EU issues guidelines for bioterrorism attacks

The European Medicines Evaluation Agency (EMEA) has released comprehensive guidance on the treatment and prevention of potentially devastating diseases that could be released as part of a major bioterrorist attack: anthrax, the plague, tularemia, smallpox, viral haemmorhagic fever and botulism.

However, some of the drugs recommended are not currently authorised in the EU because very few medicines have been approved for treating these diseases. It warns that there are particular problems with anti-toxins, which are usually 'obtained through special access mechanisms in individual member states' and whose 'availability appears to be very variable across the EU'. It advises that passive immunisation with equine antitoxin is effective in reducing botulism symptoms 'if administered early in the course of the disease'.

For smallpox there are currently no known treatment drugs. However, for anthrax ciprofloxacin is recommended as the first line treatment. For plague, the document says that although streptomycin has historically been the preferred treatment, gentamicin 'has been used successfully and is currently recommended'.