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Tuesday, August 24, 2010

Seven Letters Re: A Doctor's Thoughts on Antibiotics, Expiration Dates, and TEOTWAWKI

TamifluImage via Wikipedia
Hi Jim,
In response to the letters sent to you regarding my article, the FORTE version of the antibiotics described would be appropriate for full-grown men and all but the most petite women (less than, say, 100 pounds or so). Children would be best served with the 250mg fish antibiotic dose. Frequency of these medications is from 2-4 times a day, depending on the individual drug. The risk of under-dosage would be suboptimal progress in healing. Overdosage often manifests itself as diarrhea.. Treatment length is usually from 5-10 days.
A good internet drug index can be found at rxlist.com.

If you suspect that you have influenza (a viral illness), antibiotics will do you little good. Instead, you should get Tamiflu and take it 2 times a day for 5 days. It is most effective when taken very early in the onset of the illness.

I would recommend stockpiling as many antibiotics as you can afford. Over the course of time, I guarantee you will need it; if you don't need it, it will be an excellent barter item. Thanks again, - Dr. Bones
Hello Jim,
Here are a couple of resources for looking up drug information and recommended dosages:
At the NIH web site
At the FDA web site
Keep up the good work! - G.W. in Ohio

James Wesley;
Antibiotics, or any internally consumed medication for that matter, have a dosage range. To find the dosage range of a particular drug based on body weight, a drug information handbook will be needed. This will detail the appropriate milligrams of drug / Kilogram of body weight / per day (essentially the maximum dosage per day based on body weight) of the particular drug you need. All dosage amounts are in the metric system (mg) so you will need to convert it to the English pound system. Once you find the range, you can decide (based on the weight, age, medical status, virulence of infection and extent of infection) how much you would like to dispense.

A simple formula for converting the mg. of drug / Kg. of body weight / per day into mg. of drug / pounds of body weight / per day is:
(mg. of drug x weight in lbs. of person) / 2.2 lbs = maximum mg. of drug per day based on weight in lbs.

So, an example for the mathematically challenged using Amoxicillin:

The drug handbook lists Amoxicillin:
Child: 20-50 mg/kg/day in divided doses every 8 hours.
Adult: 250-500 mg every 8 hours.

If your child’s weight is 50 lbs. and he is in good general health (using the upper limit of the drug), multiple 50mg of Amoxicillin x 50 lbs. divided by 2.2 lbs = 1,136 mg/ lbs./ per day. So, 1,136 mg of Amoxicillin should not be exceeded per day.

Now, take the 1,136 mg and divide by 3 (because it is taken every 8 hours) = 379 mg every 8 hours (not to exceed ,1136 mg in a 24 hour period). The drug is only dispensed in capsule form as 250mg or 500mg capsules. So, based on the above child, I would prescribe a 250mg capsule every 8 hours for 7 days and monitor his response. If he starts to feel better, continue with the medication. If he gets worse, then up the dosage to 500mg every 8 hours and monitor or switch to a different antibiotic drug class.

The problem with under-dosage would be the bacterial infection is not eradicated from the body and the infection gets worse and possible resistant to the antibiotic. Over-dosage of an antibiotic when be difficult to do and the results even harder to estimate in my opinion. I would postulate that a prolonged over-dosage of an antibiotic (depending on the type of antibiotic) would alter the normal micro flora of an individual leading to gastrointestinal problems (diarrhea). I hope this helps, - Tennessee Dentist

Dear Jim,
I am board certified in family medicine. In general, I agree with the antibiotics recommended by Georgia Doc. Ten day courses of Levaquin and Bactrim are usually adequate for most infections. I have found Alldaychemist.com to be a reliable and reasonably priced source for most common antibiotics and other medications. It is based in India. Perhaps some of your pharmacist readers, can comment on if it is true the eighty percent of the world's generic medications are manufactured in India. Keep up the good work. Sincerely, - Dr. Jim

Dear Mr. Rawles,
Please let your readers know that there are three resources available to help determine the drug and dosage needed for specific illnesses. The first is The Merck Manual, which is a thick book with every known disease and syndrome. It's used by doctors and gives dosage recommendations for adults and children (including how to calculate dosage); it also provides alternative drugs should the patient be allergic to the first drug of choice.
The second resource is The Pill Book which is for sale at many pharmacies and most bookstores. It's a little less technical and is organized alphabetically rather than by disease, as The Merck Manual is.
Finally, everyone should be aware of what drugs they take for frequently occurring disorders such as tonsillitis, sinusitis, cystitis, etc. If your doctor regularly prescribes 500 mg Amoxicillin, you can be assured the drug and dosage are correct for you.
Thanks so much for your blog. - S.S. in Tennessee

Hello JWR,
First off, thank you for the site. My wife and I have just recently 'woke up' regarding preparedness (less than a month ago). It's really been a great bonding experience and also allows us to get back to basics. We are nowhere near 'ready', but we are working on it daily and have a plan of action. Hopefully we'll never really use any of this, but again, thank you for potentially saving our lives! We are very grateful, maybe I can give back a little with this e-mail.

