Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence

• DOI: 10.3201/eid0810.020349
• Publication Date: 2012-06-27T18:15:10Z
• Authors: Colin W. Shepard; Montse Soriano-Ga...; Elizabeth R. Zell; James Hayslett; Susan Lukacs; Susan Goldstein; Stephanie Factor; Joshua Jones; Renee Ridzon; Ian Williams; Nancy Rosenstein
• Keywords: Adult; Male; Adolescent; Infectious and parasitic diseases; RC109-216; Drug Administration Schedule; Anthrax; 03 medical and health sciences; 0302 clinical medicine; Anti-Infective Agents; Ciprofloxacin; Ethnicity; Humans; adherence; antimicrobial prophylaxis; Aged; Aged, 80 and over; R; Dispatch; Amoxicillin; Antibiotic Prophylaxis; Middle Aged; Bioterrorism; adverse events; United States; Anti-Bacterial Agents; 3. Good health; Bacillus anthracis; Doxycycline; District of Columbia; Medicine; Female; New York City

We collected data during postexposure antimicrobial prophylaxis campaigns and from a prophylaxis program evaluation 60 days after start of antimicrobial prophylaxis involving persons from six U.S. sites where Bacillus anthracis exposures occurred. Adverse events associated with antimicrobial prophylaxis to prevent anthrax were commonly reported, but hospitalizations and serious adverse events as defined by Food and Drug Administration criteria were rare. Overall adherence during 60 days of antimicrobial prophylaxis was poor (44%), ranging from 21% of persons exposed in the Morgan postal facility in New York City to 64% of persons exposed at the Brentwood postal facility in Washington, D.C. Adherence was highest among participants in an investigational new drug protocol to receive additional antibiotics with or without anthrax vaccine--a likely surrogate for anthrax risk perception. Adherence of <60 days was not consistently associated with adverse events.