Little white pill: panacea or Pandora's box?

Health officials announced on Thurs., Oct. 25 that more than 10,000 Americans, mostly postal workers, are currently taking the antibiotic drug Cipro as a prophylactic measure against anthrax.

GETTY IMAGES Cipro, manufactured by the German pharmeceutical giant Bayer, has been the drug of choice for combating anthrax in the U.S.

At Yale, however, despite what a spokesperson for University Health Services (UHS) has dubbed "a mini-epidemic of concerned parents" who have requested Cipro and other antibiotics to protect their families from anthrax, not one prescription has been issued. "There has been no documented or even suspected exposure," an official said.

Doctors and public health officials have traditionally remained reluctant to prescribe potent drugs such as Cipro, which belongs to the family of antibiotics referred to as fluoroquinolones, since unrestrained use of the drugs could potentially lead to the development of drug-resistant strains of the very bacteria Cipro is designed to kill.

"The major risk of people taking Cipro for the long term," Dr. Geoffrey Chupp, an assistant professor of medicine at the Yale Medical Schools, said, "is that bacteria may develop resistance to anthrax."

In New York and Washington, conservative prescription practices have now given way to the extensive dissemination of a drug previously reserved for the only the most serious cases of demonstrated infection, anthrax or otherwise. Over 7,000 postal workers in New York City were prescribed the powerful antibiotic, manufactured by the German pharmaceutical company Bayer, despite tests in numerous mailing facilities around the city that have failed to show even trace signs of the deadly anthrax bacteria.

The sudden emergence of anthrax in the mail has sent postal, public health, and White House officials reeling to present a coherent plan of action to the public. Some critics have faulted officials for inaction in response to confirmed outbreaks in the Washington, D.C. postal infrastructure, outbreaks that have resulted in the deaths of two workers. In response, the Bush administration, led by Director of Homeland Security Tom Ridge, publicly acknowledged on Thurs., Oct. 25 that the germs identified were indeed of the most deadly quality and that a broader and more comprehensive employment of antibiotics would follow.

Even as the Bush administration finalized a deal with Bayer on Wed., Oct. 24, that would secure the availability of 100 million tablets of the antibiotic by Jan. 1, 2002 at the reduced price of 95 cents per tablet, questions remain as to whether or not the nation should turn to only one drug in its defense against biological warfare when other effective drugs remain available, including penicillin, doxycycline and others—pharmaceutical diversity that might prevent the rapid development of immunity to any single drug within the anthrax bacteria.

Nationwide, drug-resistant bacteria appeared in 77 percent of the 90,000 infection-related fatalities last year in hospitals, according to one official.

All forms of anthrax presently identified have responded well to treatment with Cipro.

Ironically, despite the near universal choice of Cipro to combat the lethal pathogen, the text of the anthrax-tainted letter sent to Tom Brokaw, a news anchor for NBC, read, "Take Penacilin [sic] Now, Death to America, Death to Israel, Allah is Great."

Chupp warns of possible side effects of Cipro, including liver function abnormalities, rash, and some neurological problems. While rare, such side effects are bound to surface with widespread use of the drug. One postal worker has already visited a Virginia hospital with such side effects.

While Chupp acknowledges the danger that the uncontrolled prescribing of Cipro poses to public health, he highlights "identification of anthrax" as the more difficult challenge in combating this new epidemic, since signs of anthrax infection often masquerade as common flu-like symptoms. He warns, "We can't put the whole country on Cipro."

Joanna Lim contributed to this article.

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