Although potentially effective for ensuring that large numbers of people have rapid access to antibiotics, prepositioning strategies require more resources than strategies relying on distribution from central locations after an attack, and some could increase health risks. Prepositioning strategies, therefore, provide the greatest value in enhancing response to large-scale attacks in high-risk areas with limited dispensing through the current POD system and in filling specific gaps in current capabilities. Conversely, prepositioning strategies may offer little added value in areas in which the risk of an attack is low or dispensing capability is sufficient.

In their planning efforts, state, local, and tribal officials should give priority to improving dispensing capability and developing prepositioning strategies such as local stockpiles and workplace caches. The committee recommends against broad use of home antibiotic storage for the general population because of concerns about inappropriate use, lack of flexibility as a response mechanism, and high cost. In some specific cases, home storage may be appropriate for individuals or groups that lack access to antibiotics through other timely dispensing mechanisms.

Because communities differ in their needs and capabilities, this report sets forth a framework to assist state, local, and tribal policy makers and public health authorities in determining whether prepositioning strategies would be beneficial for their community. The committee’s recommendations also identify federal- and national-level actions that would facilitate the evaluation and development of prepositioning strategies, including the development of national guidance to enhance public-private coordination on prepositioning, distributing, and dispensing antibiotics for use in response to an anthrax attack.

If bioterrorists released aerosolized Bacillus anthracis (anthrax) over a large city, hundreds of thousands of people could need rapid access to antibiotics to prevent the deadly inhalational form of anthrax. Delivering antibiotics effectively following an anthrax attack is a tremendous public health challenge, however, because of the large number of people who may be exposed and the brief time window during which people exposed to anthrax spores must start taking antibiotics to prevent illness and death.

Since the anthrax attack in 2001, the nation has made much progress in developing plans for the rapid delivery of antibiotics. Nonetheless, there are ongoing concerns about the threat of anthrax, the scope of the public



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