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Cure could be as bad as the disease

The New Straits Times, November 4, 2001

By Professor Dzulkifli Abdul Razak

FIRST of all, we would like to pay tribute to a fellow columnist who died recently. A veteran in the media world, S.H Tan will be sorely missed by many readers who have followed his Ramblings closely.

We always regarded the latter an inspiration for our column as we focus on how vulnerable our own lives are. Ramblings in many ways allowed us to smile at life though the world is increasingly being "poisoned", sometimes as if it is completely out of control.

The most recent impression perhaps is because of anthrax.. As many act unilaterally to ward off the anthrax scare, a drug named Cipro has become a convenient solution. In fact, one source says American pharmacies are reporting record sales.

Even online prescription services and Internet sites are selling the drug at more than US$7 (RM26.60) per tablet. Likewise during the 1991 Gulf War, in anticipation of an anthrax attack, the US Department of Defence is said to have ordered reserves of the oral antibiotic. And now the drug is proclaimed as "the unequivocal drug of choice in the anthrax war".

Cipro is the trade name for the active substance, ciprofloxacin hydrochloride, reportedly the only drug named by the US Food and Drug Administration, under its "accelerated approval" regulations, for the treatment of pulmonary (inhalatory) anthrax. Until recently, ciprofloxacin was used primarily to combat urinary tract infections.

According to Time, the drug producer, Bayer, is estimated to have tripled its production of the drug, promising the US Government it will deliver 200 million Cipro tablets in the next three months (http://www.time.com/time/nation/article/0,8599,180092,00.html).

Further, in the past few weeks, the drug's price too has gone up, leading to accusations Bayer is profiteering from the anthrax scare. The company has denied it, however.

As expected, since the patent for Cipro will not expire any time soon, the drug will continue to monopolise the market at a relatively high price.

But there are cheaper alternatives. In actual fact, other types of antibiotics such as the penicillins and tetracyclines are capable of treating anthrax. And of late the generic drug named doxycycline has been favoured.

But what may have propelled Cipro ahead of others is the alleged "evidence" that terrorists have engineered strains of the anthrax bacteria resistant to both penicillin and doxycylcine. However this is yet to be fully substantiated.

Unlike the alternatives, ciprofloxacin essentially is yet another "fluorinated drug", specifically of the quinolone type. It is no different from those discussed in the previous Poison Control column (Sept. 2).

For example, there were reports of fatal liver failure associated with the use of ciprofloxacin; also it has been implicated in several cases of acute renal failure. In fact, it is one of the most established fluoroquinolones to cause such renal dysfunction.

And like other "fluorinated drugs", it too can cause musculoskeletal disorders such as rhabdomyolysis or muscle-wasting.

Pregnant women should never take ciprofloxacin since it passes through the placenta. It can inhibit a special liver enzyme (P450 1A2) shown to be critical for neonatal survival, by influencing the physiology of respiration in neonates.

And respiratory distress is a side-effect. The drug also transfers through breast milk and should be avoided for lactating mothers.

All these are important, but left unsaid, in the light of the paranoia about anthrax. The chances are that many will be persuaded to follow the US-led hysteria with pharmacies and individuals rushing to "stockpile" the drug. Worse still, some would be self-medicating without proper medical advice, risking unwarranted dangers that range from nausea to death.

In fact, ciprofloxacin (or other antibiotics, for that matter) improperly used can result in the anthrax bacteria changing form and rendering the drug ineffective. This would worsen the phenomenon called drug resistance, already being reported to occur for the drug.

In other words, the bacteria have mutated into a drug-resistant organism, making the disease more difficult to treat. More will die due to this phenomenon.

The American Medical Association has thus advised its members to prescribe ciprofloxacin very cautiously, saying the worldwide problem of antibiotic resistance poses future dangers worse than the anthrax attacks of today, according to a report in the Orlando Sentinel (Oct. 20, 2001).

In the last decade, research has it that there is a dramatic increase in bacterial strains multi-resistant to antibiotics, including ciprofloxacin. The emergence of this antibiotic resistance is a result of the overwhelming use of antibiotics in human and veterinary medicine.

High rates of fluoroquinolone resistance have been reported in many countries. For example, in Asia Cipro no longer can be used to treat gonorrhea, because the disease has become resistant to the drug, according one research report.

Thus as we preoccupy ourselves with the anthrax scare, we must not forget drugs too have their share of scares we need to be aware of. Otherwise it will be only a matter of time before we are "poisoned" one way or the other.

Meanwhile to S.H. Tan, RIP.

Recommended website: http://www.healthink.com/-anthrax

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