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In the event that persons are exposed to potentially aerosolized Bacillus anthracis spores, what will CDC recommend to prevent inhalational anthrax?
CDC will recommend 60 days of selected oral antibiotics in conjunction with a 3-dose regimen (0, 2 weeks, 4 weeks) of anthrax vaccine (BioThrax™, formerly known as AVA) as an emergency public health intervention. Two major U.S. national advisory bodies have considered strategies for post-exposure prophylaxis for prevention of inhalational anthrax among individuals exposed to potentially aerosolized B. anthracis spores. Both groups, the Advisory Committee on Immunization Practices (ACIP) and the John Hopkins Working Group on Civilian Biodefense, concluded that based on available data, the best means for prevention of inhalation anthrax is prolonged antibiotic therapy in conjunction with anthrax vaccination. In addition, a recent Institute of Medicine Report on anthrax vaccine safety and efficacy also concluded that based on limited animal studies, anthrax vaccine administered in combination with antibiotics following exposure to B. anthracis spores may help to prevent the development of inhalational anthrax. BioThrax™ is not licensed for post-exposure prophylaxis for prevention of inhalational anthrax, or for use in a 3-dose regimen; therefore, this program would be conducted under an Investigational New Drug (IND) application.
Why does CDC recommend 60 days of antibiotics?
Anthrax spores grow like plant seeds. If you plant seeds and give them sun and water, they will grow into plants. If you give anthrax spores the right environment, such as the human body, they can grow into the harmful form of the bacteria that can cause anthrax disease. It takes anthrax spores an average of 7 days to grow into the harmful form of the bacteria, but it can take longer. For this reason, CDC recommends preventive antibiotics for the full 60 days.
Which antibiotics does CDC recommend for prevention of inhalational anthrax?
In selecting an antibiotic, we will be guided by the organism's culture and sensitivity results, history of allergic reactions, age and health status factors and antibiotic availability. When no information is available about the antimicrobial susceptibility of the implicated strain of B. anthracis, initial therapy with ciprofloxacin or doxycycline is recommended for adults and children.
What drugs are FDA-approved for postexposure prophylaxis (PEP)?
Ciprofloxacin and doxycycline are FDA-approved for PEP.
Are there special instructions for taking ciprofloxacin or doxycycline?
As with all antibiotics, take the medication according to the schedule you were instructed, and even if you begin to feel better, continue taking it for the full number of days.
What is cipro (ciprofloxacin)?
Ciprofloxacin, or cipro as it is commonly known, is a broad-spectrum, synthetic antimicrobial agent active against several microorganisms. The use of ciprofloxacin is warranted only under the strict supervision of a physician.
Does ciprofloxacin have an expiration date?
Yes. Antibiotics, just like all medicines, have expiration dates. If you received your ciprofloxacin through a pharmacist, the expiration date should be listed on the bottle. If you can't find it or have questions about the expiration date, contact your pharmacist directly.
What side effects could I get from taking cipro?
Common side effects of Cipro include an upset stomach, vomiting, diarrhea, fatigue, dizziness, or headache. If you have problems with any of these symptoms, tell your doctor. Less common side effects include pain in arms or legs, changes in vision, restlessness, ringing in the ears, or mental changes. If any of these symptoms occur, call your doctor right away.
Can other fluoroquinolones be used instead of ciprofloxacin for postexposure prophylaxis (PEP)/treatment?
Other fluoroquinolones, such as ofloxacin and levofloxacin, are not specifically recommended as alternatives to ciprofloxacin because of a lack of sufficient data on their efficacy. However, if first-line drugs were not available, these other fluoroquinolones may be effective.
Besides anthrax, what else is ciprofloxacin prescribed for? Has there been resistance to ciprofloxacin when used in other instances (historically)?
Ciprofloxacin is a broad-spectrum, highly effective antibiotic that has been part of the "international traveler's" kit at CDC for at least a year. It can be used against most bacterial infections. However, ciprofloxacin is frequently overused for many diseases that can be treated with less powerful, narrower-spectrum drugs. Right now, most bacteria are susceptible to ciprofloxacin, which is why we want to be cautious about its use. Overuse of ciprofloxacin could lead to the development of resistance.
Is there a generic form of ciprofloxacin?
No, there is currently no generic form of ciprofloxacin in the United States.
What side effects could I get from taking doxycycline?
Common side effects of doxycycline include an upset stomach, vomiting, or diarrhea. If you have problems with any of these symptoms, tell your doctor. Less common side effects include dark urine, yellowing of the eyes or skin, sore throat, fever, unusual bleeding or bruising, fatigue, white patches in the mouth. If any of these symptoms occur, call your doctor right away.
What side effects could I get from taking amoxicillin?
Common side effects of amoxicillin include an upset stomach, vomiting, and diarrhea. If you have problems with any of these symptoms, tell your doctor.
What side effects are serious enough that I should go to a doctor?
Any side effect that forces you not to take your medicine is serious enough that you should consult or see your doctor.
Serious side effects of ciprofloxacin include seizures, mental confusion, rash that does not go away, or excessive diarrhea.
If you have any of these effects, call your doctor.
Serious side effects of doxycycline include jaundice (yellow eyes or skin), rash that does not go away, or excessive diarrhea. If you have any of these effects, call your doctor.
Any reaction that causes a rapid swelling of the lips and face, shortness of breath, or hives is a medical emergency. You should call 911. These types of reactions are extremely rare.
