Testing Flowchart

For Healthy Adults - Ciprofloxacin Antibiotic Postexposure Prophylaxis
LEGEND
Start/Finish

Disclaimers:
- Medical history, current
medications, and
medication allergies were
discussed with a medical
provider and considered
before the medical
countermeasures (MCMs)
were administered to the
adult user
- Text messages are not
intended to be used as
medical advice or
treatment
- User speaks English
- User is not sharing their
cellular phone with others
- User is taking
ciprofloxacin antibiotic
- User is not sharing their
antibiotic medication with
others
- User will receive
information about
anthrax exposure and
anthrax symptoms
through other media
sources

End
Decision Points
Messages to Recipients
Information Points

END
User receives relevant ad
hoc messages

6
(Day 1) Know anthrax
symptoms: shortness of
breath, chest pain, severe
headaches, confusion, fever,
chills, severe sweating,
cough, or nausea.

User enrolled in StopAnthrax at
the site of MCM dispensing

END

1
(Day 1) (1/2)Hi [NAME].
You have joined CDC's
StopAnthrax. This is an
automated system. Message and
data rates may apply.
Text END at any time
to cancel.

START

8
(Day 1) (2/2)You cannot
catch anthrax from
another person the way
you might catch a cold
or the flu. To learn
more, visit
www.cdc.gov/anthrax.

7
(Day 1) (1/2)CDC: These
messages are not intended to
provide medical services,
diagnosis, or treatment. Always
seek the advice of a doctor for
any medical questions.

2
(Day 1) (2/2)Text INFO
for program info or
HELP for CDC's
hotline.

9
(Day 1) (1/3)CDC: You were
given directions for taking
cipro when you got your
medicine. Continue to take
cipro as directed. Do not
crush, chew, or split these
tablets.

10
(Day 1) (2/3)If cipro upsets
your stomach, take it with
food, but do not take it
with cheese, milk, or other
dairy products. Taking
antibiotics can save your
life.

12
(Day 1) (1/2)CDC: Call 9-1-1
or see a doctor NOW if you
have: throat closing or
trouble breathing, swelling
of your tongue or face,
trouble swallowing, severe
headaches

11
(Day 1) (3/3)Avoid taking
cipro with multivitamins or
dietary supplements. Cut
back on drinks with
caffeine, such as coffee,
soda, tea, or energy drinks.

13
(Day 1) (2/2)OR fast
heartbeat, seizures,
confusion, fainting, double
vision, fever, chills, unusual
bleeding, severe sweating
or body rash, or severe/
bloody diarrhea.

15
(Day 1) (2/2)[NAME], call
1-800-332-1088 if you
need help reporting to
MedWatch. Operating
hours are 9:00 am – 5:00
pm Monday through
Friday ET.

14
(Day 1) (1/2)CDC
recommends that you or a
doctor report all side
effects to MedWatch at
www.fda.gov/medwatch.

16
(Day 1) CDC: Birth
control pills may not
work as well while
taking antibiotics. Use a
second form of birth
control.

17
(Day 1) CDC: If you are
breastfeeding, you can
continue while taking
antibiotics, unless a
doctor tells you to stop.

18
(Day 2) CDC: Remember,
anthrax can be deadly.
CDC recommends you
take cipro to prevent you
from getting sick, even if
you do not have
symptoms.

20
(Day 2) (2/2)OR fast
heartbeat, seizures,
confusion, fainting, double
vision, fever, chills, unusual
bleeding, severe sweating
or body rash, or severe/
bloody diarrhea.

HELP
INFO
5
(Day 1) To speak to someone
at CDC's National Contact
Center, call 1-800-232-4636.
Operating hours are 8:00 am
to 8:00 pm Monday through
Friday, Eastern Time (ET).

3
(Day 1) (1/2)This program
sends reminders,
information about your
medicine and anthrax, and
asks you questions about
the medicine.

31
CDC PILOT TEST
NOTIFICATION: In a real
incident, we would switch
you to the amox protocol.
For this pilot test, you will
continue receiving cipro
messages.

