IX.
ESSENTIAL OVER-THE-COUNTER DRUGS
Over-the-counter (OTC) medications are useful for a wide variety of problems. These drugs are widely available and easy to accumulate in quantity. As such, they are ideal for the survival medic’s cache of medical supplies. The Physicians’ Desk Reference puts out a guide to OTC medications with descriptions, images, risks, benefits, dosages, and side effects. Consider this book for your survival medical library.
There are a dozen meds you absolutely must have in quantity as part of your medical supplies. The medications will be listed by their generic names, with US brand names in parenthesis where applicable. Adult doses are listed. They are described below in no particular order:
Ibuprofen (Motrin, Advil), 200 mg: A popular pain reliever, anti-inflammatory, and fever reducer. This medication is useful for many different problems, which makes it especially useful as a stockpile item. It can alleviate pain from strains, sprains, arthritis, and traumatic injury and help reduce inflammation in the injured area. Ibuprofen is also useful in reducing fevers from infections. The downside to this medication is that it can cause stomach upset. Ibuprofen in this dosage can be used 1–2 every 4 hours, 3 every 6 hours, or 4 every 8 hours.
Acetaminophen (Tylenol), 325 mg: Another popular pain reliever and fever reducer, acetaminophen can be used for all of the problems that you can take ibuprofen for, with the added benefit of not causing stomach irritation or thinning the blood. Unfortunately, it has no significant anti-inflammatory effect. This drug is excellent for treatment of pain and fevers in children at lower doses. Tylenol comes in regular and extra strength (650 mg); adults should take 1–2 every 4 hours.
Aspirin, 325 mg: Aspirin has been around since the late nineteenth century as a pain reliever, fever reducer, and anti-inflammatory. It has blood thinning properties as well, and may be all we have to help those with medical issues that require the use of anticoagulants. It is also useful to treat older folks with coronary artery disease. If you suspect someone of having a heart attack, have them chew an adult aspirin immediately; 1 baby aspirin (81 mg) daily may help prevent coronary artery disease. Have patients take 2 adult aspirin every 4 hours for pain, fever, and inflammation.
Loperamide (Imodium), 2 mg: Food and water are highly likely to have contamination issues in off-grid situations, so this medication is essential as an antidiarrheal. By slowing intestinal motility, less water loss will occur from the body. This decreases the chance of developing dehydration, a known killer in austere settings. With diarrheal disease, you often have nausea and vomiting, so you will also want to have:
Meclizine (Antivert), 12.5, 25, 50 mg: Meclizine is a medication that helps prevent nausea and vomiting. Often used to prevent motion sickness, meclizine also helps with dizziness and tends to act as a sedative. As such, it may have uses as a sleep aid or antianxiety medication. To prevent motion sickness, patients should take 1 tablet (25 mg) 1 hour before traveling for dizziness, anxiety, or to induce sleep, 50–100, divided into several doses, should be taken daily.
Antibiotic ointment (Neosporin, bacitracin, Bactroban): When injuries break the skin, it puts us in danger of infections that could lead to a life-threatening condition. Antibiotic ointment is applied at the site of injury to prevent infections. It should be noted that antibiotic ointment won’t cure a deep infection; you would need oral or IV antibiotics for that, but using the ointment immediately after an injury will give you a good chance at preventing it. Apply 3–4 times a day.
Diphenhydramine (Benadryl), 25 mg, 50 mg: Diphenhydramine is an antihistamine that alleviates the itching, rashes, nasal congestion, and other symptoms of allergic reactions. It also helps drain the nasal passages in some respiratory infections. At the higher 50 mg dose, it makes an effective sleep aid. The recommended dose is 25 mg every 6 hours for mild reactions; 50 mg every 6 hours for severe reactions, anxiety, or sleep. Diphenhydramine also comes in an ointment for skin eruptions.
Pseudoephedrine (Sudafed): Pseudoephedrine is a nasal decongestant for respiratory infections like the common cold or influenza. Obtain small amounts at a time, as it is also an ingredient in the manufacture of the recreational drug methamphetamine, and purchases may be monitored.
Hydrocortisone cream (1 percent): Highly useful for rashes, this cream is used for various types of dermatitis that causes redness, flakiness, itching, and thickening of the skin. It’s a mild steroid that reduces inflammation and, as such, the various symptoms of allergic dermatitis, eczema, diaper rash, etc. Apply 3–4 times a day to affected area.
Omeprazole (Prilosec), 20–40mg; cimetidine (Tagamet), 200–800mg; ranitidine (Zantac), 75–150 mg: In a situation where we may be eating things we’re not accustomed to, we may have issues with stomach acid. The above antacids will calm heartburn, queasiness, and stomach upset. Calcium carbonate (Tums) or magnesium sulfate (Maalox) is also fine in solid form. These medications are also useful for acid reflux and ulcer disease.
Clotrimazole, miconazole cream or powder (LotriminTM, Monistat): Infections can be bacterial, but they can also be caused by fungus. Common examples of this are athlete’s foot, vaginal yeast infections, ringworm, and jock itch. These conditions will be just as common in times of trouble as they are now, if not more. Apply clotrimazole 2 times a day externally or miconazole 1 time a day intravaginally.
Multivitamins: In a societal collapse, the unavailability of a good variety of food may lead to dietary deficiencies, not just in calories but in vitamins and minerals. Vitamin C deficiency, for example, leads to scurvy. To prevent these issues, you should have plenty of multivitamins, commercial or natural, in your medical storage. You won’t necessarily have to take these on a daily basis; many multivitamins give you more than you need if taken daily.
The good news is that you can probably obtain a significant amount of all of the above drugs for a reasonable amount of money. To retain full potency, these medications should be obtained in pill or capsule form; avoid the liquid versions if possible. Remember that medications should be stored in cool, dry, dark places.
PAIN MEDICATIONS
It stands to reason that minor issues with discomfort now will be multiplied by the increased workload demands of a power-down situation. Sprains, strains, and worse will be part and parcel of any long-term survival situation. Therefore, any person who hasn’t considered providing for pain issues in times of trouble is not medically prepared. It’s a good idea to have a working knowledge of the actions and uses of various pain medications.
As pain is variable, there are many different types of drugs available that have different mechanisms of action for pain relief (analgesia), as described below.
Nonsteroidal anti-inflammatories (NSAIDS): These drugs act to decrease inflammation and fever as well as pain. The most popular NSAIDs are ibuprofen and aspirin; naproxen is another NSAID that is available without a prescription. For quick relief from pain, the shorter-acting ibuprofen or aspirin is superior to naproxen. Naproxen may not have an effect until a couple of doses, but works well for long-term relief.
Acetaminophen: This drug relieves pain by changing the body’s sensitivity to things that cause pain (its pain threshold), and also lowers fever. This drug is often as effective as NSAIDs for pain and has fewer side effects (unless you have liver disease). Acetaminophen has no anti-inflammatory action, however; therefore, it may be less effective than NSAIDs for some conditions.
Steroids: Corticosteroids exert their effect upon pain by a very strong anti-inflammatory action. The most common steroids used for inflammation are prednisone and cortisone. They can be taken orally or are sometimes injected directly into damaged and inflamed joints. Long-term use of steroids is associated with a whole gamut of side effects and must be used with the utmost caution.
Muscle relaxants: These drugs not only relax injured muscles but also have a sedative effect. A common one is cyclobenzaprine (Flexeril). These are especially helpful for back strains or other injuries that cause muscle spasms.
Opioids: Narcotics are used for pain in severe cases and act by modifying pain-signal transmission in the brain. If you have had surgery, you likely have been given these medications for pain relief during recovery.
Antianxiety and antidepressant agents: Drugs such as Xanax or Prozac may have an effect on pain by relieving psychogenic factors, such as anxiety or depression; this enables the patient to better deal with their pain issues. They work by adjusting the level of certain chemicals in the brain tissue.
Antiseizure medication: Some anticonvulsant drugs, such as Tegretol, used for epilepsy are useful to calm damaged nerves and are possible options for neuropathic pain.
Combination drugs: Some pain medications are combinations of different drugs. Percocet, for example, is acetaminophen and oxycodone (an opioid). Some are used alternatively during the day, for example, an NSAID may be prescribed between doses of an opioid.
Most of these drugs are by prescription only, and it will be unlikely that you’ll be able to stockpile large quantities of any but the nonprescription versions. As such, it will be important to know about some natural alternatives you have for pain relief.
NATURAL PAIN RELIEF
In a long-term survival situation, your limited supplies of the medicines described above will eventually run out. This leaves you with natural alternatives from products that you can grow yourself or, perhaps, find in your environment. Their benefit will vary from person to person. We describe some of these alternatives below.
Capsaicin: This is an ingredient in chili peppers that decreases pain sensation by deactivating pain receptors. This is especially helpful for those who suffer from headache, muscle ache, and arthritis and those with neuropathic pain. The most pain relief occurs after using capsaicin for a month or so.
Salicin: The original ingredient in the first pharmaceutical, aspirin, salicin has been manufactured since the nineteenth century. Salicin is found in the bark of willow, aspen, and poplar trees. Pain sufferers can get relief by chewing on strips of the green underbark (not outer bark) of these trees or making a tea out of it. Like aspirin, salicin will also help reduce fever.
Arnica: A natural anti-inflammatory, this substance reduces swelling and, therefore, discomfort from injuries to joints and muscles.
Methylsulfonyl-methane (MSM): Derived from sulfur, this substance helps slow down degeneration from joint disease, especially when combined with glucosamine and chondroitin. Over the course of time, arthritis sufferers often report significant pain relief.
Curcumin: The herb turmeric contains this substance, which increases the body’s defense against inflammation, thereby decreasing pain.
Ginger root: A tea made of ginger root is thought to decrease inflammation and provide relief from stomach pain.
Boswellia: This herb from India produces certain acidic compounds that are touted as useful for chronic pain and is said to decrease inflammation.
S-adenosylmethionine (SAM-e): SAM-e seems to reduce inflammation and increase neurotransmitters in the brain that increase the sensation of well-being. Taking this supplement long-term seems to give the best likelihood of obtaining pain relief.
Be open to every strategy available to deal with a medical issue; there are a lot of tools in the medical woodshed, and you should take advantage of all methods that may keep your family and community healthy in uncertain times.
