Anthrax antibiotic sales up

Fear of biological warfare boosts sales of Bayer's Cipro

September 25, 2001: 8:17 p.m. ET NEW YORK (Reuters) - Pharmacists in New York have sold greater-than-normal amounts of antibiotics for treating anthrax, a highly contagious and potentially fatal disease, amid rising fear of biological warfare after the attacks on the World Trade Center.

Though sales of antibiotics normally rise in September when children return to school and parents are concerned about their exposure to infections, pharmacists said the sale of Bayer AG's anti-microbial drug Cipro are much higher than usual.

Cipro, the German drug maker's best-selling drug, is used to treat a number of diseases and infections, including anthrax, a disease that can cause bleeding blisters, difficulty in breathing, shock and coma. Even with early treatment, the inhalation of anthrax spores is almost always fatal.

"We're hearing that Cipro is a front-line defense against anthrax and in the last couple of days I've sold about a month's worth," said Barry Reiter, chief operating officer of Brooklyn-based Remo Drug Corp., one of the largest independent pharmaceutical supply companies in America.

"Today we'll be out of stock and we've already reordered," Reiter said Tuesday.

Check out drug stocks here

The U.S. Federal Aviation Administration on Tuesday said crop-duster planes could fly again after they were grounded for two days because of rising fear of biological or chemical attack in the wake of the Sept. 11 hijacked jetliner attacks in New York and outside Washington.

Bayer said it sells worldwide about $1 billion a year of Cipro, a drug used to treat urinary tract and gastrointestinal infections, as well as pneumonia and bronchitis. The drug was approved by the U.S. Food and Drug Administration to treat exposure to anthrax in August 2000 and it is the only orally administered drug recommended for such use by the Centers for Disease Control and Prevention in Atlanta.

The dosage to treat anthrax is two pills a day for 60 days, while a patient suffering from a gastro-intestinal infection would take two pills a day for about a week.

Cipro demand soars

Sylvia Lifshitz, a pharmacist at independent Drug Mart on Manhattan's Upper East Side, normally prescribes about 300 Cipro tablets in a two- to three-week period. That is for about five patients who buy a month's supply of 60 tablets for about $1 each to ward off gastrointestinal microbes picked up from water when traveling, or squelch infections after surgery, for instance.

Over the first weekend after the World Trade Center attacks, however, Lifshitz dispensed about 1,000 Cipro tablets in three days.

"I've never done that before," Lifshitz said, adding that most of her customers have been "highly educated and highly neurotic."

Lifshitz ordered extra Cipro after New York physicians began prescribing it for themselves and their families, and currently has a stock of about 1,200 pills in the store, even though she is uncertain of its efficacy against anthrax.

Robert Berman, co-owner of Kings Pharmacy, which has six stores in New York City, including one near the World Trade Center, said he has also seen a large rise in requests for Cipro.

"I had one guy come in and buy a two-month supply for him and his wife," said Berman.

Chain drug store Rite Aid Corp. (RAD: Research, Estimates), which has 30 stores in Manhattan, said more antibiotics normally are sold in September, though it had not noticed an unusual rise in the sale of Cipro.

Cipro is not the only antibiotic available for treatment of inhaled microbes. Generic doxycycline, usually prescribed to prevent traveler's diarrhea, is another anti-microbial drug that normally sees a rise in sales in September.

"People are panicking, and we've had more than the usual number of inquiries about doxycycline, too," said pharmacist Gary Halpern at the Caligor Pharmacy on Manhattan's Upper East Side, most of whose business has come from selling vaccines.

No supply shortage

David Siegrist, a research fellow and the director of studies for the Countering Biological Terrorism program at the Potomac Institute for Policy Studies in Arlington, Virginia, said there was a reason for doctors' choosing Cipro first.

"It's believed that terrorists could make their anthrax resistant to doxycyline, but Cipro is more complicated," Siegrist said. He said that Cipro is the anti-microbial drug of choice for the U.S. military, which bought doses for the troops that served in the Gulf War in 1991.

"It wouldn't hurt to have a little Cipro on hand now," Siegrist said.

Pharmacists need not fear of a supply shortage, said Bayer, which makes the drug in a plant in Westhaven, Connecticut, and in Europe.

"We've got no supply issues at this point and people should rest assured that we have been working with the CDC and the Department of Defense for over a year," said spokesman Rob Kloppenburg.

http://hv.greenspun.com/bboard/q-and-a-post-new.tcl?topic=Grassroots%20Information%20Coordination%20Center%20%28GICC%29

-- Martin Thompson (mthom1927@aol.com), September 25, 2001

Answers

Extend the shelf life of such special items by putting them in their original containers into a sealed clean coffee can (my preference) or other container, then put into the back of your refrigerator (not freezer). Cool, dry, dark conditions are what you want.

I can't give you exact data right now, but studies have suggested the useful lifespan of these items is extended *many many* years beyond the manufacturer's expiration date printed on the bulk container. The expiration date is quite conservative and assumes "normal" abuse once the product leaves tha factory (including putting medication in the medicine cabinet in your bathroom, one of the worst places imaginable -- it's humid and warm, the opposite of what you should seek).

If you get such items in smaller containers, go ahead and ask the pharmacist what the printed date was and write that on the outside of the package for future reference.

Just my personal comments, these comments are not endorsed by my employer, my dog, or my left bunion.

--Andre Weltman, M.D., M.Sc., public health physician

-- Andre Weltman (aweltman@state.pa.us), September 26, 2001.

Here's a link to a brief article on drug expiration dates:

http://www.medletter.com/freedocs/expdrugs.pdf

In addition to the information in the Medical Letter link above, I will look for a reference to the study that I seem to recall was done a couple years ago by the U.S. Dept of Defense with regard to the stockpile of pharmaceuticals (presumably including antibiotics for bioterrorism) maintained for U.S. military use.

-- Andre Weltman (aweltman@state.pa.us), September 26, 2001.

Andre, as a public health official are you hearing anything more about the biological and chemical threats? Any information more than we already have, I mean?

-- Kathleen Sanderson (stonycft@worldpath.net), September 27, 2001.

Well, lots of speculation and concern, and lots of panicked phone calls from members of the public wanting something that just isn't there (mass anthrax vaccine, etc). I am not in a position to hear about any actual law enforcement-type news that would be meaningful...nor is this the place for such information.

Overall, what I know or suspect is coming more from "first principles" and from public sources including the "news" roundup here on GICC.

Bottom line, we are all alert and aware, as is the public. But whether something is actually going to happen, who the hell knows.

I will comment further as a reader of GICC, not as a public health doc:

I wonder if the bad guys (whoever they are) are now waiting for a U.S. military response before making the next attack (whatever is may be).

This would be a sort of media relations ploy -- "See, first the U.S. did stuff to us (1991 Gulf War; helped Israel; sent cruise missles into Afghanistan under Clinton; whatever), then we struck back with our brave airborne martyrs in NY and DC, then the satanic U.S. blew up innocents in Afghanistan, so now we did...". I don't think the West would see this as making much sense or justifying a second set of terrorist attacks on U.S. soil, but for domestic consumption in Egypt/Pakistan/Saudi Arabia it might make sense to the bad guys.

So, I really wonder if we are in a holding pattern until after the U.S. military moves in...

Just some clueless speculation.

--Andre

As always, I speak for myself only. My employer can go...well, I'll stop there.

-- Andre Weltman (aweltman@state.pa.us), September 27, 2001.