4
(Day 1) (2/2)You will get an
average of 5 to 20 messages per
week. Some days you will get a
lot of messages. Other days you
may not get any messages.

26
(Day 2) Antibiotics can save
your life. You may be able to
take a different form of
antibiotic. Talk to a doctor
to discuss your options.

29
(Day 3) Text AMOX if
you are now taking
amoxicillin. Text DOXY
if you are now taking
doxycycline.

NEW

AMOX

27
(Day 3) CDC: Text
NEW if you are now
taking a new
antibiotic. Text CIPRO
if you are still taking
ciprofloxacin.

21
(Day 2) (1/2)CDC
recommends that you or a
doctor report all side effects
to MedWatch at
www.fda.gov/medwatch.

22
(Day 2) (2/2)[NAME], call
1-800-332-1088 if you need
help reporting to
MedWatch. Operating hours
are 9:00 am – 5:00 pm
Monday through Friday ET.

YES

AMOX
or
DOXY

30
(Day 3) Great. We are glad you
are still taking antibiotics.
Remember, you should take
antibiotics for at least 60 days
to help protect you from
anthrax.
94
(Day 6) Great. We are glad
you are still taking
antibiotics. Remember, you
should take antibiotics for at
least 60 days to help protect
you from anthrax.

DOXY

CIPRO

88/92
(Day 5) (3/3)[NAME], call
1-800-332-1088 if you
need help reporting to
MedWatch. Operating
hours are 9:00 am - 5:00
pm Monday through
Friday ET.

87/91
(Day 5) (2/3)CDC
recommends that you or
a doctor report side
effects to MedWatch at
www.fda.gov/medwatch.

85/90
(Day 5) (1/3)Thank you for your
response. We hope you feel
better. Talk to a doctor or health
department to discuss other
antibiotics you can take.

93
(Day 6) CDC: Text NEW if you
are now taking a new antibiotic.
Text CIPRO if you are still taking
ciprofloxacin. Text NONE if
you stopped taking
antibiotics.

100
(Day 6) We are sorry, but
we did not understand
your reply. Please look at
the text message again
and reply with a number
(1, 2, 3, 4, 5, 6, or 7) for
your reason.

86
(Day 5) (1/3)We hope you saw a
doctor and feel better. Talk to a
doctor or health department to
discuss other antibiotics you can
take.

CIPRO

53
(Day 4) Great. We are glad
you are still taking
antibiotics. Remember, you
should take antibiotics for at
least 60 days to help protect
you from anthrax.

NEW

46/50
(Day 3) (2/3)CDC
recommends that you or
a doctor report side
effects to MedWatch at
www.fda.gov/medwatch.

44/49
(Day 3) (1/3)Thank you for your
response. We hope you feel
better. Talk to a doctor or health
department to discuss other
antibiotics you can take.

95
(Day 6) Text AMOX if you
are now taking amoxicillin.
Text DOXY if you are now
taking doxycycline.

RESPONSE NOT
UNDERSTOOD

45
(Day 3) (1/3)We hope
you saw a doctor and
feel better. Talk to a
doctor or health
department to discuss
other antibiotics you can
take.

1-6

6

AMOX
98
CDC PILOT TEST
NOTIFICATION: In a real
incident, we would switch
you to the doxy protocol.
For this pilot test, you will
continue receiving cipro
messages.

1-6

82
(Day 5) (1/2)Text your symptoms
using numbers: 1-Seizures,
2-Severe diarrhea, 3-Severe body
rash, 4-Severe headaches,
5-Confusion,
6-Other.

FEEDBACK

101/103
(Day 6) Thank you. Talk to a
doctor or health department
right away about your decision
to stop taking antibiotics. Cipro
can help protect you from
anthrax.

48
(Day 3) Text what
symptoms you
experienced.

104
(Day 6) (1/2)Taking
antibiotics can protect you
if you were exposed to
anthrax. Learn more at
www.cdc.gov/anthrax.

97
CDC PILOT TEST
NOTIFICATION: In a real
incident, we would switch
you to the amox protocol.
For this pilot test, you will
continue receiving cipro
messages.