STOCKPILING MEDICATIONS
Accumulating medications for a possible collapse may be simple when it comes to getting ibuprofen and other nonprescription drugs. It will be a major issue, however, for those who need to stockpile prescription medicines; most people don’t have a relationship with a physician who can or will accommodate their requests. Antibiotics are one example of medications that will be very useful in a collapse situation. Obtaining these drugs in quantity will be difficult, to say the least.
The inability to store antibiotic supplies is going to cost some poorly prepared individuals their lives in a collapse situation. Incidence of infection will be much larger when people have to fend for themselves and are injured as a result. Any strenuous activities performed in a power-down situation, especially ones that most of us aren’t accustomed to, will cause various cuts and scratches. These wounds will very likely be dirty. Within a relatively short time, dirty wounds can become infected, appearing red, swollen, and warm to the touch.
Treatment of such infections at an early stage improves the chance that they will heal quickly and perhaps avoid unnecessary complications, even death. The availability of antibiotics would make it possible to deal with the issue safely and effectively.
The following advice, on antibiotic options, is contrary to standard medical practice, and is a strategy that is appropriate only in the event of societal collapse. If there are modern medical resources available to you, seek them out.
Antibiotic Options
We have kept parrots for many years. Currently, we are growing tilapia as a food fish in an aquaculture pond. After years of using aquatic medicines on fish and avian medicines on birds, we decided to evaluate these drugs for their potential use in collapse situations. They seemed to be good candidates: All were widely available, available in different varieties, and didn’t require a medical license to obtain them.
A close inspection of the bottles revealed that, often, the only ingredient was the drug itself, identical to those obtained by prescription at the local pharmacy. If the bottle says Fish Mox, for example, the sole ingredient is amoxicillin, which is an antibiotic commonly used in humans.
A number of these aquatic and avian antibiotics come only in dosages that correspond to pediatric or adult human dosages. Why should this be? Why should a 1-inch-long guppy require the same dosage of, say, Amoxicillin (aquatic version: Fish Mox Forte) as a 180-pound adult human? I was told that it was because of the dilution of the drug in water. However, at the time of this writing, there are few instructions that tell you how much to put in a ½-gallon fishbowl as opposed to a 200-gallon aquarium.
Finally, my acid test was to look at the pills or capsules themselves. The aquatic or avian drug had to be identical to that found in bottles of the corresponding human medicine. When I opened a bottle of Fish Mox Forte and compared it with a bottle of human amoxicillin 500 mg produced by Dava Pharmaceuticals, I found they were the same: red and pink capsules, with the letters and numbers WC 731 on them.
Logically, then, it makes sense to believe that they are manufactured in the same way that human antibiotics are. Further, it is my opinion that they are probably from the same batches; some go to human pharmacies, and some go to veterinary pharmacies.
This is not to imply that all antibiotic medications sold for animals meet my criteria. Many cat, dog, and livestock antibiotics contain additives that might even cause ill effects on a human being. Look only for those veterinary drugs that have the antibiotic as the sole ingredient.
Here is a list of the products that meet my criteria and that I believe will be beneficial to have as supplies and are discussed in the next section:
• Fish Mox (amoxicillin 250 mg)
• Fish Mox Forte (amoxicillin 500 mg)
• Fish Cillin (ampicillin 250 mg)
• Fish Flex (Keflex 250 mg)
• Fish Flex Forte (Keflex 500 mg)
• Fish Zole (metronidazole 250 mg)
• Fish Pen (penicillin 250 mg)
• Fish Pen Forte (penicillin 500 mg)
• Fish Cycline (tetracycline 250 mg)
• Fish Flox (ciprofloxacin 250 mg)
• Fish Cin (clindamycin 150 mg)
• Bird Biotic (doxycycline 100 mg). Used in birds, but the antibiotic is, again, the sole ingredient.
• Bird Sulfa (Sulfamethoxazole 400 mg/Trimethoprin 80 mg). Also used for birds.
These medications are available without a prescription from many online sites. They come in lots of 30–100 tablets, and it appears that you could get as much as you need to stockpile for survival purposes. These quantities would be close to impossible to obtain even from the most sympathetic physician.
Of course, anyone could be allergic to one or another of these antibiotics, but it would be a very rare individual who would be allergic to all of them. There is a 10 percent chance for cross-reactivity between penicillin drugs and Keflex. (If you are allergic to penicillin, you could also be allergic to Keflex.) For penicillin-allergic people, there are safe alternatives that are suitable. Any of the following antibiotics should not cause a reaction in a patient allergic to penicillin-family drugs:
• Doxycycline
• Metronidazole
• Tetracycline
• Ciprofloxacin
• Clindamycin
• Sulfa drugs
I have personally used some (not all) of these antibiotics on myself without any ill effects. Whenever I have used them, they have been indistinguishable from human antibiotics in their effects.
Having said this, I do not recommend self-treatment in any circumstance that does not involve the complete long-term loss of access to modern medical care. This is a strategy to save lives in a postcalamity scenario only.
Antibiotics are used at different doses for different illnesses. It’s important to have as much information as possible on medications that you plan to store, so consider purchasing a hard copy of the latest Physicians’ Desk Reference. This book has just about every bit of information that exists on a particular drug.