Ciprofloxacin and doxycycline look different and come in different doses. Is one better than the other?
Ciprofloxacin 500 mg and doxycycline 100 mg both have the same killing power in your bloodstream and are equally effective against anthrax bacteria. Both have similar side effects. Doxycycline is available in both tablet and capsule form. Both will give you the same amount of medicine in your bloodstream to kill the bacteria.
What if the antibiotics I take gives me headaches? Is there anything I can do to help this?
If you don't have a history of headaches, then your headache may be related to the medicine. Changing the time of day that you take the ciprofloxacin or eating after you take the medicine may help. Pain relievers such as acetaminophen may help your headache. If your headache does not go away, you should consult your doctor.
What if the antibiotics I take makes me feel sick to my stomach? Is there anything I can do to help this?
Taking your antibiotic with food may help reduce this sick feeling. Ciprofloxacin and doxycycline should not be taken within 2 hours of taking antacids. Ciprofloxacin and doxycycline should not be taken with dairy or calcium-fortified products (such as ice cream or calcium-fortified orange juice).
What if the antibiotics I take give me diarrhea? Is there anything I can do to help this?
Antibiotics may disrupt bacteria in the gastrointestinal tract, causing diarrhea. Food may help relieve the diarrhea. If the diarrhea does not go away, your doctor may recommend another antibiotic. If you develop severe, long-lasting diarrhea, you may have a serious condition and should consult your doctor.
If taking one of the recommended antibiotics makes me feel terrible, can I switch to another of these antibiotics?
If you have tried taking the medicine with food or changing the time of your dose but still feel terrible, you should ask your doctor about switching antibiotics.
What if I get a yeast infection while taking antibiotics? Is there anything I can take for this?
Occasionally, women develop yeast infections while taking amoxicillin. You may treat the infection with over-the-counter medicines such as clotrimazole. If the symptoms do not go away, you should consult your doctor.
What if the antibiotics I am taking make me feel itchy all over. Is there anything I can do to help this?
Rashes that appear suddenly or do not go away after a few days may be signs of an allergic reaction. You should see your doctor immediately.
What if the antibiotics give me an allergic reaction and I stop taking them? What should I do?
If the allergic reaction was severe or rapid, you should notify your doctor before taking another antibiotic. Your doctor will prescribe a different antibiotic that will kill the bacteria without causing an allergic reaction. Remember: you should complete the entire 60 days of treatment even if you change antibiotics.
Why can't I take a shot, wear a patch, or take one large dose of the medicine instead of taking it for 60 days?
Spores can stay in your body for some time before they start growing and causing you to become ill. When the spores are not growing, antibiotics are not effective. Only after the spores start to grow can the antibiotics work. Therefore, you need a constant level of antibiotic in your body for 60 days to make sure that when the spores start to grow, the antibiotic is there to kill them.
I think I may feel much better if I take only one pill of ciprofloxacin, doxycycline, or amoxicillin each day. Is that okay?
No. The drug must be taken twice a day to kill the bacteria. If your body contains anthrax bacteria and you do not take the full dose, the bacteria may start to grow again and become harder to kill.
Can I drink alcohol if I am taking antibiotics?
Social drinking of alcohol (fewer than 2 drinks a day) should not cause any side effects unless you already have a liver problem. However, drinking too much alcohol can cause the medicine to leave your body faster, which will decrease the effectiveness of the medicine. If you drink more than two drinks a day, you should tell your doctor so that different medicines can be prescribed.
If I was exposed to Bacillus anthracis and was prescribed antibiotics, but took the medicine only for a couple weeks, wouldn't that weaken any anthrax that's in my body?
Inhaled anthrax spores become lodged in the body and may activate after initial exposure. Antibiotics have little or no effect when the spores are inactive. To be effective in preventing inhalational anthrax, the antibiotics must be in your system when the spores activate. It is necessary to take the medicine for at least 60 days to ensure the best protection against inhalational anthrax.
If an anthrax event occurs, should people buy and store antibiotics?
There is no need to buy or store antibiotics, and indeed, it can be detrimental to both the individual and to the community. First, only people who are exposed to anthrax should take antibiotics, and health authorities must make that determination. Second, individuals may not stockpile or store the correct antibiotics. Third, under emergency plans, the federal government can ship appropriate antibiotics from its stockpile to wherever they are needed.
Will antibiotics protect me from a bioterrorist event? Should I stockpile them?
CDC does not recommend using antibiotics unless a specific disease has been identified. There are several different agents that could be used for bioterrorism, such as bacteria, viruses, and toxins. Not a single antibiotic (or vaccine) works for all of these agents. Antibiotics only kill bacteria, not viruses or other agents that could also be used in a bioterrorist event. Antibiotics are not harmless drugs. They can cause serious side effects and drug interactions. National and state public health officials have large supplies of needed drugs and vaccines if a bioterrorism event should occur. These supplies can be sent anywhere in the United States within 12 hours.
When is a 60-day prescription of prophylactic antibiotics not needed?
People who are determined not to be at risk for inhalational anthrax do not need to take the 60-day course of prophylactic antibiotics. Prophylactic antibiotics are not indicated for the prevention of cutaneous anthrax, for hospital personnel caring for patients with anthrax, or for persons who routinely open or handle mail if there has not been a credible threat.
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