105
(Day 6) (2/2)Know anthrax
symptoms: shortness of breath,
chest pain, severe headaches,
confusion, fever, chills, severe
sweating, cough, or nausea.

106
(Day 5) CDC: [NAME], call
9-1-1 or see a doctor if you
experience any of these
symptoms.

79
(Day 5)
(1/2)CDC: Text YES if you
recently experienced:
severe headache, seizures,
confusion, fainting, double
vision, fever, chills

25
(Day 2)
CDC: Text YES if you
are having trouble
swallowing the
antibiotic
tablets.

78
(Day 4) CDC:
Taking antibiotics
can protect you if
you were exposed
to anthrax. Learn
more at
www.cdc.gov/
anthrax.

77
(Day 4) CDC: You were given
directions for taking cipro
when you got your medicine.
Continue to take cipro as
directed. Do not crush, chew,
or split these tablets.

76
(Day 4) CDC: See a
doctor if you have pain
or unusual swelling of
joints, yellow eyes or
skin, or burning or
tingling of hands or feet.

42
(Day 3) (2/2)If you had
more than one symptom,
reply with a number for
each symptom you had.
Use a comma to separate
numbers (Example: 1,2 or
2,4,5).

RESPONSE
NOT
UNDERSTOOD
58
(Day 4) Text the reason you
stopped taking antibiotics by using
numbers: 1-Side effects, 2-Too
many pills, 3-Forgot, 4-Feel fine,
5-Scared, 6-Doctor's orders,
7-Other.

7

55
(Day 4) Great. We are glad you
are still taking antibiotics.
Remember, you should take
antibiotics for at least 60 days to
help protect you from anthrax.

DOXY
AMOX

43
(Day 3) We are sorry
[NAME], but we did not
understand your reply.
Please look at the text
message again and reply
with a number for each of
your symptoms.

FEEDBACK

57
CDC PILOT TEST
NOTIFICATION: In a real
incident, we would switch
you to the doxy protocol.
For this pilot test, you will
continue receiving cipro
messages.

1-6

60/62
(Day 4) Thank you. Talk to
a doctor or health
department right away
about your decision to
stop taking antibiotics.
Cipro can help protect
you from anthrax.

63
(Day 4) (1/2)Taking
antibiotics can protect
you if you were exposed
to anthrax. Learn more
at www.cdc.gov/
anthrax.

64
(Day 4) (2/2)Know anthrax
symptoms: shortness of
breath, chest pain, severe
headaches, confusion,
fever, chills, severe
sweating, cough, or
nausea.

41
(Day 3) (1/2)Text symptoms
using numbers: 1-Trouble
breathing, 2-Tongue/face swelling,
3-Trouble swallowing, 4-Seizures,
5-Severe diarrhea, 6-Severe
body rash,
7-Other.

75
(Day 4)
(2/2)[NAME], call 1-800332-1088 if you need help
reporting to MedWatch.
Operating hours are 9:00
am – 5:00 pm Monday
through Friday ET.

74
(Day 4) (1/2)CDC
recommends that you or a
doctor report all side
effects to MedWatch at
www.fda.gov/medwatch.

73
(Day 4) (2/2)OR fast
heartbeat, unusual
bleeding, severe sweating
or body rash, or severe or
bloody diarrhea.
Remember, StopAnthrax is
an automated system.

34
(Day 3) (1/2)CDC: Know the
symptoms of anthrax:
shortness of breath, chest pain,
severe headaches, confusion,
fever, chills, severe sweating,
cough, or nausea.

AMOX
or DOXY

61
(Day 4) Text the
reason you stopped
taking your
antibiotics.

END
User receives relevant
ad hoc messages

YES

80
(Day 5)
(2/2)OR fast heartbeat,
unusual bleeding, severe
sweating or body rash, or
severe or bloody
diarrhea.

28
(Day 3) Great. We are glad you
are still taking antibiotics.
Remember, you should take
antibiotics for at least 60 days
to help protect you from
anthrax.

54
(Day 4) Text AMOX if you
are now taking amoxicillin.
Text DOXY if you are now
taking doxycycline.