Under each medicine, you will find the “indications,” which are the medical conditions that the drug is used for. Also listed will be the dosages, risks, side effects, and even how the medicine works in the body. It’s okay to get last year’s book; the information doesn’t change a great deal from one year to the next.
Antibiotic Overuse
It’s important to understand that you will not want to indiscriminately use antibiotics for every minor ailment that comes along. In a collapse, the medic is also a quartermaster of sorts; you will want to wisely dispense that limited and, yes, precious supply of lifesaving drugs. You must walk a fine line between observant patient management (doing nothing) and aggressive management (doing everything). Liberal use of antibiotics is a poor strategy for a few reasons:
Overuse can foster the spread of resistant bacteria, as you’ll remember from the salmonellosis (food poisoning caused by the bacteria in the Salmonella genus) outbreak in turkeys in 2011. Millions of pounds of turkey meat were discarded after 100 people were sent to the hospital with severe diarrheal disease.
• Potential allergic reactions may occur that could lead to anaphylactic shock.
• Making a diagnosis may be more difficult. If you give antibiotics before you’re sure what medical problem you’re actually dealing with, you might “mask” the condition. In other words, symptoms could be temporarily improved that would have helped you know what disease your patient has. This could cost you valuable time in determining the correct treatment.
You can see that judicious use of antibiotics, under your close supervision, is necessary to fully utilize their benefits. Discourage your group members from using these drugs without first consulting you.
How to Use Antibiotics
There are many antibiotics, but which that are accessible to the average person would be good additions to your medical storage? When do you use a particular drug? In this section, we discuss antibiotics (all available in veterinary form without a prescription) that you will want in your medical arsenal:
• Amoxicillin 250 mg or 500 mg (Fish Mox, Fish Mox Forte)
• Ciprofloxacin 250 mg or 500 mg (Fish Flox, Fish Flox Forte)
• Cephalexin 250 mg or 500 mg (Fish Flex, Fish Flex Forte)
• Metronidazole 250 mg (Fish Zole)
• Doxycycline 100 mg (Bird Biotic)
• Ampicillin 250 mg or 500 mg (Fish Cillin, Fish Cillin Forte)
• Sulfamethoxazole 400 mg/Trimethoprim 80 mg (Bird Sulfa)
• Clindamycin 150 mg (Fish Cin)
• Azithromycin 250 mg (Aquatic Azithromycin)
There are various others that you can choose, but these selections will give you the opportunity to treat many illnesses and have enough variety so that even those with penicillin allergies will have options.
Other than allergies, there are other times when a particular antibiotic (or other drug) should not be used. Many medications, for example, are not recommended for use during pregnancy. Sometimes, this is because lab studies have shown birth defects in animal fetuses exposed to the drug. Other times, it is because no studies on pregnant women or animals have yet been performed.
There are additional circumstances where a particular medication should not be used. There may be warnings about mixing one drug with another because there may be a dangerous interaction between them. For example, taking the antibiotic metronidazole (Fish Zole) and drinking alcohol will make you vomit. Some drug interactions may cause the effect of one of them to become stronger or weaker. A certain medicine, for example, may decrease the effect of another when taken together. You also may wish to avoid some drugs because of their side effects. This information is freely available; you just have to spend some time absorbing it.
Different physicians may use a specific antibiotic for different purposes and to treat a variety of infections. Some will not agree with everything you see written in this book. Below are examples of how to use some antibiotics.
Amoxicillin
Amoxicillin (veterinary equivalent: Fish Mox, Fish Mox Forte, Aqua Mox): comes in 250 mg and 500 mg doses, usually taken 3 times a day. Amoxicillin is the most popular antibiotic prescribed to children, usually in liquid form. It is more versatile and better absorbed and tolerated than the older pencillins and is acceptable for use during pregnancy. Ampicillin (Fish Cillin) and cephalexin (Fish Flex) are related drugs. Amoxicillin may be used for the following diseases:
• Anthrax (prevention or treatment of cutaneous transmission)
• Chlamydia infection (sexually transmitted)
• Urinary tract infection (bladder and kidney infections)
• Helicobacter pylori infection (causes peptic ulcer)
• Lyme disease (transmitted by ticks)
• Otitis media (middle-ear infection)
• Pneumonia (lung infection)
• Sinusitis
• Skin or soft tissue infection (cellulitis, boils)
• Actinomycosis (causes abscesses in humans and livestock)
• Bronchitis
• Tonsillitis and pharyngitis (strep throat)
You can see that amoxicillin is a versatile drug. It is even safe for use during pregnancy, but all of the above is a lot of information. How do you determine what dose and frequency would be appropriate for which individual? Let’s take an example: Otitis media is a common ear infection often seen in children. Amoxicillin is often the drug of choice for this condition. That is, it is recommended to be used firstwhen you make a diagnosis of otitis media. The drug of choice for a particular ailment can change over time on the basis of new scientific evidence.
Before administering this medication, however, you would want to determine that your patient is not allergic to amoxicillin. The most common form of allergy would appear as a rash, but diarrhea, itchiness, and even respiratory difficulty could also manifest. If you see any of these symptoms, you should discontinue your treatment and look for other options. Antibiotics such as azithromycin or sulfamethoxazole/trimethoprim (Bird Sulfa) could be a second-line solution in this case.
