Sir, - Having recently returned from a visit to the United States, I was surprised to learn that the Irish Medicines Board has requested the delivery of 150,000 ciprofloxacin tablets (list price £250,000) in its preparations for an outbreak of anthrax. This is particularly so in light of an admission by the Minister of State at the Department of Health, Dr Tom Moffatt, that there was no specific threat of bio-terrorism in Ireland (The Irish Times October 25th).
Most newspapers in the United States have carried articles outlining the background to the hype surrounding this particular drug in that country. When anthrax was first confirmed it was feared that the original source of the spores may have been biochemical warfare laboratories in the former Soviet Union. It was known that prior to ceasing their biochemical warfare programme, Russian experts had not only manipulated anthrax spores in size so as to facilitate inhalation, but had also made them resistant to common antibiotics such as penicillin, tetracycline and erythromycin.
Pending results of drug sensitivity testing it was appropriate therefore to recommend ciprofloxacin for those initially exposed. It quickly transpired, however, that all spores analysed to date are from another source and that none are resistant to any of the inexpensive antibiotics listed above.
General practitioners are often criticised by the Department of Health for prescribing newer, more expensive antibiotics such as ciprofloxacin. We are constantly advised to avoid prescribing these agents in circumstances where the infections being treated may be caused by organisms sensitive to cheaper drugs. Indeed, if GPs do not make savings on drug costs by, among other things, prescribing cheaper antibiotics, they will receive no funding for practice development. Perhaps now the Department of Health should follow its own advice to GPs on antibiotic prescribing.
In the unlikely event of any anthrax spores reaching these shores the public can be treated effectively with inexpensive, readily available antibiotics such as penicillin, tetracycline and erythromycin. - Yours, etc.,
R. Spelman, MB, MRCGP, MICGP, Health Centre, Bridgetown, Co Wexford.