What us the reasoning behind this? Isn’t this the way to make SuperAnthrax? DC postal workers are getting tested, why not the New Jersey ones?
In the current situation, there are two reasons to give antibiotics and two reasons to test.
You can give antibiotics prophylactically (to prevent infection in exposed people) or as therapy (to cure infected people).
The two reasons to test are to determine whether or not someone was exposed and to determine whether or not a sick person is infected with anthrax. You use different tests in the two situations.
It makes perfect sense to give antibiotics prophylactically without testing. If you think someone has been exposed (e.g., they were in room where anthrax spores were found), you give them antibiotics to prevent disease without waiting for them to get sick first. The testing is not necessary because the tests are not 100% sensitive (i.e., they may miss a few positives). If you think there is a high probability that a person was exposed and you know that the test sometimes misses exposure, then you know that you will give the person prophylactics regardless of the test result (because you will interpret a positive result as a true positive and a negative as possible false negative). So you don’t really need to do the test because it won’t affect your decision to give prophylactic antibiotics or not. However, you may want still want to test for exposure, not to decide whether not to give the individual prophylactic antibiotics but to find out what proportion of people in a given population were exposed.
When testing for environmental exposure, having a less than 100% sensitive test is not so important. For example, take a test that is 90% sensitive. If you test 100 people of whom 50 are exposed, the test will tell you 45% are exposed. That’s close enough to 50% to let you know there has been a helluva lot of exposure. On the other hand, you wouldn’t want to base decisions on giving prophylaxis on the test results. In the above example, we found that 45% of people were positive and, accounting for the 90% sensitivity of the test, estimate that about 50% or 1 in 2 of the people were exposed. Now we have 55 people who tested negative but, accounting for the 90% sensitivity of the test, we estimate that about 5 of the 55 or 1 in 11 was, in fact, exposed. If we think that a 1 in 11 chance of exposure is enough to justify giving prophylactic antibiotics (for inhalation anthrax, it is) then we give everybody, including all 55 with negative test results, antibiotics. So in this case the test was useful for establishing exposure of the population although individual tests weren’t used to make decisions about giving prophylaxis.
To carry the example one step further: another member of the same population, no. 101, shows up after the testing has all been done. What to do? Just give the prophylactic antibiotic based on a chance of exposure of 50% knowing that even if you tested the person and the person had a negative result, that person would still have about a 10% chance of having been exposed to anthrax and you would give them prophylactic antibiotics anyway.
As for SuperAnthrax: not a worry. Remember, people infected with anthrax are not contagious so the bacteria that end up in people will never pass on any mutations. (Unless the person dies and is buried out on the prairie, etc.)
Biggirl, I’m not sure why Mr. Bahrle says that NJ postal workers are not getting tested. According to the NJ Department of Health and Senior Services site, 1100 have been tested with nasal swabbing.
As far as the use of antibiotics: We do need to be concerned about the misuse of antibiotics with regards to exacerbating antibiotics-resistance. So what constitutes misuse? When there is the suspicion of exposure to anthrax, the appropriate response is to implement an antibiotic regimen (the 10 day course) until exposure can either be confirmed or ruled out. We can confirm it with a positive nasal swab. (Nasal swabs, however, can produce “false negatives” if the person has, say, blown their nose prior to the test or if the swab simply misses the few spores that may be present.) Once confirmed, the person goes onto the full course (60 or 90 days, depending on the dosage/formulation.) A negative swab does not mean the person will not get the full course as other factors come into play (environmental swabbing of the work area, for example). The problem of resistance for those potentially exposed weighs in less than the risk of anthrax.
The misuse of antibiotics arises when folks flock to their doctors demanding a prescription without a medical reason or, worse yet, when they self-dose with medications bought over the internet. In the latter case, people have little guarantee that what they purchase is of the proper dosage or purity. They’re likely not to take the full course and when we are talking about many thousands verses a few (the general public verses the postal/goverment workers), then the contribution toward drug resistant organisms is far greater. And it’s not just Bacillus anthracis that Cipro affects. This Cipro label (in pdf) lists many organisms where the antibiotic is indicated: Legionella pneumophila, Staphylococcus haemolyticus, and Vibrio cholerae, to name a few. Finally, Cipro is not without side-effects. Those of us that do not need to be on it should not expose ourselves to those risks.
On preview, I see Yeah has already answered you eloquently (but I’m posting anyways :)).