E-drug: Literature review on anthrax prevention and treatment
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[Excellent job, Leo! Thanks for sharing this with us. HH]
Dear colleagues,
One of the moderators has asked me to critically assess available
literature data on anthrax prophylaxis and treatment and summarize
those for our network. Much has become clear to me which was
obfuscated by the media and the American mass hysteria.
This is not meant to deny that anthrax is a terrible and dangerous
disease, but let's restrict ourselves to the facts:
There is a lot of (old) clinical evidence on anthrax from tropical
countries and from the time when it was a well known risk of
butchering and hunting: Many countries outside the English-
speaking area had their own folk names for the disease, like
Mjaeltbrand (Swedish), miltvuur (Dutch), maladie du charbon
(French), and milzbrand (German), to name a few, indicating that it
was a well known and common disease. When one reads classical
textbooks such as the Oxford textbook of Medicine, Kucers &
Benett, O'Grady and Lambert 1st line treatment is 4 times daily
250.000 U penicillin, and prophylaxis is by vaccination.
Since the Gulf war there has been an anthrax "scare", and this has
changed the situation. 590.000 US soldiers have been vaccinated
with an attenuated vaccine produced by BioPort in Michigan.
However, two years ago the factory closed down because the FDA
refused to register the vaccine. Why? Not because of worries about
the quality, but because FDA thought that safety precautions were
insufficient to prevent burglary or theft of microbes or the vaccine.
So there is no or insufficient supply of the vaccine, which in itself is
quite effective. There also seems to be a British vaccine, but I have
no data on that.
Now about ciprofloxacin: Why this drug? There is NO clinical data
on the efficacy of ciprofloxacin (or any other fluoroquinolone) in
anthrax, only in a restricted number of monkeys. There is
reasonable evidence on the efficacy of doxycycline both for
treatment and prevention. The preference for ciprofloxacin dates
back to a consensus conference, published in JAMA in 1999. There
was some evidence that Russia had been developing strains
resistant to penicillin and doxycyclin, but the evidence was very
flimsy. Other fluoroquinolones might be just as effective - it is
worthy of note that the patent for norfloxacin dates back to 1979.
The committee therefore recommended to use ciprofloxacin "in
case of a terrorist attack", unless the strain had been
bacteriologically shown to be sensitive to penicillin or doxycylin.
The governor of Michigan has rightly stressed that the vaccine plant
should be reopened, safe or not. Why only soldiers and not
secretaries?
Many authorities seem to have been sleeping; there has already
been an earlier "powder-letter" scare in 1998, but that proved to be
a hoax (MMWR 1999;48:69-74).
In summary, the standard prophylaxis remains vaccination; the
vaccine has proved to be perfectly safe and had no side effects.
For treatment: Doxycycline or i.v. penicillin as recommended in the
past both by CDC and the WHO.
I hope this info is helpful.
Best wishes to everybody,
Dr.L.Offerhaus
Koedijklaan 1a
1406 KW Bussum
The Netherlands
Phone +31-35-6923288
Fax +31-35-6923277 (number changed since 1.11.01)
E-mail: lo@euronet.nl
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