Once you have identified amoxicillin as your treatment of choice to treat your patient’s ear infection, you will want to determine the dosage. As otitis media often occurs in children, you might have to break a tablet in half or open the capsule to separate out a portion that would be appropriate. For amoxicillin, you would give 20–50 mg per kilogram (2.2 pounds) of body weight (20–30 mg per kilogram for infants younger than 4 months old). This would be useful if you have to give the drug to a toddler who is less than 30 pounds.
A common older child’s dosage would be 250 mg, and a common maximum dosage for adults would be 500 mg 3 times a day. Luckily (or by design), these dosages are exactly how the commercially made aquatic medications come in the bottle. Take this dosage orally 3 times a day for 10–14 days (2 times a day for infants). All of the above information can be found in the Physicians’ Desk Reference.
If your child is too small to swallow a pill whole, you could make a mixture with water (a suspension). To make a liquid suspension, crush a tablet or empty a capsule into a small glass of water and drink it; then, fill the glass again and drink that (particles may adhere to the walls of the glass). You can add some flavoring to make it taste better.
Do not chew or make a liquid out of time-released capsules of any medication; you will wind up losing some of the gradual release effect and perhaps get too much into your system at once. These medications should be plainly marked “time-released.”
You will probably see improvement within 3 days, but don’t be tempted to stop the antibiotic therapy until you’re done with the entire 10–14 days. Sometimes you’ll kill most of the bacteria, but some colonies may persist and multiply if you prematurely end the treatment. This is often cited as a cause of antibiotic resistance. In a long-term survival situation, however, you might be down to your last few pills and have to make some tough decisions.
Ciprofloxacin
A useful antibiotic option is ciprofloxacin (veterinary equivalent: Fish Flox). Ciprofloxacin is in the fluoroquinolone family. It kills bacteria by inhibiting the reproduction of DNA and bacterial proteins. This drug usually comes in 250 mg and 500 mg doses.
Ciprofloxacin (Cipro) can be used for the following conditions:
• Bladder or other urinary infections, especially in females
• Prostate infections
• Some types of lower respiratory infections, such as pneumonia
• Acute sinusitis
• Skin infections (such as cellulitis)
• Bone and joint infections
• Infectious diarrhea
• Typhoid fever caused by Salmonella
• Inhalational anthrax
In most cases, you should give 500 mg 2 times a day for 7–14 days, with the exception of bone and joint infections (4–6 weeks) and anthrax (60 days). You can get away with 250 mg doses for 3 days for most mild urinary infections. Generally, you would want to continue the medication for 2 days after improvement is noted.
Unlike amoxicillin, many antibiotics may not be safe for use in certain situations. For example, ciprofloxacin has not been approved for use during pregnancy. Among its side effects, Cipro has been reported to cause weakness occasionally in muscles and tendons. It may also cause joint and muscle complications in children, so it is restricted in pediatric use to urinary tract infections and pyelonephritis due to E. coli (the most common type) and occasionally to inhalational anthrax.
In children, the dosage is measured by multiplying 10 mg by the weight of the child, in kilograms (1 kg equals 2.2 pounds). The maximum dose should not exceed 400 mg total twice a day, even if the child weighs more than 100 pounds. Ciprofloxacin should be taken with 8 ounces of water.
Cephalexin
Cephalexin (veterinary equivalent: Fish Flex, Fish Flex Forte) is an antibiotic in the cephalosporin family. It is different from but cross-reactive with the penicillin family; this means that a percentage of penicillin-allergic patients will also be allergic to cephalosporins.
Cephalexin works by interfering with the bacteria’s cell wall formation. This causes the defective wall to rupture, killing the bacteria. This antibiotic is useful treating the following:
• Cystitis (bladder infections)
• Otitis media (ear infections)
• Pharyngitis (sore throats)
• Skin or soft-tissue infection (infected cuts)
• Osteomyelitis (infections of the bone)
• Prostatitis (prostate infections)
• Pyelonephritis (kidney infections)
• Upper respiratory tract infection
Cephalexin is also used as a preventative before surgical procedures in people who are at risk for heart-valve infections. It is also one of the few antibiotics that is thought to be safe to use during pregnancy. Cephalexin is marketed in the United States under the name Keflex.
To use this medication, you would normally give 250 mg (Fish Flex) or 500mg (Fish Flex Forte) every 6 hours for 7–14 days. Severe bacterial infections may require an additional week of treatment. Infections of the bone (osteomyelitis) are particularly dangerous and require 4–6 weeks of therapy.
Pediatric dosages are calculated using 12.5–25 mg per kilogram of body weight orally every 6–12 hours. (Don’t exceed adult dosages.)
Doxycycline
Another useful antibiotic in a collapse would be doxycycline (veterinary equivalent: Bird Biotic). Doxycycline is a member of the tetracycline family and is also acceptable to use with patients who are allergic to penicillin. It inhibits the production of bacterial protein, which prevents its reproduction. Doxycycline is marketed under various names, including Vibramycin and Vibra-Tabs.
