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Bampwg module 4

In the unlikely event of a bioterrorism disaster requiring Bay Area counties and cities to dispense antibiotics to entire populations, it is extremely important that all Bay Area counties and cities are using the same screening practices.
Mass prophylaxis means providing preventive medications (pre or post exposure) to the masses – all people in a community, city or county. In the case of something like anthrax, it is the goal of mass prophylaxis planners to ensure that the right pills get into people, minimizing adverse events and reactions. When the governor declares a state of emergency for California, it will trigger the California Board of Pharmacy lifting restrictions on who can dispense antibiotics. In an infectious disease emergency like this, anyone can dispense antibiotics, you don’t have to be licensed. But it’s important that all screening practices in the Bay Area be the same, that is why health officers from the entire Bay Area agreed on a screening algorithm. In the algorithm, a series of questions are asked of patients to dispense the two primary drugs: doxycycline Doxycycline and ciprofloxacin, also called doxy and cipro for short, are supplied by the federal government. The federal government manages a large stockpile of medicines and medical equipment that can be deployed anywhere in the US in the case of a large-scale disease or medical emergency. This stockpile is called the Strategic National Stockpile, or SNS. There is currently a greater percentage of doxy in the SNS than there is of cipro. So, the screening algorithm is called a “doxy dominant” algorithm, meaning doxycycline will be antibiotics dispensed to most people. This algorithm is also based on the fact that the SNS contains very little supply of liquid formulation or “suspension” of cipro that can be used in small children.
If the ratio of doxy to cipro every flipped, meaning there was more available ciprofloxacin than doxycycline, a different algorithm would be followed.
If there was a substantial quantity of ciprofloxacin suspension, that would also result in a different algorithm being followed.
For basic instructional purposes, however, we will assume the antibiotic supply to be about 80-90% doxycycline and 10-20% ciprofloxacin and we will assume a very limited amount of liquid ciprofloxacin suspension.
For a patient who arrives at the clinic, the first question asked of them is whether or not they are allergic to doxycycline or any other drugs that end in “cycline” such as tetracycline. This question may be asked by the way of signage or by the way of a screening form, or even in person. Being allergic to a “cycline” drug means that a medical professional has told the patient that they are allergic or the patient has experienced a life-threatening reaction in the past as a result of taking that drug. A patient might be allergic to different things, like penicillin or sulfa drugs, but being allergic to other things doesn’t mean they are allergic to doxycycline. Even with other allergies, it is fine to take doxycycline unless the patient knows they are allergic to a “cycline” drug. The other question that is asked, is whether the person is pregnant. This question means that the woman is currently pregnant, not thinking about becoming pregnant. If the patient doesn’t know, then one should assume that Patients who are not allergic to doxycycline and who are not pregnant will receive doxycycline. This should be the vast majority of patients coming to a POD as it is not common to have an allergy to a “cycline” drug and it is a usually a minority of women who are pregnant.
Those who are dispensing medicines to patients who are not allergic to cycline drugs and are not pregnant also need to ask about children. For any child who is younger than age 18 AND weighs less than 90 pounds, the child will need a smaller dose of doxycycline. Whoever is picking up for that child will need crushing instructions too, so they can crush doxycycline at home and combine it with a sweet tasting substance like chocolate or maple syrup.
If the patient is either allergic to doxycycline or pregnant, then they need to 1. Are they allergic to ciprofloxacin or any other “floxacin” drug? (the same applies – they are allergic if a doctor has told them they are allergic, or they have experienced a life-threatening reaction to the drug 2. Do they have a history of seizures or epilepsy?3. Are they currently taking the drug Tizanidine, which could also be known If the answer to all of these questions is no, then the patient should be given If the answer to any of these questions is yes, it means that the patient potentially has issues with taking both doxycycline and ciprofloxacin. This means that the patient will need to speak with a medical consultant at the point of dispensing or POD site. Or this patient will need to speak to his/her own primary care provider to receive an antibiotic that they can safely take.
At medical consultation within a POD site, a clinician will talk to the patient to determine whether they are truly allergic to a certain antibiotic and they will talk to the patient and discern if they can leave with one of the offered antibiotics at the POD, or whether they need a written prescription, to be taken and filled at a local pharmacy.
The number of patients that will have issues with taking both doxycycline and It is very uncommon for a young child to be allergic to doxycycline, but screeners at PODs must be prepared for this possibility. For a child who cannot take doxy, the medical consultant associated with the POD would make the Caregivers cannot be given instructions on how to crush ciprofloxacin for their children and combine it with other things, because no matter how people try to mask the taste of ciprofloxacin, it is unbearable. Crushed cipro can also induce The methods for asking screening questions will vary by POD. Some PODs will use individual screening forms for each person who will be receiving antibiotics, some will use forms that can accommodate multiple people on one form, others may use signs and not use a form for some of the questions at all. Any staff that are tasked with working at a POD will not know the particular method of screening until they arrive, but all Bay Area PODs will be asking the 1) Are you or the person for whom you are picking up antibiotics allergic to 2) Are you or the person for whom you are picking up antibiotics pregnant? If the answer to both of these questions is no, the patient receives doxycycline. If the patient cannot swallow pills, they will need pill crushing instructions for If the answer to either of these questions is yes, the patient gets asked three 1) Are you or the person for whom you are picking up antibiotics allergic to 2) Do you or the person for whom you are picking up antibiotics have a 3) Are you or the person for whom you are picking up antibiotics currently taking Tizanidine (also called Zanaflex).
If the answer to all of these questions is no, the patient receives ciprofloxacin.
If the answer to any of these questions is yes, the patient is referred to medical consultation to have a conversation with a clinician.
All patients receiving antibiotics should also receive information about the drugs they will be taking – and all children under age 18 and under 90 pounds will need to have a smaller dose of doxycycline. For patients who have questions about how the antibiotics will interact with other drugs or vitamins they might already be taking, or other medical conditions that they may have, it is important to refer them to the drug information sheets.
Following these steps ensures consistency and quality all throughout the Bay Area, which keeps our population well protected and informed.
Visuals on this will include screening forms, drug information sheets, a graphic of the algorithm itself, pictures of people getting screened, crushing

Source: http://bayareadisastermeds.org/training/docs/BAMPWG_MODULE_4.pdf

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