59
(Day 4) We are sorry, but we
did not understand your
reply. Please look at the text
message again and reply
with a number (1, 2, 3, 4, 5,
6, or 7) for your reason.

RESPONSE NOT
UNDERSTOOD

81
(Day 5) Call 9-1-1 or see
a doctor NOW if you still
have any of these
symptoms.

107
(Day 5) CDC: You need
cipro for at least 60 days to
prevent anthrax. We
understand you are taking
antibiotics longer than
usual. Take them for as
long as directed.

7

DOXY

102
(Day 6) Text the
reason you stopped
taking your
antibiotics.

RESPONSE NOT
UNDERSTOOD

84
(Day 5) We are sorry [NAME],
but we did not understand your
reply. Please look at the text
message again and reply with a
number for each of your
symptoms.

96
(Day 6) Great. We are glad you
are still taking antibiotics.
Remember, you should take
antibiotics for at least 60 days
to help protect you from
anthrax.

99
(Day 6) Text the reason you
stopped taking antibiotics by
using numbers: 1-Side effects,
2-Too many pills, 3-Forgot, 4-Feel
fine, 5-Scared, 6-Doctor's
orders, 7-Other.

7

CIPRO

33
(Day 3) CDC: Text CHANGE at
anytime if you switch
antibiotics so that we can send
you text messages about your
new antibiotic.

NO
RESPONSE

NO
RESPONSE

83
(Day 5) (2/2)If you had more
than one symptom, reply with a
number for each symptom you
had. Use a comma to separate
numbers (Example: 1,2 or
2,4,5).

NEW

FEEDBACK

AMOX
or DOXY

FEEDBACK

89
(Day 5) Text what
symptoms you
experienced.

52
(Day 4) CDC: Text NEW if you
are now taking a new antibiotic.
Text CIPRO if you are still taking
ciprofloxacin. Text NONE if
you stopped taking
antibiotics.

47/51
(Day 3) (3/3)[NAME], call
1-800-332-1088 if you
need help reporting to
MedWatch. Operating
hours are 9:00 am - 5:00
pm Monday through
Friday ET.

32
CDC PILOT TEST
NOTIFICATION: In a real
incident, we would switch
you to the doxy protocol.
For this pilot test, you will
continue receiving cipro
messages.

35
(Day 3) (2/2)Call 9-1-1 or see a
doctor NOW if you are
experiencing any of these
symptoms of anthrax.

56
CDC PILOT TEST
NOTIFICATION: In a real
incident, we would switch
you to the amox protocol.
For this pilot test, you will
continue receiving cipro
messages.

36
(Day 3) CDC: See a doctor or
pharmacist or visit
www.cdc.gov for more
information if you are
concerned about these
antibiotics interfering with
your current medicines.

END
User receives relevant
ad hoc messages

37
(Day 3) CDC: Dosing of cipro is
typically twice a day. Try your
best to take cipro at the same
time every day. Text END at
any time to cancel text
messages.

40
(Day 3) Call 9-1-1 or see
a doctor NOW if you still
have any of these
symptoms.

72
(Day 4) (1/2)CDC: Call 9-1-1
or see a doctor NOW if you
have: severe headaches,
seizures, confusion,
fainting, double vision,
fever, chills

71
(Day 4) CDC: Talk to a
doctor or health
department or visit
www.cdc.gov if you
have questions at
any point.

70
(Day 4) CDC: [NAME],
try your best to take
antibiotics around the
same time each day.
Setting cell phone
alarms is a great way
to remember.

69
(Day 4) (2/2)If you
develop a yeast
infection, see a
doctor or
pharmacist. Visit
www.cdc.gov/
anthrax to learn
more.

68
(Day 4) (1/2)CDC: Keep
taking antibiotics if you
develop a yeast infection.
Symptoms can include
genital itching or
discharge, and pain when
urinating.

YES

67
Day 4) (2/2)Taking cipro
with food may reduce
nausea and vomiting.
Remember, do not take
cipro with dairy products.
Talk to a doctor if these
problems get worse.