Doxycycline is an extraordinarily versatile drug. Indications for its usage include the following:
• E. coli, Shigella, and Enterobacter infections (diarrheal disease)
• Chlamydia (sexually transmitted disease)
• Lyme disease
• Rocky Mountain spotted fever
• Anthrax
• Cholera
• Plague
• Gum disease (severe gingivitis, periodontitis)
• Folliculitis (boils)
• Acne and other inflammatory skin diseases, such as hidradenitis (seen in armpits and groins)
• Some lower respiratory tract (pneumonia) and urinary tract infections
• Upper respiratory infections caused by strep
• Methicillin-resistant Staphylococcus aureus (MRSA) infections
• Malaria (prevention)
• Some parasitic worm infections (kills bacteria in their gut that they need to survive)
In the case of Rocky Mountain spotted fever, doxycycline is indicated even for use in children. Otherwise, doxycycline is not meant for those younger than 8 years old. It has not been approved for use during pregnancy.
The recommended doxycycline dosage for most types of bacterial infections in adults is 100 mg–200 mg per day for 7–14 days. For chronic (long-term) or more serious infections, treatment can be carried out for a longer time. Children should receive 1–2 mg per pound of body weight per day. For anthrax, the treatment should be prolonged to 60 days. As prevention against malaria, adults should use 100 mg per day.
Although antibiotics may be helpful in diarrheal disease, always start with hydration and symptomatic relief. Prolonged diarrhea, high fevers, and bleeding are reasons to consider antibiotic use. The risk is that one of the most common side effects of antibiotics is . . . diarrhea!
Azithromycin
Another antibiotic available in an aquatic equivalent is azithromycin 250 mg. Azithromycin is a member of the macrolide (erythromycin) family and can be found also as Aquatic Azithromycin. It works by stopping the growth and multiplication of bacteria. I prefer it to aquatic erythromycin powder (Fish Mycin), as azithromycin is available in a capsule and thus more easily administered.
Azithromycin can be used to treat various types of the following:
• Bronchitis
• Pneumonia
• Ear infections
• Skin infections
• Throat infections (some)
• Sinusitis
• Tonsillitis
• Typhoid fever
• Gonorrhea
• Chlamydia
• Whooping cough
• Lyme disease (early stages)
Azithromycin is taken 250 mg or 500 mg 1 time a day for a relatively short course of treatment (usually 5 days). The first dose is often a “double dose,” twice as much as the remainder of the doses given. This method of taking the drug is known in the United States as a Z-Pack.
For acute bacterial sinusitis, azithromycin may be taken 1 time a day for 3 days. If you are taking the 500 mg dosage and have side effects, such as nausea and vomiting, diarrhea, or dizziness, drop down to the lower dosage. Azithromycin is not known to cause problems in pregnant patients.
Clindamycin
Clindamycin (Fish Cin) is part of the lincomycin antibiotic family of drugs. It, like azithromycin, works by slowing or stopping the growth of bacteria. It works best on bacteria that are anaerobic, which means that they thrive in the absence of oxygen. It can be used to treat the following:
• Acne
• Dental infections
• Soft-tissue (skin, etc.) infections
• Peritonitis (inflammation of the peritoneum, which lines the inner wall of the abdomen and covers most of the abdominal organs)
• Pneumonia and lung abscesses
• Uterine infections (such as after miscarriage or childbirth)
• Blood infections
• Pelvic infections
• MRSA (methicillin-resistant Staphylococcus aureus infections)
• Parasitic infections (malaria, toxoplasmosis)
• Anthrax
Clindamycin is given in 150 mg or 300 mg doses every 6 hours with a glass of water. It should be used with caution in individuals with a history of gastrointestinal disease, as it can cause diarrhea during treatment. Sometimes, a very serious colitis (infection of the intestine) can develop. This drug is, like azithromycin, pregnancy category B, which means that no ill effects have been determined in animal studies. With most drugs, testing cannot be done ethically on pregnant humans, so very few drugs are willing to say that any medicine is completely safe during pregnancy.
Ciprofloxacin, clindamycin, doxycycline, and azithromycin are acceptable for use in patients with Penicillin allergies. This is not to say that you might not have a different allergy to one or the other, however.
Metronidazole
Metronidazole (aquatic equivalent: Fish Zole) 250 mg is an antibiotic in the nitroimidazole family that is used primarily to treat infections caused by anaerobic bacteria and protozoa.
Anaerobes are bacteria that do not depend on oxygen to live. Protozoa have been defined as single-cell organisms with animal-like behavior. Many can propel themselves from place to place by the means of a flagellum; a tail-like hair they whip around that enables them to move.
Metronidazole works by blocking some of the functions within bacteria and protozoa, thus resulting in their death. It is better known by the US brand name FlagylTM and usually comes in 250 mg and 500 mg tablets. Metronidazole is used in the treatment of the following bacterial diseases:
• Diverticulitis (intestinal infection seen in older individuals)
• Peritonitis (infection of the peritoneum, which lines the inner wall of the abdomen and covers most of the abdominal organs)
• Some pneumonias
• Diabetic foot-ulcer infections
• Meningitis (infection of the spinal cord and brain lining)
• Bone and joint infections
• Colitis due to Clostridia bacterial species (sometimes caused by taking clindamycin!)
