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Anthrax and Cipro: Frequently Asked Questions

Anthrax and Cipro: Frequently Asked Questions

What is anthrax ?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates (cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans when they are exposed to infected animals or tissue from infected animals. Anthrax is a powerful biological agent that could be used intentionally. The spores are very hardy and can last for years.

How common is the anthrax bacteria and who can get it ?

Anthrax is most common in agricultural regions where it occurs in animals. These include South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. When anthrax bacterias affects humans, it is usually due to an occupational exposure to infected animals or their products. Workers who are exposed to dead animals and animal products from other countries where anthrax bacterias are more common may become infected with B. anthracis (industrial anthrax). Anthrax in wild livestock has occurred in the United States.

Is there an anthrax vaccine available ?

An animal anthrax vaccine is available and widely used in countries where anthrax is common. A human anthrax vaccine is available, but there are concerns about its routine use. The effectiveness of the anthrax vaccine is unclear. The DOD has studied anthrax vaccine reactions, and some solid, accurate data was presented, which included the following:

1. In a study of 337 vaccinated service members from Korea, the rate of any reaction (from very minor to severe) was 40% in men, but 70% in women. Reactions led to "decreased activity" in 3% of males, but in 8% of females.

2. The ongoing study of 600 service members at Tripler Army Medical Center, Hawaii, has resulted in 20% (120 people) developing a systemic reaction after at least one of the first three injections.

Department of Defense Anthrax Vaccination Moratorium Act (Introduced in the House) HR 2548 IH, 106th CONGRESS, 1st Session states :

To suspend further implementation of the Department of Defense anthrax vaccination program until the anthrax vaccine is determined to be safe and effective and to provide for a study by the National Institutes of Health of the anthrax vaccine.

Despite this, the government is still offering the anthrax vaccine to certain groups and individuals. The only safe and effective alternative is to have your supply of Cipro or Doxycycline antibiotics with you in an event that calls for the use of these antibiotics for anthrax bacteria infection prevention and protection.

Why has the bacteria anthrax become a current issue ?

Because the bacteria anthrax is considered to be a potential agent for use in biological warfare, the Department of Defense (DOD) has begun mandatory vaccination of all active duty military personnel who might be involved in conflict.

How is anthrax bacteria transmitted ?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. B. anthracis spores can live in the soil for many years, and humans can become infected with anthrax bacteria by handling products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can be spread by eating undercooked meat from infected animals. In biological war, anthrax bacteria infection would most commonly occur either through skin contact or inhalation of spores.

What are the symptoms of the anthrax bacteria ?

Symptoms of the anthrax disease vary depending on how the bacteria was contracted, but symptoms usually occur within 7 days.

Cutaneous: Most (about 95%) anthrax bacteria infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that resembles an insect bite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20% of untreated cases of cutaneous anthrax will result in death.

Deaths are rare with appropriate antibiotic therapy.

Inhalation: Initial anthrax symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalating the bacteria anthrax is usually fatal if not treated immediately with antibiotics.

Intestinal: The intestinal disease form of the anthrax bacteria may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25% - 50% of cases. Immediate antibiotic therapy significantly reduces these numbers.

Is there a treatment for inhaled anthrax ?

Ideally, antibiotic therapy along with vaccination is the recommended treatment, but the vaccine is not readily available. Usually antibiotics such as Penicillin are effective against the rare naturally occurring infection. But in the event of an intentional anthrax bacteria exposure, the strains of anthrax may be resistant to many of these commonly used antibiotics. Therefore, the FDA has approved and CDC recommends the use of Cipro and Doxycycline antibiotics in the event of an inhalation anthrax exposure.

In case of a possible exposure to inhalation anthrax, immediate medical attention is necessary for post exposure prophylaxis. Antibiotic treatment needs to start immediately.

Once informed that you are at high-risk of having been exposed to inhalation anthrax, if treatment with Cipro or Doxycycline is started within the first 1 - 6 days before manifestations of symptoms, the prognosis is very good.

Do I need to have Cipro or Doxycycline on hand, or can I wait until I am exposed ?

The most crucial time for effective treatment is in the first few days after anthrax exposure even before symptoms start. In the event of some form of an intentional bacteria anthrax exposure, Cipro antibiotics may be in short supply and may not be available or you may not be able to attain it rapidly.

Therefore, it may be wise to keep a small supply of the antibiotic Cipro as part of an emergency kit to begin therapy as soon as possible until you can get a full 60 day supply, or you can even choose to keep a full 60 day supply of Cipro on hand.

Cipro can play a very important role in any emergency preparedness plan since it is the FDA-approved drug for the treatment of the anthrax bacteria and it's recommended by the CDC. As part of biodefense preparedness, authorities are preparing to have stockpiles of antibiotics in case of an emergency. But in the event of an emergency due to inhalation anthrax exposure, it may be wise to have an emergency kit of the needed Cipro antibiotic and other emergency equipment until you can reach medical assistance.

Where and how do I store Cipro for emergency use ?

STORAGE OF CIPRO: Cipro needs to be stored away from heat and away from direct sunlight. Store the Cipro antibiotic at room temperature. Do NOT store Cipro in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the antibiotic to break down. Always check and make sure that any medications you have in your emergency kit are not outdated. Store Cipro out of the reach of children!

How long does one have to take the antibiotic Cipro ?

The recommended course of treatment for inhalation exposure to anthrax is 500mg Ciprofloxacin (take 1 tablet of 500mg or 2 tablets of 250mg) every 12 hours for 60 days. The daily dose is 1000mg Ciprofloxacin.

If potentially exposed to anthrax, it is important to seek immediate medical attention, and while taking antibiotic Cipro - one needs to have weekly blood-tests.

In the event of an intentional anthrax attack, there could potentially be difficulties obtaining the needed antibiotic Cipro. Therefore, as part of an emergency medical supply kit you may want to keep a 1 - 2 week supply of Cipro tablets available, as early treatment is KEY to survival.

Does the Cipro antibiotic need to be taken 12 hours apart ?

Yes, it is important to evenly space your two doses of 500mg Cipro antibiotic tablets 12 hours apart. With the antibiotic Cipro, it is important to keep a constant blood level and therefore the two doses need to be spaced about 12 hours apart, not just twice a day.

What if I miss a dose of the antibiotic Cipro ?

Cipro works best against the anthrax bacteria or any other bacteria when there is a constant amount in the blood. To help keep the antibiotic levels constant, take your doses at evenly spaced intervals of 12 hours and try not to miss a dose (500mg). If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, SKIP the one you missed and go back to your regular schedule.

NEVER take 2 doses of the 500mg Cipro antibiotic at the same time.