The mass administration of anti-infective drugs in disaster-affected populations is not recommended. Scientific reasons why this is so include the fact that antibiotics are not effective against viral diseases, such as influenza, hepatitis and the common cold; no single antibiotic provides adequate coverage against all potential bacterial or rickettsial diseases; and antibiotics have to be taken indefinitely to prevent infection with a susceptible organism. Moreover, anti-infective agents can induce allergic reactions and toxic side effects which include death. The promiscuous use of antibiotics can rapidly lead to emergence of drug resistant bacteria, particularly of enteric organisms. Plasmid mediated antibiotic resistance is, moreover, frequently not just against the antibiotic administered, but against multiple antibiotics. In addition, perhaps more compelling reasons to avoid massive use of anti-infective drugs are the constraints of logistical and human resources, as already discussed in connection with mass immunization after disaster.
The prophylactic administration of antibiotics or sulfonamides to prevent diarrhea and the routine treatment of uncomplicated upper respiratory complaints with antibiotics should be discouraged for these reasons. It is sometimes advocated to administer anthelminthics, on the premise that children in the tropics are malnourished and have multiple intestinal parasites. Unfortunately, the cheapest anthelminthic drugs, such as piperazine, are of limited spectrum against Ascaris lumbricoides (round worm). Broader spectrum anthelminthics such as thiabendazole and mebendazole, cause toxic reactions unacceptably high for general use in asymptomatic patients, and they are too expensive for many relief efforts.
Providing chemosuppressive drugs against malaria to populations affected by disaster requires a more complex decision dependent upon local conditions and circumstances. Usually, the key factor is whether or not an affected population has moved from an area free of malaria to one with high levels. The presence of chloroquine resistant strains of malaria is also a factor to consider. In an organized or well educated community, it is feasible that local leaders or heads of families administer chloroquine once a week. The regimens which prevent chloroquine resistant falciparum malaria are either more complicated, such as weekly administration of chloroquine-primaquine and daily administration of dapsone, or consist of drugs which may not be readily available, Fansidar/pyrimethamine-sulfadoxine combination tablets. It is thus fortunate that stages 11 and 111 of chloroquine resistance are not the severe problem in the Americas that they are in southeast Asia.
Malaria chemosuppression is not usually practiced in areas where levels of malaria are high. This is because most members of the population have considerable immunity, which would be reduced by drug administration, and because community-wide chemosuppression cannot be maintained after the departure of relief agencies. Mass curative therapy is also discouraged among populations from holoendemic areas who have been displaced. It is argued that eliminating subclinical infection reduces acquired immunity and makes patients more susceptible to disease upon returning to their homes.
The mass administration of single parenteral doses of penicillin in communities where yaws (Treponema pertenue) is found needs brief mention. This may be the only universally accepted indication for community-wide anti-infective chemotherapy (57). Logistical constraints, demands for health services, and limited numbers of disease control personnel, however, create difficulties in undertaking even this response to yaws during an emergency.