AMC/NOMA NOTABLES – November 1, 2001

The CDC/NCID/Division of Healthcare Quality Promotion is now sending out

More frequent updates about bioterrorism events. AMC/NOMA members may be interested in the following information.

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The following is an Official CDC Advisory:

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Official CDC Health Advisory: USE OF CIPROFLOXACIN OR DOXYCYCLINE FOR

POSTEXPOSURE PROPHYLAXIS FOR PREVENTION OF INHALATIONAL ANTHRAX

Interim recommendations, MMWR 50(no 41):893 Oct 19,2001, for postexposure prophylaxis to prevent inhalational anthrax after exposure to B. anthracis spores recommend ciprofloxacin or doxycycline as initial therapy in situations associated with the current bioterrorist attack in the United States.

EFFECTIVENESS: There is no evidence which demonstrates that ciprofloxacin is more or less effective than doxycycline for postexposure prophylaxis for prevention of infection with B. anthracis

RESISTANCE: Widespread use of any antibiotic will promote resistance. Many common pathogens are already resistant to tetracyclines such as doxycycline. However, ciprofloxacin resistance is not yet common in these same organisms. To preserve the effectiveness of ciprofloxacin against other infections, use of doxycycline for prevention of B. anthracis infection is reasonable. Ciprofloxacin is an effective antimicrobial for a variety of other bacterial infections. Thus, the wide use of this drug in thousands of individuals may lead to increased resistance of other bacterial pathogens to ciprofloxacin and other fluroquinolones, and limit the usefulness of these agents.

SIDE EFFECTS: On the basis of side-effect profiles (see below), the history of reactions, or the clinical setting, either doxycycline or ciprofloxacin may be preferable for an individual patient.

Patient Information:

ORAL TABLET 55000

This drug belongs to a class of drugs called quinolone antibiotics. You have been given this drug for protection against possible exposure to an infection-causing bacteria. This drug prevents: Anthrax. You have been provided a limited supply of medicine. Local emergency health workers or your healthcare provider will inform you if you need more medicine after you finish this supply. If so, upon your follow-up visit, you will be told how to get more medicine. You will be told if no more medicine is needed. You may also be switched from this medicine to a different medicine based on laboratory tests.

Take this medicine as prescribed: one tablet by mouth, two times a day.

You will be provided special dosing instructions for children.

Keep taking your medicine, even if you feel okay, unless your doctor tells you to stop. If you stop taking this medicine too soon, you may become ill.

You should take this medicine with a full glass of water. Drink several glasses of water each day while you are taking this medicine. It is best to take this medicine 2 hours after a meal. If it upsets your stomach, you may take it with food, but do not take it with milk, yogurt, or cheese.

If you miss a dose, take the missed dose as soon as possible. If it is almost time for your next regular dose, wait until then to take your medicine, and skip the missed dose. Do not take two doses at the same time.

DRUGS AND FOODS TO AVOID: Do not take the following drugs within 2 hours of taking Ciprofloxocin: antacids such as Maalox or Mylanta, vitamins, iron supplements, zinc supplements, or sucralfate (Carafate). You may take them 2 hours after or 6 hours before Ciprofloxocin. Also, make sure your doctor knows if you are taking asthma medicine like theophylline, gout medicine like probenecid (Benemid), or a blood thinner such as Coumadin.

Avoid drinking more than one or two caffeinated beverages (coffee, tea, soft drinks) per day. Avoid taking this medicine with foods containing large amounts of calcium, like milk, yogurt, or cheese.

WARNINGS: If you have epilepsy or kidney disease, or if you are pregnant, become pregnant, or are breastfeeding, notify emergency healthcare workers before you start taking this medicine.

Do not take this medicine if you have had an allergic reaction to ciprofloxacin or other quinolone medicines such as norfloxacin (Noroxin), ofloxacin (Floxin) or nalidixic acid (NegGram).

This medicine may make you dizzy or lightheaded. Avoid driving or using machinery until you know how it will affect you.

This medicine increases the chance of sunburn; make sure to use sunscreen to protect your skin.

SIDE EFFECTS: Call your doctor or seek medical advice right away if you are having any of these side effects: rash or hives; swelling of face, throat, or lips; shortness of breath or trouble breathing; seizures; or severe diarrhea. Less serious side effects include nausea, mild diarrhea, stomach pain, dizziness, and headache. Talk with your doctor if you have problems with these side effects.

Patient Information:

DOXYCYCLINE 100 MG

ORAL TABLET

This drug belongs to a class of drugs called tetracycline antibiotics. You have been given this drug for protection against possible exposure to an infection-causing bacteria. This drug prevents: Anthrax

You have been provided a limited supply of medicine. Local emergency health workers or your healthcare provider will inform you if you need more medicine after you finish this supply. If so, upon your follow-up visit, you will be told how to get more medicine. You will be told if no more medicine is needed. You may also be switched from this medicine to a different medicine based on laboratory tests.

Take this medicine as prescribed: one tablet by mouth, two times a day.

You will be provided special dosing instructions for treatment of children under 8 years of age.

Keep taking your medicine, even if you feel okay, unless your healthcare provider tells you to stop. If you stop taking this medicine too soon, you may become ill.

You may take your medicine with or without food or milk, but food or milk may help you avoid stomach upset.

DRUGS AND FOODS TO AVOID: Do not take the following medicines within 2 hours of taking DOXYCYCLINE: antacids such as Maalox or Mylanta, calcium or iron supplements, cholestyramine (Questran) or colestipol (Colestid).

While you are taking this medicine, birth control pills may not work as well; make sure to use another form of birth control.

WARNINGS: If you have liver disease, or if you are or might be pregnant, or if you are breastfeeding, tell emergency healthcare workers before you start taking this medicine.

This medicine increases the chance of sunburn; make sure to use sunscreen to protect your skin.

Do not take this medicine if you have had an allergic reaction to any tetracycline antibiotics.

Women may have vaginal yeast infections from taking this medicine.

SIDE EFFECTS: Call your doctor or seek medical attention right away if you are having any of these side effects: skin rash, hives, or itching; wheezing or trouble breathing; swelling of the face, lips, or throat. Less serious side effects include diarrhea, upset stomach, nausea, sore mouth or throat, sensitivity to sunlight, or itching of the mouth or vagina lasting more than 2 days. Talk with your doctor if you have problems with these side effects.

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The Health Alert Network originally sent this message directly to State and Local Public Health Agencies. The AMC/NOMA has been asked by the Cuyahoga County Board of Health to distribute these messages to our members as they become available.

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For additional information regarding bioterrorism preparedness and response see <http://www.bt.cdc.gov/>

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This has been sent to you for distribution to appropriate health care personnel by the CDC/NCID/Division of Healthcare Quality Promotion (DHQP) Rapid Notification System.