I am writing regarding the recent pharmacy articles. Very well written and I agree with them completely. As a pharmacist and owner of an independent pharmacy myself, I can't stress enough that if SHTF, the pharmacies at CVS (I used to work there), Walgreens, Wal-Mart, and the like will be locked up. Count on it. I know if times became truly bad, I would take everything home with me and work from there while I had supplies left to prevent looting. I've stocked up on antibiotics, blood pressure meds, pain relievers, diuretics and other 'survival meds' (the cheap ones anyway) in bulk for the communities that I serve for awhile, but I doubt that most places have. I worry about my diabetic patients, along with those in the nursing home and homebound. I guess that the only thing that keeps me awake more than the Golden Horde is the image of those patients in the nursing homes that I serve, post SHTF, it really breaks my heart to think what could happen there.

I would just like to add a couple more products that I haven't really seemed mentioned anywhere that would be extremely beneficial, potentially lifesaving in my opinion.

Meclizine, brand names Bonine, some versions of Dramamine, (double check the active ingredient which are usually highlighted in yellow on the back of the box) can be used for multiple uses, but it's main function is preventing and treating nausea and dizziness. I imagine needing to gather firewood, hunting, or other outdoor activities while undergoing a dizzy spell. Not a good combination, although the job may need to be done You can get a generic bottle of 100 tablets with a long shelf life at my pharmacy (I'm assuming others as well) for around $5. The brand name is much much more expensive for the same amount. Be careful giving to children though, there is a Bonine for Kids that is a different ingredient that I use for my kids on car trips. Make sure that you're not confusing dizziness with dehydration.

Silver Sulfadiazine (brand names SSD and Silvadene). This is a prescription medication but if the opportunity presents itself, get hold of some. Treats burned skin to prevent secondary infections and it greatly increases healing time. Will work for cuts, burns, infected bug bites, etc. Similar product to Neosporin (triple antibiotic cream, without a prescription), except much more effective. My suggestion to get hold of some, next time you get a normal burn from the lawn mower muffler or curling iron, instead of treating it at home, go see your physician. Tell them a friend used SSD and you would like some. Shouldn't seem like a strange request. I've heard you may be able to get the same stuff from your Vet, but I'm not sure on that. This product is inexpensive, so ask for [a prescription for] a large quantity. Also, be careful if your have a sulfa allergy, since SSD has sulfadiazine in it, which is sulfa based.

Prednisone is another prescription that would be extremely beneficial post-SHTF. Can be used for strains and the like (although ibuprofen and naproxen are over the counter and much safer with far fewer side effects). However I envision it for near emergency situations with flu and breathing issues. Prednisone has a lot of side effects both short term and long term so be careful.

Sun Screen in bulk. You run the risk of dehydrating much much faster with a sunburn. At least wear a hat and loose lightweight long sleeve clothing. Dehydration will kill quickly and it is not a pleasant way to go.

Get a hardcopy of a medication book (I recommend The Pill Book by Harold Silverman, but there are others). Invaluable in my opinion. It will tell you side effects, common uses, common dosages, some interactions, etc.

I can't stress this one enough: Get healthy, now. Quit smoking/chewing, lose weight, get in shape. You may not even need that blood pressure, diabetic or cholesterol med if you loose the gut. It's hard work but it does work. You are going to have to become much more active post-SHTF, might as well get in shape before hand. Makes the whole civilization ending thing easier to handle. I'm working on my caffeine addiction now, I can't imagine these headaches after the Pepsi shelf is empty.

There are so many others to be addressed (diuretics, pain meds, anxiety meds, vitamins, etc.) but this would be a place to start along with Michael's advice. Just my two cents. - Dustin in Kansas

Mr. Editor:
Thanks to Dr. Bones for the tip on sourcing antibiotics from aquarium supply stores.
The main bacteria present these days in open trauma wounds is called methicillin (penicillin family) resistant Staph Aureus (MRSA). The Centers for Disease Control (CDC) in Atlanta) top recommended oral
antibiotic for MRSA is Bactrim DS, 3-4 tablets per day for 10 days. This is more than the classic Bactrim dose of two tablets a day that got used for female urinary tract infections and other less serious infections. Pharmacists sometimes challenge the higher dosage, but only because they are uneducated on this use for the drug. Other drugs that are often prescribed for for open trauma are Levaquin, and Augmentin. Levaquin cannot be given to kids. Augmentin syrup is the number one antibiotic for kids.
Here are the contents of the first-aid pack attached to our G.O.O.D. bags:
1- Trauma Pack; Tac-Pack Battle Pack, Option 2;
2- CELOX-A Hemostat syringe;
2- Betadine scrub, B-D Easy Scrub Brush
2- Sterile pairs of gloves
1- Sterile instrument set, tweezers, scissors, forceps, and needle driver, all in a sterile double peel pack
2 -1% Lidocaine 5ml syringes with capped needle
2 -No. 15 Sterile scalpel
1 - 5-0 Monofil suture
1 - 6-0 Chromic Gut suture
2- Steril gauze, Israeli 4" Field Dressing;
1- Coban, 2" Tan roll
1- Cheaper Than Dirt Universal Splint;
10 - Fever/Pain medicine, Tylenol travel packets-Extra Strength
Antibiotic tablets, Bactrim-DS: qty 30 (3/day x 10 days)
Antibiotic ointment, Bactroban cream, one tube
I am looking to add a transfusion kit, such as described in your novel, “Patriots”. Thanks, - Ragnar in Texas