Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence

Abstract

We collected data during postexposure antimicrobial prophylaxis campaigns and from a prophylaxis program evaluation 60 days after start of antimicrobial prophylaxis involving persons from six U.S. sites where Bacillus anthracis exposures occurred. Adverse events associated with antimicrobial prophylaxis to prevent anthrax were commonly reported, but hospitalizations and serious adverse events as defined by Food and Drug Administration criteria were rare. Overall adherence during 60 days of antimicrobial prophylaxis was poor (44%), ranging from 21% of persons exposed in the Morgan postal facility in New York City to 64% of persons exposed at the Brentwood postal facility in Washington, D.C. Adherence was highest among participants in an investigational new drug protocol to receive additional antibiotics with or without anthrax vaccine—a likely surrogate for anthrax risk perception. Adherence of <60 days was not consistently associated with adverse events.

Modeling the optimum duration of antibiotic prophylaxis in an anthrax outbreak

“…The adherence rates to the 60-day regimen of antibiotics in the 2001 U.S. outbreak were only 64%, 61%, and 31% in the Washington, DC, New Jersey, and Florida clusters, respectively (19). No anthrax cases occurred among any persons who started antibiotic prophylaxis, which at first may seem surprising considering the low adherence rates to the antibiotic regimen.…”

“…We performed these calculations in three main clusters of the 2001 inhalational anthrax outbreak in the United States (17)(18)(19). These calculations were based on 4 cases of 2,747 exposed persons through the 4th day after exposure in the Brentwood postal facility in Washington, DC, 2 cases of 1,404 through the 6th day in the Hamilton postal facility in New Jersey, and 2 cases of 1,084 through the 9th day in the Florida media publishing company.…”

The impact of communications about swine flu (influenza A H1N1v) on public responses to the outbreak: results from 36 national telephone surveys in the UK.

“…5,8,9 As well as information received from public health campaigns, information from social contacts or the media and previous experiences with similar incidents can influence how people react during an outbreak, or if they will react at all. One important task that public health bodies can perform during any major incident is to assess how the public responds to the novel threat and what factors are important in influencing those responses.…”

Cost-Effectiveness Comparison of Response Strategies to a Large-Scale Anthrax Attack on the Chicago Metropolitan Area: Impact of Timing and Surge Capacity

“…For example, in a study involving people from the 6 US sites where B. anthracis exposures occurred in 2001, overall adherence to the recommended 60-day course of antimicrobial prophylaxis was only 44%. 30 In addition, vaccination is especially important if the strain of B. anthracis used in an attack is developed to be resistant to certain antibiotics to enhance its virulence. Furthermore, vaccination provides long-term protection from recurrent exposure to victims who remain in anthrax spore-contaminated areas.…”