Cipro Has Some Side Effects

By THE ASSOCIATED PRESS

Filed at 3:37 p.m. ET

WASHINGTON (AP) -- After five days on Cipro, Jill Perel can't imagine why anyone would take the anti-anthrax drug without a clear need and a doctor's prescription.

``I had never been so sick,'' she said from Delray Beach, Fla. ``People taking Cipro with no exposure to anthrax have to be out of their minds.''

For many people, warding off a possible case of anthrax infection has become a pain in the neck, head, belly and more, thanks to the unpleasant and sometimes dangerous side effects of the antibiotic.

Some are all too happy to exchange it for doxycycline, the antibiotic the government is now recommending for those possibly exposed to anthrax spores. Although doxycycline also is not to be taken lightly, its side effects are rarer and tend to be less serious.

``I have two more days of it,'' Doug Burton, a 27-year-old engineer for the U.S. Postal Inspection Service, said of his Cipro treatment. He knows the drug is not supposed to be taken with milk, yogurt or cheese, but his love of dairy products led him to swallow it once with his cereal. ``I felt like I was going to throw up.''

He was standing in line outside the District of Columbia General Hospital, waiting to get his prescription for doxycycline.

Perel landed in the hospital after taking Cipro. She took the drug because she had been at American Media Inc., a tabloid publishing company in Boca Raton, Fla., where a photo editor died of inhalation anthrax.

But five days after she started taking it, Perel, wife of the National Enquirer's editor, David Perel, had a toxic reaction that affected her body's ability to make bone marrow.

``I could not even get out of bed,'' she said. ``I was dizzy, vomiting, had a fever and a pounding, pounding headache. That headache took forever to go away.''

Doctors put her on doxycycline. When that made her sick to her stomach, she and her doctors decided that because her risk of exposure to anthrax was minimal, she would stop taking the antibiotics altogether.

But her husband has stayed on Cipro, a cure for anthrax when taken early. ``His knees hurt,'' she said. ``He has no energy.''

When anthrax cases surfaced, the government recommended Cipro, which is in a special class of drugs prescribed when doctors don't know exactly how vulnerable an organism is to particular antibiotics.

On Monday, government health officials began to recommend doxycycline, believed equally effective in treating anthrax, because they feared some common bacteria could become resistant to Cipro if it were overprescribed. It's also cheaper and more available than Cipro.

More than 10,000 postal and mail room employees, Capitol Hill workers and others have been prescribed Cipro as a treatment or precaution. Officials say people should not take it without a doctor's guidance but that has not stopped some Americans from hoarding the drug.

Cipro has been used by more than 280 million patients worldwide, according to the drug's manufacturer, Bayer Corp., which recently reached an agreement with the government to supply up to 300 million tablets of Cipro. The prescribing information states that Cipro is discontinued in 3.5 percent of patients treated because of adverse reactions, primarily related to the gastrointestinal or central nervous systems.

Bayer says that the drug's safety has been chronicled in 32,000 publications, and that it has proven effective not only against anthrax, but in alleviating a host of urinary tract infections -- especially acute cystitis in women -- and against inflammation of the prostate gland in men. Unlike other antibiotics, Bayer says, Cipro remains effective against E. coli, even after 13 years of treating the bug.

The Physician's Desk Reference reports that of 2,799 patients who took Cipro during clinical investigations, 16.5 percent had adverse reactions that were possibly or probably related to the drug. The most frequently reported reactions: nausea, diarrhea, vomiting, abdominal discomfort, headache, restlessness and rashes.

More serious but much rarer effects include hallucinations, depression, gastrointestinal bleeding, kidney failure, joint problems or heart attacks -- occurring in less than 1 percent of patients.

``My wife took one pill and ended up in the emergency room and ended up with side effects that she still is being treated for today,'' said Stephen Fried, who wrote a book about the hazards of legal drugs after his wife suffered a reaction in 1992 to Floxin, an antibiotic in the same family as ciprofloxacin.

``In her case, it triggered manic-depressive illness and a seizure.''

It's rare, but drugs in that family also have been associated with the rupture of tendons, he said.

``People are running to get Cipro because it's the brand name version of the treatment and most of them don't realize there are risks,'' he said.

Rosalyn Graham, a Government Printing Office employee, is more concerned about anthrax than antibiotic risks.

Although a post office tainted with anthrax delivers to her building, she was told she probably could not get the antibiotics being dispensed from D.C. General because she could not show she had direct exposure.

Graham decided to stay in line anyway.

``I just want to get the pills,'' she said.

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On the Net:

Bayer's Cipro site: http://infections.bayer.com/treatment/ciprofloxacin--ciprobay--en.html

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