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Pharmacists should consider whether scripts for Cipro as an precaution against anthrax are clinically appropriate, according to the American Pharmaceutical Association.
Pharmacists must use their best professional judgment about whether to fill Cipro prescriptions for people worried about a possible bioterrorist attack with anthrax, according to professional and regulatory officials.
Cipro prescriptions for anthrax fall within the pharmacist's general responsibility for ensuring that the Rx is valid and clinically appropriate, according to Susan Winckler, group director of policy and advocacy, American Pharmaceutical Association.
"If they believe that such a prescription is clinically inappropriate, then they should refuse to dispense it," said Winckler. "Some say that the customer is always right. Well, no. There is a clinical appropriateness question, and the pharmacist can't abdicate that responsibility."
The medical standard of practice was set when the Food & Drug Administration and the American Medical Association both advised physicians not to prescribe Cipro for anthrax prophylaxis or for hoarding by patients. That prohibition creates a dilemma for pharmacists, said Carmen Catizone, executive director, National Association of Boards of Pharmacy.
"The medical standard of practice indicates that the drug should not be prescribed," Catizone told Drug Topics. "However, the patient presents a prescription to the pharmacist and says, 'I told my doctor to give me this because I'm worried about anthrax, but I don't have any symptoms.' It's going to be difficult for the pharmacist not to dispense it. Technically, that's not a valid prescription if people are saying it shouldn't be prescribed. It falls within the pharmacists' professional judgment and on their shoulders, unfortunately."
Consumers were cautioned by APhA against stockpiling antibiotics because it can contribute to antimicrobial resistance and cause critical shortages; also, taking the medication as a preventive can cause side effects without any benefit.
Panicky pharmacists considering hoarding Cipro for themselves and their families have to answer the same questions posed to their patients, said Winckler. Is there a valid script? Is it clinically appropriate? However, as healthcare professionals, they have an additional responsibility to consider antibiotic resistance and whether hoarding could deprive patients who really need the medication.
Hoarding for yourself "is an absolutely human thing to want to do, but that's why we are professionals," Winckler said. "If you're a pharmacist trying to give the message that people should not hoard medication, it certainly raises questions about your own actions. "
Hoarding by pharmacists is a potential problem, agreed Catizone. "If there is an anthrax contamination and we need to get antibiotics to people but others have hoarded it and it's not in supply, people are going to die," he said. "Hoarding is just not the right thing to do. This goes beyond pharmacy. This is a national tragedy and a situation in which pharmacists have to act responsibly as citizens."
Carol Ukens. Cipro Rxs need professional judgment, say officials.