• Endocarditis (heart infection)
• Bacterial vaginosis (common vaginal infection)
• Pelvic inflammatory disease (infection in women that can lead to abscesses)—used in combination with other antibiotics
• Uterine infections (especially after childbirth and miscarriage)
• Dental infections (sometimes in combination with amoxicillin)
• Helicobacter pylori infections (causes peptic ulcers)
• Some skin infections
And the following protozoal infections:
• Amoebiasis—dysentery caused by Entamoeba species (contaminated water or food)
• Giardiasis—infection of the small intestine caused by Giardia species (contaminated water or food)
• Trichomoniasis—vaginal infection caused by a parasite that can be sexually transmitted
Amoebiasis and giardiasis can be caught from drinking what appears to be the purest mountain stream water. Never fail to sterilize all water, regardless of source, before drinking it.
Metronidazole is used in different dosages to treat different illnesses. The following are the dosages and frequency of administration for several:
• Amoebic dysentery—750 mg orally 3 times daily for 5–10 days. For children, give 35–50 mg per kilograms of the child’s weight per day orally in 3 divided doses for 10 days (no more than adult dosage, of course, regardless of weight).
• Anaerobic infections (various)—7.5 mg/kg orally every 6 hours, not to exceed 4 grams daily.
• Clostridia infections—250–500 mg orally 4 times daily or 500–750 orally 3 times daily.
• Giardia—250 mg orally 3 times daily for 5 days. For children give 15 mg/kg/day orally in 3 divided doses (no more than adult dosage regardless of weight).
• Helicobacter pylori (ulcer disease)—500–750mg 2 times a day for several days in combination with other drugs, such as Prilosec (omeprazole).
• Pelvic inflammatory disease (PID)—500 mg orally 2 times a day for 14 days in combination with other drugs, perhaps doxycycline or azithromycin.
• Bacterial vaginosis—500 mg 2 times a day for 7 days.
• Vaginal trichomoniasis—2 g single dose (4 500 mg tablets at once) or 1 g twice total.
Like all antibiotics, metronidazole has side effects that you can review by picking up a Physicians’ Desk Reference or going to drugs.com or rxlist.com. One particular side effect has to do with alcohol: drinking alcohol while on metronidazole will very likely make you vomit. Metronidazole should not be used in pregnancy but can be used in those allergic to penicillin.
Sulfa Drugs
Sulfamethoxazole 400 mg combined with trimethoprim 80 mg (veterinary equivalent: Bird Sulfa) is a combination of medications in the sulfonamide family. This drug is well known as its US brand names Bactrim and Septra. Our British friends may recognize it by the name co-trimoxazole.
Sulfamethoxazole acts as an inhibitor of an important bacterial enzyme. Trimethoprim interferes with the production of folic acid in bacteria, which is necessary to produce DNA. The two antibiotics together are stronger in their effect than alone (at least in laboratory studies).
Sulfamethoxazole 400 mg/trimethoprim 80 mg is effective in the treatment of the following:
• Some upper and lower respiratory infections (chronic bronchitis and pneumonia)
• Kidney and bladder infections
• Ear infections
• Intestinal infections caused by E. coli and Shigella bacteria
• Skin and wound infections
• Traveler’s diarrhea
• Acne
The usual dosage is 1 tablet twice a day for most of the above conditions in adults for 10 days (less in traveler’s diarrhea).
The recommended dose for pediatric patients with urinary tract infections or acute otitis media is 8 mg/kg trimethoprim and 40 mg/kg sulfamethoxazole per 24 hours, given in 2 divided doses every 12 hours for 10 days. (Remember that 1 kilogram equals 2.2 pounds.) This medication is contraindicated in infants 2 months old or younger.
In rat studies, the use of this drug was seen to cause birth defects; therefore, it is not used during pregnancy. Sulfamethoxazole 400 mg/trimethoprim 80 mg is well known to cause allergic reactions in some individuals. These reactions are almost as common as seen in penicillin allergies.
Ampicillin
Ampicillin (veterinary equivalent: Fish Cillin) is a member of the penicillin family. It interferes with the ability of bacteria to make cell walls. Ampicillin can be used to treat a number of infections:
• Respiratory-tract infections (bacterial bronchitis)
• Throat infections
• Ear infections
• Cellulitis
• Meningitis
• Urinary tract infections
• Typhoid fever (caused by Salmonella)
• Dysentery (caused by Shigella)
Ampicillin is usually given to adults in doses of 500 mg 4 times a day for 7–10 days. A common pediatric dosage formula is 6.25–12.5 mg/kg every 6 hours (maximum 2 to 3 g daily). Ampicillin is acceptable for use during pregnancy. Like most antibiotics, it has a stronger effect in intravenous form and can be used intravenously in some cases of septicemia (blood infection) and endocarditis (heart infection).
Antifungal Drugs
Not every medication you use to treat infection will kill bacteria. Viruses and fungi can also cause infection, and you will have to stockpile these drugs as well. Common fungal infections, such as ringworm, athlete’s foot, and jock itch will be rampant in wet climates or in situations where you might not be able to change socks or underwear often.
Therefore, it makes sense to keep some antifungal medication around as well. Clotrimazole (Lotrimin) is a good choice here, as it comes in cream or powder and doesn’t require a prescription. Medications such as miconazole (Monistat) would be useful for vaginal yeast infections. There is an oral tablet as well, fluconazole (Diflucan), which may be more convenient than creams or powders but requires a prescription.
