Letter to Health Care Providers Regarding Ciprofloxacin
For immediate release:
October 24, 2001
Contact: Linda Dorey - 802-863-7281
Vermont Department of Health
BURLINGTON - The following letter has been sent to Vermont health care providers:
Dear Vermont Health Care Provider:
With the recent events concerning bioterrorism, and in particular anthrax exposure, several issues have been raised concerning antibiotic use and approach to the patient with a possible bioterrorism exposure.
A. Many patients are requesting and some providers are recommending prescriptions for ciprofloxacin to use prophylactically in case of a possible bioterrorism exposure. We recommend that you DO NOT write these prescriptions. The use of ciprofloxacin in this manner is detrimental and counterproductive and does the patient and our community a serious disservice.
- Inappropriate stockpiling of the drug will deplete the supplies of ciprofloxacin at regional hospitals and pharmacies. When ciprofloxacin is truly needed in case of a true anthrax exposure or to treat other infections not related to bioterrorism due to agents such as Pseudomonas aeruginosa, there may not be enough ciprofloxacin available for those who truly need it.
- Patients will not know when to take the medication leading to excess and inappropriate use. This will inevitably lead to increased adverse drug reactions. Excess use will also contribute to the growing problems of bacterial resistance in our communities.
In a situation where someone has been exposed to confirmed Bacillus anthracis, there is enough time to safely contact those individuals and begin treatment with appropriate antibiotic therapy to prevent illness.
B. Individuals with no anthrax exposure (as determined by the Vermont Department of Health and law enforcement called to the site) do not need medical evaluation or antibiotic prophylaxis. Patients should NOT have nose cultures performed attempting to isolate Bacillus anthracis. The sensitivity and specificity of the test are poor and should not be used as a clinical diagnostic tool. Nasal cultures are being used as an epidemiological tool only under the guidance of the Centers for Disease Control and Prevention.
C. If a patient calls your office concerned about a possible bioterrorism exposure, they should be instructed to call 911 or local law enforcement. They should not come to your office or be sent to the local emergency department. Other recommendations that can be made over the phone regarding suspicious packages/ mail or powder include:
- Remain calm. Carefully close the envelope or package so as not to create a dust cloud or disturb the contents.
- If you are able, place the envelope or package in a plastic bag or cover it with something (newspaper, trash can, etc) and leave it covered.
- All persons should leave the room. The door should be closed to prevent others from entering.
- Wash hands with soap and water.
- Report the event by dialing 911 or local law enforcement.
- Shower with soap and water as soon as possible. Do not use bleach or disinfectants.
- If clothes are heavily contaminated with the powder, they should be placed in a plastic bag and sealed.
D. If a patient calls your office with concerns about symptoms related to a bioterrorism exposure, address their medical needs first and recommend
that they contact 911 or local law enforcement if they have not already done so.
If you should have any questions, please call the Vermont Department of Health at 863-7240 or 1 -800-640-4374 or the infectious disease service at FAHC at 802-847-2700. Additional information is available at the Health Department's website (www.state.vt.us/health) and the CDC website (www.cdc.gov).
Sincerely,
Christopher Grace, MD
Director, Infectious Diseases
Fletcher Allen Health Care
Jan K. Carney, MD, MPH
Commissioner of Health
Vermont Department of Health
Ann Fingar, MD, MPH
State Epidemiologist
Vermont Department of Health