BioterrorismReport: anthrax antibiotic should be stockpiled locally

A new report describes a plan for the United States to be better prepared in the event of a bioterrorist attack using anthrax. The report recommends that public health officials in high-risk areas should consider stockpile anthrax antibiotics in local locations to make it easier to dispense quickly to an area of need, rather than continuing to use the single national stockpile. The report – titled “Prepositioning Antibiotics for Anthrax” – was issued last Friday by the Institute of Medicine.

“If bioterrorists released aerosolized Bacillus anthracis (anthrax) over a large city, hundreds of thousands of people could need rapid access to antibiotics,” the report said. Dr. Robert Bass, chairman of the committee that wrote the report and executive director of the Maryland Institute for Emergency Medical Services Systems, said the issue is not whether there is enough antibiotic to go around – because there is — but rather how to get it to people.

The current plan involves taking anthrax antibiotics from the Strategic National Stockpile, a repository managed by the Centers for Disease Control and Prevention (CDC), and distributing them after an attack. The antibiotics are most effective if taken within four days of exposure.

The new report outlined ways to store these medications closer to people who may need them, which could speed up antibiotic distribution. Bass notes, however, that there is no “one-size-fits-all” method. Regions across the country differ in their risks of a terrorist attack, and in their abilities to dispense medications quickly. “Each community needs to assess their capabilities and develop strategies that are appropriate for their community,” Bass said.

The report examined several ways to bring anthrax antibiotics closer to people in need. One way would be to store antibiotics in workplaces, including hospitals, and police and fire departments.

Another is for people to keep anthrax antibiotics in their homes. The problem here is hat people might take the antibiotics when they do not need them, such as when they are sick with a different disease, or hear a false report of an anthrax attack. This is the reason, the report concluded, that the general public should not house anthrax antibiotics.

Stockpiling anthrax medications locally is more expensive that distributing medications from a centralized place, the report said. Therefore, only high-risk areas that lack good capabilities for dispensing medications may benefit from local stockpiling strategies. Washington, D.C., and New York City might be considered at high risk for an anthrax attack, Bass said. Low-risk areas with good dispensing capabilities may gain little from local-storage strategies.

“You’re going to spend more as you get [antibiotics] closer to the end user, but you’re not going to necessarily get the same level of benefit,” Bass said.