Label Comprehension of a Prototype Household Antibiotic Kit for Emergency use in Anthrax Bioterror Preparedness

Mohamed Al-Ibrahim*, Kathleen Yeager and Susan R Al-Ibrahim

Background: In 2001, powdered spores of Bacillus anthracis were used for bioterrorism attacks in several U.S. cities. In response, the U.S. government implemented a strategic national stockpile strategy and experimented with household antibiotic kits (HAKs) for emergency use. However, regulatory approval for public distribution of HAKs was not implemented due to concerns about misuse and potential adverse health effects.

Objective: This study assessed comprehension of key HAK labeling messages, including indication, dosage, contraindications, warnings, and overall safe use of HAK contents among the general population and first responders. The influence of literacy and socio-economic variables on comprehension of the labels was also evaluated.

Study design: This prospective, open-label, cross-sectional pilot study assessed the comprehension of key HAK labeling messages through one-on-one interviews using a pre-tested questionnaire. Adults from the general population and first responders in Maryland were recruited for the study; highly trained health professionals such as doctors, pharmacists, and nurses were excluded. Participants’ health literacy was stratified using the Rapid Estimate of Adult Literacy in Medicine (REALM) tool.

Results: At least 80% of participants from the general population, and a higher proportion of first responders, correctly answered 80% or more of the pre-tested questionnaire. Participants with a REALM-equivalent literacy level of 7th grade or above demonstrated significantly higher comprehension across all categories of HAK labeling, while a literacy level of 6th grade or below was a strong predictor of inadequate comprehension. 

Conclusion: Comprehension levels of 80% or higher for correct HAK use are comparable to or exceed those for standard prescription medications, supporting its potential approval for public distribution as an anthrax preparedness measure. However, observed lower comprehension of rates in those with a REALM score sixth grade or below emphasizes the need for further improvement for HAK labeling and additional interventions to ensure safe and effective use across all demographics.

Keywords:

Published on: Jan 22, 2026 Pages: 1-7

Full Text PDF Full Text HTML DOI: 10.17352/ojpp.000028
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat