LONDON (Reuters Health) – Indiscriminate, prolonged antimicrobial prophylactic treatment of anthrax may lead to drug resistance in commensal bacteria, UK scientists warn. This resistance could then be transferred to pathogenic bacteria, even Bacillus anthracis itself.
In a commentary of the British Medical Journal for November 3, Dr. C. Anthony Hart of the University of Liverpool, and Dr. Nicholas J. Beeching of the Liverpool School of Tropical Medicine, recommend that prophylactic treatment be given only to those who really need it.
Just who that should be "is the million-dollar question," Dr. Beeching told Reuters Health. "I can tell you who shouldn't take it–that's the man in the street who has walked past a railway train that's gone through a town where there might be a building that might be contaminated."
He emphasized that experts on the scenes of contamination must decide if there was a high risk of exposure or a very low risk, and ensure that only those people exposed or likely to have been exposed receive antimicrobials. Equally important, he said, "when a potentially contaminated package or area has been shown to be clear and safe to everybody's best knowledge, then people should be told it's safe to stop taking antibiotics."
Dr. Beeching recognizes the difficulty in making recommendations when an area of contamination is found. However, he said, "if there is no risk of spores being blown around in the air conditioner, or up and down elevator shafts, one would only advise prophylaxis for those that were in the room where exposure occurred."
If the difficulties are problematic, the alternative is worse, Drs. Beeching and Hart believe. "To induce antimicrobial resistance on a mass scale would be an even greater triumph for the terrorists," they write.
Br Med J 2001;323:1017-1018.
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