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Primary Care Research

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Primary care doctors demonstrated restraint in prescribing antibiotics following the 2001 anthrax attacks

Despite widespread alarm in response to the October 2001 anthrax attacks, only one in five patients who initiated discussion about anthrax or smallpox with doctors at a New York internal medicine practice either requested antibiotics or received them. This is particularly significant, since the practice was near media and health care facilities where cutaneous and inhalational anthrax cases occurred. These findings do not suggest widespread antibiotic abuse in the aftermath of the 2001 terrorist attacks, notes Nathaniel Hupert, M.D., M.P.H., of the Weill Medical College of Cornell University. His work is supported by the Agency for Healthcare Research and Quality (contract 290-00-0013).

Prescription of antibiotics appropriate for anthrax prophylaxis (that is, ciprofloxacin, doxycycline, or amoxicillin) was most highly associated with patient requests, followed by report of potential exposure and abnormal findings on physical examination. The study included a large number of postal workers and office workers from midtown Manhattan, both populations in which inhalational and cutaneous anthrax cases had been diagnosed by mid-October. Agreeing with requests by these patients for prophylactic antibiotics may have appeared to be a low-risk strategy with high potential benefit, especially if there was report of potential exposure.

In light of changing guidelines for screening and uncertainty about the clinical presentation or appropriate management of anthrax exposure during this time, the clinicians studied showed notable therapeutic restraint (for example, 28 percent of telephone requests for antibiotics were denied). The lower rate of prescribing for symptomatic patients suggests that physicians may have used clinical judgment in making treatment decisions in this setting. These results highlight the importance of including primary care physicians in community-wide bioterrorism response planning, notes Dr. Hupert.

See "Antibiotics for anthrax: Patient requests and physician prescribing practices during the 2001 New York City attacks," by Dr. Hupert, Wairimu Chege, M.D., M.P.H., Gonzalo M.L. Bearman, M.D., M.P.H., and Fred N. Pelzman, M.D., in the October 11, 2004, Archives of Internal Medicine 164, pp. 2012-2016.

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