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Prophylactic treatment of anthrax with antibiotics

BMJ 2001; 323 doi: (Published 03 November 2001) Cite this as: BMJ 2001;323:1017

Indiscriminate use of antibiotics will lead to resistance in organisms

  1. C Anthony Hart, professor of medical microbiology (,
  2. Nicholas J Beeching, senior lecturer in tropical medicine
  1. Department of Medical Microbiology and Genito-Urinary Medicine, University of Liverpool, Liverpool L69 3GA
  2. Liverpool School of Tropical Medicine, Liverpool L3 5QA

    B acillus anthracis has long been considered a potential biological weapon. The Scottish island of Gruinard was contaminated with spores for 45 years and the Aum Shinrikyo terrorists made unsuccessful attempts to release aerosols of anthrax and Clostridium botulinum spores in Tokyo.1 In addition, anthrax spores were inadvertently released from a microbiological facility in Sverdlovsk in the former Soviet Union, resulting in at least 79 people getting anthrax and 68 deaths.1 In response to the recent anthrax attacks in the United States, the US and other governments have bought large amounts of ciprofloxacin, and in the US many potentially exposed individuals have started prophylactic treatment. Unofficial use of ciprofloxacin will be common in the light of the worldwide panic. Ciprofloxacin has been chosen to treat anthrax for its ease of administration, good safety profile, and predictable activity. The alternatives are amoxicillin or doxycycline, but these too have side effects and can induce resistance. The important thing is to ensure that prophylactic treatment is given only to those who really need it, and to discourage its mass use by an understandably alarmed public. Indiscriminate …

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