Health Experts Fear Cipro Risks as Drug Given to 7,000 in N.Y.

Even as fears mounted Wednesday over the threat of anthrax, medical experts debated the wisdom of distributing Cipro to 7,000 postal workers in Manhattan, where tests have shown no signs of contamination at any postal facility.

The decision to distribute the antibiotic to thousands of apparently unexposed workers marked a leap of activism by public health officials reeling from criticism that their earlier inaction led to the deaths of two Washington postal employees. Even the top public health officials in Washington and New Jersey, where postal workers have been exposed to the deadly bacterium, warned against over-prescribing the drug when the risk is unconfirmed.

“People need to realize there will be side effects from mass use of Cipro,” said George T. DiFerdinando, New Jersey’s acting health commissioner.

“This [decision] is not based on knowledge that a hot letter went through a facility. Apparently it’s for peace of mind.”

But in light of postal worker deaths that some believe were preventable, other medical experts have concluded that the risk of medicating a perfectly healthy population is outweighed by the unknown traits of anthrax.

“Prior to the postal workers in Washington actually dying of what proved to be inhaled anthrax, I would have considered this serious overkill,” said Dr. Theodore Eickhoff, an infectious-disease expert at the University of Colorado.

“But in light of what happened, I think the reaction may well be justified simply because we were all caught a little off guard.”

Already, one postal worker has shown up at a Virginia hospital suffering from side effects of Cipro, and health officials warned that more adverse reactions are likely.

Thousands of postal workers in New York, New Jersey and Washington, D.C., as well as news media employees and nervous members of the public, are taking the drug as a preventive. Side effects can run from minor gastrointestinal disorders to difficulty breathing.

But using Cipro as a preventive has consequences beyond physical side effects, doctors warn. Bacteria can grow resistant to the drug, leading to the development of infections that are hard to kill.

And if bacteria resist Cipro--known as the antibiotic of last resort--doctors will be left with a dramatically weakened arsenal.

“I am very concerned about people taking medications they don’t need,” said Dr. Ivan Walks, Washington’s chief health officer, citing one postal worker who had a life-threatening reaction to the drug. “We know enough now that the minute there is any confirmed risk, people will get the medication they need.”

The population of people on Cipro grew Wednesday, but the criteria for prescribing it seemed arbitrary. All State Department mail handlers were instructed to take the antibiotic as a precaution, even though no anthrax has been found there.

Yet postal workers in Bethesda, Md., who handle some government mail, have been denied the drug. Window clerk Wayne Hurst complained that his office had been “shafted,” their requests for Cipro turned down even though they handled mail that passed through Washington’s Brentwood facility, where anthrax has been found.

“That place is contaminated. The mail exposed to anthrax there is just going to be shipped to another station,” Hurst said.

“They’re just going to wait for one of us to die before they do anything.”

The disagreement over just who should take Cipro underscored the dilemma of a public health network that has no playbook for anthrax and is inventing strategies with each turn of events.

Experts who once presumed that anthrax could not escape a sealed envelope were proved fatally wrong, and now they are struggling to weigh the risks.

And even positive developments were laced with contradiction. Ernesto Blanco, a Florida employee of the tabloid company American Media Inc. who was stricken with inhaled anthrax, was released from the hospital Tuesday night--the first known survivor of inhaled anthrax in decades.

While that came as excellent news to the medical community, it also summed up its dilemma: early treatment saved the man, but the very antibiotics that cured him could become disabled if they are misused by the larger public.

“What is an acceptable risk? Do you put 100,000 people on Cipro to save one life and accept the toxicity of 100,000 people? We are really on uncharted ground here,” said Dr. Peter Katona, assistant professor of clinical medicine at UCLA.

Meanwhile, the Bush administration girded to increase the stock of Cipro, announcing it will pay Bayer $95 million for “an initial order” of 100 million tablets to be available Jan. 1--enough to treat 12 million people, according to White House Press Secretary Ari Fleischer.

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Times staff writers Bob Drogin, Marisa Schultz and Megan Garvey contributed to this report.