Results do not suggest widespread anthrax antibiotic abuse in the aftermath of the 2001 terrorist attacks

Prescriptions for antibiotics that could be taken in advance to prevent against anthrax were uncommon among concerned patients after September 11, 2001 and the 2001 U.S. anthrax attacks, according to an article in the October 11 issue of The Archives of Internal Medicine.

According to the article, nationwide, more than 10,000 affected workers and others were given 3.75 million prophylactic antibiotic pills through official dispensing campaigns between October 2001 and January 2002. However, media reports suggest that even more prescriptions were given out by individual physicians.

Nathaniel Hupert, M.D., M.P.H., of the Weill Medical College of Cornell University, New York, N.Y., and colleagues reviewed the electronic medical records of outpatient telephone contacts and clinic visits at a large, primary care practice in New York City from September 11 to December 31, 2001 to identify factors associated with prescribing antibiotics to prevent anthrax.

There were 30,456 total patient visits (via phone or in person) between September 11 and December 21, 2001. Of these visits, 244 involved patient-initiated discussion about bioterrorism: 92 (0.6 percent) of 14,917 telephone contacts and 152 (1.0 percent) of 15,539 office visits. Average patient volume was higher from October to December in 2001 (221.2 patients per day) compared with the same time period in 2000 (199.1 patients per day).

Fifty patients (21 percent of the 244 who discussed bioterrorism with their physician) requested antibiotics or vaccines, and 52 patients (22 percent) received antibiotics: 39 received ciprofloxacin; 12 doxycycline; and 1 received both drugs.

"Despite widespread popular concern about bioterrorism and speculation about increased patient requests and physician prescribing of antibiotics for anthrax prophylaxis, only one in five patients who initiated discussion about anthrax or smallpox with physicians at this internal medicine practice in the wake of the 2001 terrorist attacks either requested antibiotics or received them," write the researchers.

"While we cannot comment on the New York City population as a whole, our results do not suggest widespread antibiotic abuse in the aftermath of the 2001 terrorist attacks, as measured by patient requests and physician prescribing in this academic outpatient practice," the authors state. "Prescription of antibiotics appropriate for anthrax prophylaxis (i.e., ciprofloxacin, doxycycline, or amoxicillin) was most highly associated with patient requests, followed by report of potential exposure and abnormal findings on physical examination."