Official
CDC Health Advisory:
Use
of Ciprofloxacin or Doxycycline for
post-exposure prophylaxis for prevention of inhalation anthrax
Interim
recommendations, MMWR 50(no 41):893 Oct 19,2001, for
postexposure prophylaxis to prevent inhalational anthrax after
exposure
to B. anthracis spores recommend ciprofloxacin or doxycycline
as initial
therapy in situations associated with the current bioterrorist
attack in
the United States.
Effectiveness:
There is no evidence which demonstrates that ciprofloxacin is
more or less
effective than doxycycline for postexposure prophylaxis for prevention
of
infection with B. anthracis
Resistance:
Widespread use of any antibiotic will promote resistance. Many
common
pathogens are already resistant to tetracyclines such as doxycycline.
However, ciprofloxacin resistance is not yet common in these same
organisms. To preserve the effectiveness of ciprofloxacin against
other
infections, use of doxycycline for prevention of B. anthracis
infection
is reasonable. Ciprofloxacin is an effective antimicrobial for
a variety
of other bacterial infections. Thus, the wide use of this drug
in thousands
of individuals may lead to increased resistance of other bacterial
pathogens
to ciprofloxacin and other fluroquinolones, and limit the usefulness
of these
agents.
Side
effects:
On the basis of side-effect profiles (see below), the history
of reactions, or
the clinical setting, either doxycycline or ciprofloxacin may
be preferable
for an individual patient.
Patient
Information:
Ciprofloxacin 500 mg
ORAL TABLET 55000
This
drug belongs to a class of drugs called quinolone antibiotics.
You have
been given this drug for protection against possible exposure
to an infection-
causing bacteria. This drug prevents: * Anthrax
You
have been provided a limited supply of medicine. Local emergency
health workers or your healthcare provider will inform you if
you need more
medicine after you finish this supply. If so, upon your follow-up
visit, you will
be told how to get more medicine. You will be told if no more
medicine is
needed. You may also be switched from this medicine to a different
medicine
based on laboratory tests.
Take this medicine as prescribed: one tablet by mouth, two times
a day.
You will be provided special dosing instructions for children.
Keep
taking your medicine, even if you feel okay, unless your doctor
tells
you to stop. If you stop taking this medicine too soon, you may
become ill.
You
should take this medicine with a full glass of water. Drink several
glasses
of water each day while you are taking this medicine. It is best
to take this
medicine 2 hours after a meal. If it upsets your stomach, you
may take it with
food, but do not take it with milk, yogurt, or cheese.
If you miss a dose, take the missed dose as soon as possible.
If it is almost
time for your next regular dose, wait until then to take your
medicine, and skip
the missed dose. Do not take two doses at the same time.
Drugs
and foods to avoid:
Do not take the following drugs within 2 hours of taking Ciprofloxocin:
antacids such as Maalox or Mylanta, vitamins, iron supplements,
zinc
supplements, or sucralfate (Carafate). You may take them 2 hours
after
or 6 hours before Ciprofloxocin. Also, make sure your doctor knows
if
you are taking asthma medicine like theophylline, gout medicine
like
probenecid (Benemid), or a blood thinner such as Coumadin.
Avoid drinking more than one or two caffeinated beverages (coffee,
tea,
soft drinks) per day. Avoid taking this medicine with foods containing
large amounts of calcium, like milk, yogurt, or cheese.
Warnings:
If you have epilepsy or kidney disease, or if you are pregnant,
become
pregnant, or are breastfeeding, notify emergency healthcare workers
before you start taking this medicine.
Do
not take this medicine if you have had an allergic reaction to
ciprofloxacin or other quinolone medicines such as norfloxacin
(Noroxin),
ofloxacin (Floxin) or nalidixic acid (NegGram). This medicine
may make
you dizzy or lightheaded. Avoid driving or using machinery until
you know
how it will affect you. This medicine increases the chance of
sunburn;
make sure to use sunscreen to protect your skin.
Side
effects:
Call your doctor or seek medical advice right away if you are
having any
of these side effects: rash or hives; swelling of face, throat,
or lips;
shortness of breath or trouble breathing; seizures; or severe
diarrhea.
Less serious side effects include nausea, mild diarrhea, stomach
pain,
dizziness, and headache. Talk with your doctor if you have problems
with these side effects.
Patient
Information:
DOXYCYCLINE 100 MG
ORAL TABLET
This
drug belongs to a class of drugs called tetracycline antibiotics.
You
have been given this drug for protection against possible exposure
to an
infection-causing bacteria. This drug prevents: * Anthrax
You
have been provided a limited supply of medicine. Local emergency
health workers or your healthcare provider will inform you if
you need more
medicine after you finish this supply. If so, upon your follow-up
visit, you
will be told how to get more medicine. You will be told if no
more medicine
is needed. You may also be switched from this medicine to a different
medicine based on laboratory tests.
Take
this medicine as prescribed: one tablet by mouth, two times a
day.
You will be provided special dosing instructions for treatment
of children
under 8 years of age.
Keep
taking your medicine, even if you feel okay, unless your healthcare
provider tells you to stop. If you stop taking this medicine too
soon, you
may become ill.
You
may take your medicine with or without food or milk, but food
or milk
may help you avoid stomach upset.
If
you miss a dose, take the missed dose as soon as possible. If
it is
almost time for your next regular dose, wait until then to take
your
medicine, and skip the missed dose. Do not take two doses at the
same
time.
Drugs
and foods to avoid:
Do not take the following medicines within 2 hours of taking DOXYCYCLINE:
antacids such as Maalox or Mylanta, calcium or iron supplements,
cholestyramine (Questran) or colestipol (Colestid).
While
you are taking this medicine, birth control pills may not work
as
well; make sure to use another form of birth control.
Warnings:
If you have liver disease, or if you are or might be pregnant,
or if you are breastfeeding, tell emergency healthcare workers
before
you start taking this medicine.
This
medicine increases the chance of sunburn; make sure to use
sunscreen to protect your skin.
Do
not take this medicine if you have had an allergic reaction to
any
tetracycline antibiotics.
Women
may have vaginal yeast infections from taking this medicine.
Side
effects: Call your doctor or seek medical attention right
away if you
are having any of these side effects: skin rash, hives, or itching;
wheezing
or trouble breathing; swelling of the face, lips, or throat. Less
serious side
effects include diarrhea, upset stomach, nausea, sore mouth or
throat,
sensitivity to sunlight, or itching of the mouth or vagina lasting
more than
2 days. Talk with your doctor if you have problems with these
side effects.
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updated 9-3-04
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