66
(Day 4) (1/2)CDC: Keep
taking your antibiotics
as directed, even if
you have mild nausea,
vomiting, or diarrhea,
unless a doctor tells
you to stop.

65
(Day 3) CDC:
[NAME], call 9-1-1
or see a doctor if
you experience any
of these symptoms.

39
(Day 3)
(2/2)OR fast heartbeat,
seizures, confusion,
fainting, double vision,
fever, chills, unusual
bleeding, severe
sweating or body rash,
or severe/bloody
diarrhea.

108
(Day 6) CDC: Talk
to a doctor if you
are considering
becoming pregnant
or think you may
be pregnant.

109
(Day 6) CDC: Cipro can
cause your skin to be
sensitive to the sun. Be
sure to use sunscreen
and to cover exposed
skin when outside.

110
(Day 6) CDC: Keep pill
bottles away from
children and pets. Call
your local poison
center if they take the
medicine by accident:
1-800-222-1222.
111
(Day 6) (1/2)CDC: Know
the symptoms of anthrax:
shortness of breath, chest
pain, severe headaches,
confusion, fever, chills,
severe sweating, cough, or
nausea.

112
(Day 6) (2/2)Call 9-1-1
or see a doctor NOW
if you are
experiencing any of
these symptoms of
anthrax. Remember,
StopAnthrax is an
automated system.

113
(Day 6) CDC: Cut back on
caffeine, such as coffee,
soda, tea, or energy drinks.
Drinking too much caffeine
while taking cipro can make
you feel nervous or jittery.

114
(Day 7) CDC: Listen for
advice from public health
officials on the radio or TV
to find out if you need to
take more antibiotics and
where to get them.

115
(Day 7) CDC: Remember,
anthrax can be deadly. If you
have been exposed,
antibiotics can save your
life.

116
(Day 7) CDC: If cipro upsets
your stomach, take it with
food, but do not take it with
cheese, milk, or other dairy
products.

117
(Day 8) CDC: The mild side
effects from antibiotics may
be uncomfortable. However,
anthrax is a much greater
threat to your health.

118
(Day 8) CDC: Talk to a doctor
if you start taking any new
medicine while you are on
cipro. Text END at any time
to cancel StopAnthrax text
messages.

119
(Day 8) CDC: Setting cell
phone alerts or alarms each
day is a great way to
remember to take your
antibiotics.

120
(Day 9) CDC: Remember,
listen for advice from public
health officials on the radio
or TV to find out if you need
to take more antibiotics and
where to get them.

23
(Day 2) CDC: See a doctor if
you have pain or unusual
swelling of joints, yellow
eyes or skin, or burning or
tingling of hands or feet.

24
(Day 2) CDC: Anthrax germs
can remain in your body for
at least 60 days without
causing symptoms. CDC
recommends taking
antibiotics for the full 60
days.

NONE

NONE

1-5

19
(Day 2) (1/2)CDC: Call 9-1-1
or see a doctor NOW if you
have: throat closing or
trouble breathing, swelling
of your tongue or face,
trouble swallowing, severe
headaches

121
(Day 9) CDC: Drinking too
much caffeine while taking
cipro can make you feel
nervous or jittery. Cut back
on caffeine if this happens.

122
(Day 9) (1/2)CDC: Keep
taking your antibiotics as
directed, even if you have
mild nausea, vomiting, or
diarrhea, unless a doctor
tells you to stop.

123
(Day 9) (2/2)Talk to a
doctor if these problems
get worse. Antibiotics can
protect you if you were
exposed to anthrax.

FOR PILOT TESTING WITH WISCONSIN AND ILLINOIS

124
(Day 10) CDC: Remember
[NAME], you cannot catch
anthrax from another
person the way you might
catch a cold or the flu. To
learn more, visit
www.cdc.gov/anthrax.

125
(Day 10) CDC:
Remember, these
messages are not
intended to provide
medical services,
diagnosis, or treatment.
Always get the advice of
a doctor for medical
questions.

FINISH

38
(Day 3)
(1/2)CDC: Text YES if you
recently experienced: throat
closing or trouble breathing,
swelling of your tongue or
face, trouble swallowing,
severe headaches