Antiviral Drugs
Finally, antiviral medications will be useful as well. Many of the infections, especially respiratory, that we assume to be bacterial in nature are more likely to be viral. Antibiotics have no significant effect on viruses; despite this, many patients will demand an antibiotic prescription from their doctors. This overuse is one of the reasons that antibiotic resistance is growing.
One of the most popular antiviral influenza drugs is Tamiflu (oseltamivir). Tamiflu gives effective relief against symptoms of influenza. It can be taken upon exposure to the infection, even before symptoms have begun. If the drug is taken early enough, it might even prevent the illness altogether. Taken in the first 48 hours of a flu-like syndrome, it may decrease the severity and duration of symptoms.
The adult preventative dose of Tamiflu is 75 mg 1 time a day for 10 days. To treat symptoms, take 75 mg 2 times a day for 5 days. For children, use this regimen but with the following doses:
• 15 kg (33 lbs) or less—30 mg dosage
• 16–23 kg (34–51 lbs)—45 mg dosage
• 24–40 kg (52–88 lbs)—60 mg dosage
• More than 40 kg (89 lbs or more)—adult dosage
Tamiflu will not have much effect if taken after the first 48 hours of flu symptoms. Also, it is not proven to be effective against anything other than influenzas (it will not treat Ebola, for example). Despite this, it is wise to obtain prescriptions for every member of your family at the beginning of every flu season.
Other antiviral drugs, such as acyclovir or famcyclovir are usually used to treat conditions related to the herpes virus, such as those listed below.
Shingles (painful skin eruption)
Adults: 800 mg every 4 hours for 5 to 10 days
Children under 40 kg (and older than 2 years): 20 mg/kg 4 times a day for 5 days.
Varicella (chickenpox)
Adults: 800 mg 4 times a day for 5 days
Children under 40 kg (and older than 2 years): 20 mg/kg orally 4 times a day for 5 days.
Oral or genital herpes (herpes simplex)
Adults: 200 mg every 4 hours for 10 days or 400 mg 3 times a day for 7–10 days.
Children under 40 kg (and older than 2 years): 40 to 80 mg/kg a day in 3 to 4 divided doses for 5–10 days (maximum dose: 1 g per day).
Don’t forget that natural products, such as garlic and honey, have significant properties against certain infections. Garlic, for example, is thought to have antibacterial, antifungal, and antiviral effects. Many people report significant antibacterial and antiviral effect with colloidal silver as well. Before there were antibiotics, there was silver; it is still used in topical creams to prevent infection.
Expiration Dates
A question that we are asked quite often is “What happens when all these drugs I stockpiled pass their expiration date?” The short answer is “In most cases, not very much.”
Since 1979, pharmaceutical companies have been required to place expiration dates on their medications. But what do they signify? Officially, the expiration date is the last day that the company will certify that their drug is fully potent. Some believe this means that the medicine in question is useless or in some way dangerous after that date.
This is a false assumption in the vast majority of medicines that come in pill or capsule form. Expiration dates pertain to the strength of the medication in question. You will not grow a third eye in the middle of your forehead simply because the drug has “expired”; it just loses potency.
An exception to this was thought to be tetracycline. A report of kidney damage after taking expired tetracycline was published in the Journal of the American Medical Association in 1963. Since that time, the formulation for the drug has changed, and there are few, if any, recent reports of complications. Having said that, I recommend stockpiling doxycycline over tetracycline, as it is a newer-generation drug and might have less resistance issues.
About twenty-five years ago, the US military commissioned a study regarding expiration dates. They had more than a billion dollars’ worth of medications stockpiled and were faced with the challenge of destroying huge quantities every two years or so.
The results revealed that 90 percent of medications tested were acceptable for use 8–15 years after the expiration date. The exceptions were mostly in liquid form (insulin, among others). These lose their potency very soon after the date on the package. One sign of this is a change in the color of the liquid, but this is not proof one way or another.
More recently, a program, the Shelf Life Extension Plan (SLEP), evaluated a number of medications stockpiled by the Federal Emergency Management Agency (FEMA); these were mostly antibiotics that had been stockpiled for use in natural disasters that had passed their expiration dates. They also found that the grand majority of medications in pill or capsule form were still good 2–10 years after their expiration dates. The conclusion of the study, published in 2006, is as follows:
“The SLEP data supports the assertion that many drug products can be extended past the original expiration date. . . .”
As a result of all these findings, the federal government has changed its stance on expiration dates. During a recent flu epidemic, a 5-year extension was issued for the use of expired Tamiflu, a drug used to prevent and treat swine flu and other influenzas.
The effective life of a drug usually is in inverse relation to the temperature at which it is stored. In other words, a drug stored at 50 degrees will last longer than one stored at 90 degrees. Freezing, however, affects many drugs negatively. Storing in opaque or “smoky” containers is preferable to clear containers. Humidity will also affect medications, and could even cause mold and mildew to form, especially on natural remedies, such as dried herbs and powders.
Planning ahead, we must consider all alternatives in the effort to stay healthy in hard times. Don’t ignore any option that can help you achieve that goal, even expired medicine. We encourage everyone to conduct their own study into the truth about expiration dates; come to your own conclusions after studying the facts.