Other Antiviral Agents

Approved efficacious antiviral agents for herpes simplex virus (HSV) and varicella virus, including a number of nucleoside analogues (e.g., adenine arabinoside [Ara-A], acyclovir [Zovirax], valacyclovir [Valtrex]; see Field and Laughlin, 1999), are widely used for therapy and prophylaxis. If patients have normal immune response to HSV, the development of resistance to nucleoside analogues is not a significant problem, but the current antivirals are not curative. Antiviral agents for hepatitis B and C (interferons plus antivirals) are approved or in development. Ribavirin, a triazole nucleoside analogue, inhibits RNA polymerases and transcription and is broadly reactive against respiratory syncitial virus, papillomaviruses, and arenaviruses (see Table 4-3).

As a result of increasing antibiotic resistance, drug options for treatment of some bacterial infections (e.g., vancomycin-resistant enterococci and vancomycin-resistant staphylococci) are increasingly limited. Although defining the precise public health risk of emergent antibiotic resistance is not simple, the problem is global in scope and very serious. Many generic but essential antibiotics are in short supply (Strausbaugh, 2001), and the development of new antibiotics has been severely curtailed. Antivirals are available for only a limited number of viruses, and few are in development. When one considers the bacterial and viral threats of bioterrorism and the ability to generate antibiotic-resistant bacterial weapons, the urgent need for new antimicrobials becomes clear. Thus, many of the issues raised regarding vaccine production apply also to antibiotics and antivirals.

The U.S. Secretary of Health and Human Services should ensure the formulation and implementation of a national strategy for developing new antimicrobials, as well as producing an adequate supply of approved antimicrobials. The U.S. Secretary of Health and Human Services should work closely with other relevant federal agencies (e.g., DOD, the Department of Homeland Security), Congress, industry, academia, and the public health community to carry out this responsibility.

Need for Stockpiling

The 2001 anthrax outbreak clearly demonstrated the need to have access to a stockpile of effective antimicrobial agents for immediate use during the aftermath of a bioterrorist attack. In the absence of vaccines, antimicrobials are the only effective population-based preventive measure for use against a bioterrorist attack once exposure has occurred, provided, of course, that an effective drug exists. Fortunately, ciprofloxacin was de-



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