Valium may be the healthier choice. Yes, anthrax is a deadly germ with real potential as a weapon. But our fear now poses a greater health threat than the bacterium itself. Despite recent events in Florida, New York and Nevada, a typical civilian’s chances of getting infected are still vanishingly small. Taking Cipro may help us feel less vulnerable, but the drug itself can have a range of adverse effects, especially in children. And overusing any antibiotic is a sure way to breed pathogens that can resist it. “All we would need right now is for everybody to start using Cipro,” says Dr. Marjory Nigro, a Houston dermatologist who uses it to treat serious skin infections. “Six months from now, it wouldn’t kill anything.”
Not that anthrax is a threat to take lightly. The infection is rarely fatal when contracted through a skin lesion (as it happened at NBC’s New York headquarters). Patients may develop flulike symptoms and some nasty topical sores, but most people recover even without treatment, and antibiotics are almost always curative. Anthrax spores are far more deadly when ingested or inhaled in large quantities because they disseminate more widely within the body. Ingestion isn’t a big threat in the United States, where farm animals are vaccinated and meat is routinely inspected. But as the recent death in Florida makes clear, inhaled anthrax may pose a growing threat. A person who breathes the white powder in a terrorist’s package may feel fine for a week, then develop flulike symptoms such as fatigue, fever and muscle aches. Chest pain and labored breathing follow within 24 hours, followed by shock and death.
Even inhaled anthrax is highly treatable if it’s detected within the first few days of exposure. But drugs are largely useless once a person develops symptoms. “If you inhaled the spores now and someone gave you antibiotics, you would survive because the organisms would not multiply to the density needed to kill you,” says David Straus, a microbiologist at Texas Tech University in Lubbock. “But the pulmonary form of the disease is almost invariably lethal because it isn’t recognized in time.” Fortunately it can be detected early. To test for inhalational anthrax, a physician simply swabs the patient’s nostrils and cultures the sample in agar. The result comes back within 24 hours. And patients who start treatment before symptoms set in have excellent chances of surviving.
Cipro is the first drug used to treat any suspected case of inhaled anthrax, but the vast majority of infections can be managed with penicillin or tetracycline once the spores have been evaluated in the lab. The standard course of treatment involves 60 days of antibiotic therapy, or 30 days of medication and a series of three vaccine shots.
As word of the NBC case spread late last week, many New Yorkers rushed to get themselves tested–“Our physician referral service is swamped with calls,” says Dr. Robert Holzman of Bellevue Hospital and the NYU School of Medicine–but experts stressed the slim chances of contracting the infection without warning. “If you open an envelope that’s full of white powder, yes, worry about it,” says Holzman. “But we’ve only had a handful of anthrax cases and there are 280 million people in this country.”
Experts are even more adamant in urging people not to stockpile medication. Many of the people buying Cipro last week simply wanted to keep it on hand for an emergency, but others were ready to take the cure without the disease. If they couldn’t get prescriptions from their doctors, there were plenty of opportunists online offering anyone with a credit card a 30-day “prevention pack” for $299. The pack wouldn’t fully protect a person who actually inhaled powdered anthrax (the spores can take six weeks to germinate), but it wouldn’t cause a healthy adult much direct harm unless she was also taking theophylline for asthma (the two drugs can cause fatal interactions). Children are another story. Cipro is rarely prescribed to pregnant women or to anyone under 18 except in known cases of anthrax exposure. Animal studies suggest it can disrupt the formation of cartilage.
But side effects aren’t the main concern. The greater danger is that by using this powerful drug as a hedge against anxiety, we will exhaust its power against a range of bacterial menaces. Cipro is a potent, broad-spectrum antibiotic that, because it’s only 14 years old, can eliminate bugs that have developed resistance to older medications. It is one of our ultimate weapons against gonorrhea, infectious diarrhea, typhoid fever and hospital-acquired pneumonia. By stockpiling drugs like Cipro, and using them casually, we virtually guarantee that all of those diseases will become less treatable. Pharmacies may run low on Cipro for the next few weeks, but there is no looming shortage. In the unthinkable event that it’s needed on a wide scale, there will be plenty to go around. For now, our best defense against anthrax is to leave the drug alone. To squander it is to surrender.
