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Antibiotics for Anthrax
Patient Requests and Physician Prescribing Practices During the 2001 New York City Attacks
Nathaniel Hupert, MD, MPH;
Wairimu Chege, MD, MPH;
Gonzalo M. L. Bearman, MD, MPH;
Fred N. Pelzman, MD
Arch Intern Med. 2004;164:2012-2016.
Background Little is known about patient encounters with primary care physicians and prescribing practices during the 2001 US anthrax attacks.
Methods We retrospectively reviewed the electronic medical record of outpatient telephone and clinic visits at a large primary care practice in New York City from September 11 to December 31, 2001, to identify physician- and patient-related factors that were associated with prescribing antibiotics for anthrax prophylaxis.
Results Average daily patient volume from October to December was higher in 2001 (221.2 patients per day) compared with 2000 (199.1; P<.01) and 2002 (215.8; P = .14). Patient-initiated discussion about anthrax or smallpox were involved in 244 patient contacts with 63 physicians, including 92 (0.6%) of 14917 telephone contacts and 152 (1.0%) of 15 539 office visits. Fifty patients (21%) requested antibiotics or vaccines and 52 (22%) received antibiotics: 39 received ciprofloxacin; 12, doxycycline; and 1, both drugs. Independent predictors of receiving anthrax prophylaxis included requesting medication (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.5-18.6), reporting powder or workplace exposure (OR, 4.5; 95% CI, 2.1-10.0), having an abnormal physical examination finding (OR, 3.9; 95% CI, 1.4-11.0), and being asymptomatic (reporting any illness symptoms was associated with an OR of 0.3 [95% CI, 0.1-0.6]).
Conclusions Primary care physicians played an important and heretofore underdocumented role in responding to the 2001 anthrax attacks. Prescription of prophylactic antibiotics for anthrax was uncommon and appears to have been selective among concerned patients. These results highlight the importance of including primary care physicians in community-wide bioterrorism response planning.
From the Weill Medical College of Cornell University, New York, NY (Drs Hupert and Pelzman); Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Chege); and Medical College of Virginia, Virginia Commonwealth University, Richmond (Dr Bearman). The authors have no relevant financial interest in this article.
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