Antibiotics for anthrax: patient requests and physician prescribing practices during the 2001 New York City attacks.
BACKGROUND
Little is known about patient encounters with primary care physicians and prescribing practices during the 2001 US anthrax attacks.


METHODS
We retrospectively reviewed the electronic medical record of outpatient telephone and clinic visits at a large primary care practice in New York City from September 11 to December 31, 2001, to identify physician- and patient-related factors that were associated with prescribing antibiotics for anthrax prophylaxis.


RESULTS
Average daily patient volume from October to December was higher in 2001 (221.2 patients per day) compared with 2000 (199.1; P<.01) and 2002 (215.8; P = .14). Patient-initiated discussion about anthrax or smallpox were involved in 244 patient contacts with 63 physicians, including 92 (0.6%) of 14917 telephone contacts and 152 (1.0%) of 15 539 office visits. Fifty patients (21%) requested antibiotics or vaccines and 52 (22%) received antibiotics: 39 received ciprofloxacin; 12, doxycycline; and 1, both drugs. Independent predictors of receiving anthrax prophylaxis included requesting medication (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.5-18.6), reporting powder or workplace exposure (OR, 4.5; 95% CI, 2.1-10.0), having an abnormal physical examination finding (OR, 3.9; 95% CI, 1.4-11.0), and being asymptomatic (reporting any illness symptoms was associated with an OR of 0.3 [95% CI, 0.1-0.6]).


CONCLUSIONS
Primary care physicians played an important and heretofore underdocumented role in responding to the 2001 anthrax attacks. Prescription of prophylactic antibiotics for anthrax was uncommon and appears to have been selective among concerned patients. These results highlight the importance of including primary care physicians in community-wide bioterrorism response planning.
Weill Medical College of Cornell University, New York, NY, USA. nah2005@med.cornell.edu
Nathaniel
N
Hupert
Wairimu
W
Chege
Gonzalo M L
GM
Bearman
Fred N
FN
Pelzman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000881:Anthrax / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D023482:Bioterrorism; D002939:Ciprofloxacin / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D004318:Doxycycline