Ob-Gyn Coding Alert

In light of recent anthrax scares, ACOG (the American College of Obstetricians and Gynecologists) and the CDC (Centers for Disease Control and Prevention) have released recommendations for treating pregnant women whove been exposed to anthrax.

 
The CDC is recommending that pregnant or lactating patients exposed to anthrax be started on a course of Cipro (ciprofloxacin) for 60 days. While ACOG agrees with that initial approach, its recommendations go one step farther. The organization recommends that if the anthrax bacteria to which the woman was exposed are revealed to be penicillin-sensitive after testing, the patient should be switched to amoxicillin.
 
ACOGs suggestion is based on the lack of data concerning the use of Cipro in pregnant women. Although there is no evidence to suggest that Cipro is harmful to pregnant women or their fetuses, there is no compelling evidence to prove otherwise. Conversely, amoxicillin has proven to be a safe alternative for treating bacteria that respond to penicillin. The amoxicillin regimen is the same as Cipro; the patient remains on the drug for 60 days.
 
If the bacteria are nonresponsive to penicillin, the patient should remain on Cipro for the full 60-day regimen. Even with ACOGs concerns about the safety of Cipro during pregnancy and lactation, the risks of serious illness and death from anthrax far outweigh any risk to mother and fetus associated with Cipro. The amoxicillin route is merely a more cautious approach in light of the lack of data on Cipro and pregnancy.

 
Vaccines against anthrax are now available only to military personnel, individuals working in labs where anthrax is present, or those working with animal products that might contain anthrax. In the unlikely event of a widespread epidemic of anthrax, this vaccine might be made available to the public.
 
The CDCs recommendations relating to the vaccine and pregnancy are similar to those for Cipro. If the pregnant woman has definitely been exposed to anthrax and the vaccine is available, she should proceed with the vaccine because the risks associated with anthrax far outweigh those associated with the vaccine. However, if there has been no direct exposure to anthrax, the patient should wait until she is no longer pregnant to obtain the vaccine. As with Cipro, this recommendation reflects the lack of specific studies of the effects of the vaccine on pregnancy.
 
The CDCs most current information on anthrax treatment is available at www.cdc.gov/mmwr. Anthrax coding information is also available free from The Coding Institute at www.codinginstitute.com/extra/anthrax.