Memo From The Editor

Who's prescribing the Cipro?

Marianne Dekker Mattera

As I write this—about three weeks before you'll read it, and a week after Congress closed down because of an anthrax scare—I feel lousy. I've been sneezing, blowing my nose, and coughing for the better part of four days now. One of them I spent in bed, a luxury I decided to give myself after going to sleep the night before with a fever.

I gave up the towel this morning and made a doctor's appointment. They'll see me this afternoon. It's the cough that bothers me most, and I need something to break up the congestion and ease breathing. What I don't think I need is an antibiotic—I think this is just a run-of-the-mill cold.

What I really don't want is a Cipro prescription or even the offer of same. When the possibility of a biologic attack with anthrax first started building in the early days after Sept. 11, there were all sorts of reports of people rushing to doctors to get a Cipro prescription—just so they could have the drug on hand. At least one New York radio talk show host proudly told of laying in a store for his family.

It all made me mad. Granted, since that first scare, Cipro has been needed as the numbers of people exposed to anthrax has grown. But I still consider it unconscionable that physicians will prescribe the drug prophylactically—and in large quantities—to someone who has no reason to even think he's been exposed.

All we need is a bunch of Cipro sitting around in medicine cabinets all across the country. You know what will happen. Somebody—or a lot of somebodies—will start feeling crummy like I do today, and they'll remember that Cipro sitting in the closet, and they'll take it. And in a few days, they'll feel better, and they'll stop taking it, and there'll be a whole host of germs out there that are on their way to becoming Cipro-resistant.

This scenario isn't far-fetched, especially with the cold and flu season upon us. You know there will be a lot of people who feel crummy. Some will take the drugs that are sitting in the closet. Others will come pounding on your door demanding drugs. Many will ask for Cipro specifically because they'll be scared—anthrax starts with flu-like symptoms, you know; we've all heard that on TV.

I beg you, don't give in to them. Prescribe antibiotics, of course, if they're indicated, and prescribe the antibiotic that's most appropriate for the condition the patient presents with. But don't prescribe any antibiotic just because it's asked for.

In our Oct. 8 issue, we ran an article that gave proven techniques for resisting patients' demands for antibiotics ("How to say No when antibiotics won't help"). Use some of those suggestions if you need them.

But don't become one of the physicians responsible for increasing drug resistance. And, maybe even more important right now, don't become one of the physicians responsible for feeding the nation's fear.

 

Marianne Mattera. Memo from the Editor: Who's prescribing the Cipro?. Medical Economics 2001;22:6.