21 Anticipating anthrax and other bioterrorism threats
21 Anticipating anthrax and other bioterrorism threats
Vibhuti Arya, PharmD, MPH
Kristin Bohnenberger, PharmD, DABAT
Tamara Foreman, PharmD
MaRanda Herring, PharmD, BCACP
Sheila Seed, PharmD, MPH, CTH®, RPh
Trang Trinh, PharmD, MPH, BCPS, BCIDP, AAHIVP
Trina von Waldner, PharmD
Topic Area
Emergency preparedness/infectious disease
Learning Objectives
At the end of this case, students will be able to:
- Identify the clinical criteria for an inhalation anthrax diagnosis
- Recommend an appropriate medication for post-exposure prophylaxis of anthrax
- Describe the role of a pharmacist during a bioterrorist attack
Introduction
Since the terrorist attacks of September 11, 2001, the US has been on high alert.1-3 The anthrax exposures that followed shortly thereafter amplified the public cognizance that biological weapons remain a potential threat associated with terrorism.1,3 Bioterrorism, the use of biological agents as a method of terrorism, may include agents such as anthrax, plague, smallpox, viral hemorrhagic fevers, or non-replicating agents such as toxins produced by living organisms.1 A likely scenario for a biologic attack is via the dispersal of a pathogen in a densely populated area.1 For this reason, it is imperative that health systems develop a disaster management team that they can quickly deploy in the event of a mass casualty event.
The role of the pharmacist in disaster management was first described in the 1960s.2 Pharmacists were acknowledged as medication experts, capable of assisting in the emergent treatment of patients, educating the public, and developing and coordinating emergency preparedness measures.2 In 1966, APhA advocated for the development of a national stockpile of medications and for disaster management plans to include plans for the preparation and mobilization of pharmacy activities throughout all phases of public health emergencies.2 It was not until after the 2001 attacks that APhA released formal guidelines to address pharmacist involvement in bioterrorism preparedness planning.
These guidelines called for pharmacies to develop their own disaster management plans and to identify team members who should deploy in the event of a public health emergency. Furthermore, they emphasized the need for pharmacists to stay up to date on these procedures.2 The following year, ASHP’s statement describing health system pharmacists’ role in counterterrorism measures emphasized that pharmacists are capable of not only medication dispensation but making therapy recommendations as well.4 The guidelines stated that as medication experts, pharmacists can help optimize therapy as well as limit the overuse of antibiotics in a setting when the demand often exceeds the available supply.4 During the 2001 anthrax exposures, the prescribing rate for ciprofloxacin and doxycycline far exceeded recommendations of the CDC.5 In a bioterrorism event, delayed treatment, selection of incorrect antibiotics, and the overuse of antibiotics can increas