Everybody loves Cipro. In the aftermath of deadly bioterrorist attacks on U.S. soil, many people are suspected of hoarding it, or even gulping it, and supplies at pharmacies are running out. As NBC news anchor Tom Brokaw--himself the target of one of the mail attacks--put it: "In Cipro we trust." But some scientists warn that the obsession is unwarranted and may backfire.
Cipro's popularity began just before the Gulf War, says C. J. Peters, a former deputy commander of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) in Fort Detrick, Maryland. The U.S. worried that Iraq might release anthrax, and vaccines were in short supply. Peters--now at the University of Texas Medical Branch in Galveston--and other experts were concerned that Iraq had developed strains resistant to existing antibiotics. So the group focused on a relatively new drug, Bayer's ciprofloxacin, reasoning that Iraq would not have figured out how to elude it. A quick experiment at USAMRIID showed that the drug worked well in monkeys.
During the war, Bayer supplied the U.S. government with 30 million tablets of Cipro. In 1998, it appeared as the drug of choice in the Army's Medical Management of Biological Casualties Handbook, and a year later a group of experts, writing in The Journal of the American Medical Association, concluded that Cipro was the drug of choice to treat unknown strains of anthrax, because there have been no published reports of resistance. In August 2000, the FDA added Cipro to the list of antibiotics approved for use in victims of anthrax inhalation.
But Cipro isn't better than other antibiotics, such as penicillin and a class of antibiotics called tetracyclines, Peters says; the edge that it had 10 years ago--its newness--is gone. Worse, a reliance on Cipro might tempt bioterrorists to produce Cipro-resistant strains of Bacillus anthracis.
In fact, microbiologist Paul Keim of Northern Arizona University in Flagstaff and his colleagues have done just that. Their goal was to find the key mutations, which could help scientists quickly detect other Cipro-resistant strains in the future. To minimize the risk, the team used a weakened anthrax strain, but Keim says that producing a fully virulent strain seems feasible for microbiologists who know the literature. Keim's team is not going to add to that literature, at least for now. "We have a paper ready to go," says Keim, "but I think I'm going to sit on it."
Related sites
FDA
information on Cipro
Bayer
press release about Cipro
CDC information about anthrax and
the current bioterrorist attacks
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