measure.

According to Harold Demonaco, MS, director of MGH Drug Therapy Management, these individuals were placed on Cipro because they may have been exposed to anthrax. The bacteria – technically, the spores – were found in their workplace. The use of antibiotics in this way, called prophylaxis, is justified only when the risks of taking drugs like Cipro are less than the risks of contracting the disease itself.

"Many people have asked about getting their own supply of Cipro just in case something happens," says Demonaco. "In fact, it looks like many hospital employees have done just that. Partners employee prescriptions for Cipro have increased from about one per day to 40 per day."

According to Demonaco, the increase in Cipro prescriptions at the MGH contributes to the following problems:

• Cipro belongs to a group of antibiotics called quinolones. While the MGH does not use Cipro for inpatients, clinicians do use another quinolone called Levaquin to treat patients with serious infections. Bacteria can build up a resistance to any antibiotics if the drugs are used too often. The increase in Cipro prescriptions may make bacteria resistant to Levaquin, which in turn could bring harm to patients. Overuse of Cipro also could make the anthrax bacteria resistant as well.

• Cipro has side effects, and some of them are serious. The CDC reported that 19 percent – almost one out of every five people – of those who took Cipro for possible anthrax exposure developed such side effects as rash and itching, swelling of the neck or difficult breathing.

• Antibiotics are in short supply. Hoarding Cipro can keep others who really need the antibiotic from getting it. The hospital does have other antibiotics to treat anthrax but risks running low if Cipro or any other antibiotics are overprescribed.

"As employees of the MGH, we have a special opportunity to help our families, friends and neighbors deal with the threat of bioterrorism," says Demonaco. "All MGH clinicians have been asked not to give their patients – including employees – prescriptions for Cipro or any other drug unless absolutely necessary."

For more information about Cipro and other antibiotics, call Meg Clapp in MGH Pharmacy at (617) 726-2513 or visit www.cdc.gov