[e-drug] Doxycycline becomes D.C.'s anthrax drug (cont'd)

[James Love <love@cptech.org>]

E-drug: Doxycycline becomes D.C.'s anthrax drug (cont'd)
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Kirsten Myhr wrote:
> The issue of antibacterial resistance is not a straightforward one
> and should be dealt with by microbiologists. I think that CDC,
> being a WHO Collaborating Centre, should address that issue.

I think the issue is mostly whether or not people take seriously the
reports that strains of Anthrax exist that were specifically designed
to be resistant to older antibiotics, for use as weapons. In private
email, some have expressed skepticism that such strains even exist,
let alone are available to terrorists. I was not aware that CDC had
an expert opinion on what is largely a military issue, regarding the
risks of biological warfare agents. The JAMA article did of course
say this:

"Reports have been published of a B anthracis vaccine strain that
has been engineered by Russian scientists to resist the tetracycline
and penicillin classes of antibiotics.62 Although the engineering of
quinolone-resistant B anthracis may also be possible, to date there
have been no published accounts of this. (62. Stepanov AV,
Marinin LI, Pomerantsev AP, Staritsin NA. Development of novel
vaccines against anthrax in man. J Biotechnol. 1996;44:155-160.)"

Which would suggest that the risks of such strains are not zero.
With respect to a decision to stockpile medicines, one would ask, in
a society like the US, what is the appropriate level of precaution,
from a public health standpoint? 
 
With all due respect to the CDC, I don't think there has been a very
clear answer on this point, unless one reads between the lines to
hear that they don't give much weight to these published reports,
or the probability that such strains, if they exist, are available to
terrorists. Another guess is that the issue of the stockpile has been
highly political, given the dispute over the Bayer patents, and now
the offers by other firms to provide non-tested quinolones as
alternatives to ciprofloxacin.

What are the issues concerning the use of the other quinolones,
should an event occur which requires treatments other than
tetracycline or penicillin classes of antibiotics? Is there any problem
with relying upon other quinolones, should they be needed, given
the lack of testing, or are they similar enough that they would be
straightforward substitutes?

Jamie
-- 
James Love
Consumer Project on Technology
P.O. Box 19367, Washington, DC 20036
http://www.cptech.org, mailto:love@cptech.org
voice: 1.202.387.8030 fax 1.202.234.5176 mobile
1.202.361.3040


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