Anthrax: Treatment (Hansard, 10 December 2001)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, advice to doctors on the treatment of those with anthrax symptoms and those potentially exposed to spores is available through the Public Health Laboratory Service. Specific guidance is available on the PH LS website, including on the use of antibiotics. Arrangements have also been made to draw the attention of GPs and other clinical staff to the guidance as appropriate.

§ Lord Soulsby of Swaftham Prior
My Lords, I thank the Minister for that reply. It is encouraging. The Public Health Laboratory Service guidelines suggest that penicillin is used as a prophylactic and even in therapy. However, the strain of anthrax that has been disseminated in the United States and a number of strains in the wild are also producers of penicillinase, and hence can lead to resistance. Will the Minister assure the House that the guidelines are updated to take account of the abilities of these organisms?

§ Lord Hunt of Kings Heath
My Lords, antibiotic-resistant anthrax is a known phenomenon. Tests in the US indicate that the strains of anthrax identified there were susceptible to penicillin and to ciprofloxacin and doxicyclin. In the UK, the antibiotic of choice is ciprofloxacin, which is considered to be the most effective antibiotic in these circumstances.
In any incident, it is clearly important to test the anthrax for antibiotic resistance, as that cannot be predicted. Such testing will continue as the incident unfolds in case more than one strain of anthrax is used. This will then confirm the treatment. Laboratories, including the PHLS, are well able to undertake such tests as a matter of routine.
In relation to the guidance, I have checked with advisers and have been informed that it is consistent with the relevant information that is now available. I should be happy to discuss the matter further with the noble Lord.

§ Lord Clement-Jones
My Lords, the Question was also directed towards the prophylactic use of 1132 antiobiotics against anthrax. What action is the department taking to prevent such use or to discourage it?

§ Lord Hunt of Kings Heath
My Lords, the guidance issued by the PHLS recommends., at page 8, prophylaxis after exposure. In that case, ciprofloxacin is recommended as the antibiotic of choice.

§ Baroness Finlay of Llandaff
My Lords, the cascade of information from the Government to NHS trusts and GPs has been very effective. However, the difficulty remains of diagnosing the first index case. What measures are in place to ensure a continuous cascade of information so that it does not fall from the front line of the minds of those clinicians who might be faced with seeing the index case and who would be key in diagnosing it?

§ Lord Hunt of Kings Heath
My Lords, the guidance was originally available on the PHLS website on 11th October. GPs and other clinicians had their attention drawn to that advice in a letter from the Deputy Chief Medical Officer on 11th and 15th October. More detailed guidance was issued on 17th October to all health authorities. I very much take the point that the noble Baroness has raised. I can assure her that the PHLS will update guidance as appropriate. We have an effective way of then ensuring that that reaches front-line clinicians.

§ Earl Howe
My Lords, as the Minister indicated, strains of anthrax can vary in their susceptibility to antibiotics. In view of that, what are the Government doing to ensure that rapid methods are available to detect antibiotic resistance in a strain of anthrax arid, therefore, to give rapid advice when it is needed?

§ Lord Hunt of Kings Heath
My Lords, as I believe I said in my answer to the noble Lord, Lord Soulsby, tests are undertaken and it is very important to carry those out as quickly as possible. Testing continues to take place in relation to specific incidents in case more than one strain of anthrax has been used. Therefore, the purpose of testing is to confirm whether anthrax has been involved and, if so, which strain. Tests are then carried out to determine whether that strain of anthrax is resistant to a particular antibiotic. Therefore, a hierarchy of responses ensures quick and continuous testing and, if anthrax is confirmed, it identifies whether the strain would be resistant to a particular antibiotic.