Antibiotic Use in TEOTWAWKI, by GeorgiaDoc

Tuesday, Dec 29, 2009

I am a board certified Internist, and I've read with interest the SurvivalBlog articles on antibiotics. I believe that the one by FlightER, MD was the most informative, but a little over the head of most lay people. In a TEOTWAWKI situation, I think this might be helpful to lay people.

I think it would be wise to have both prescription and over-the-counter (OTC) medications on hand. But they are worthless if not used correctly. That is the problem if you are not trained and experienced in recognizing infections, and thus providing the correct antibiotic for the identified infection. I can describe the most common infections one would most likely encounter, and the best antibiotic to use in each circumstance. Please note, that if medical personnel are available, seek medical advice first, because a mistake could cost you your life if you have a serious infection. My advice is only for use in a situation where seeking medical advice is impossible, like TEOTWAWKI.

PREVENTION (Adults)

Preventing infection is better than treating an infection. The biggest advance in health was the improved sanitation in the early 1900s. Disposing of waste as far as possible from living and cooking and eating areas will prevent the common diarrhea illnesses that kill many when modern medical care is not available.

Any wound, even the most minor scratches should be thoroughly cleaned with soap and water. If dirt and debris is in the wound, do your best to scrub and irrigate with water to clean it out as best as possible. This simple thing will prevent most wound infections. Antibiotic ointments help, but simple washing and copious irrigation of open wounds is the most important.

Good hygiene helps as well. Bathing regularly as much as possible. Wiping after going to the bathroom from front to back for the ladies to prevent urinary tract infections. Brushing your teeth to prevent cavities and gum and dental infections. Having a single intimate partner to prevent STDs. We all know about condoms.

Keep your skin in good condition. Use sunscreens to prevent sunburn, and skin cancers. Use moisturizing cream to keep your skin in good condition as well. If your skin is damaged, dry, scaly which can easily happen if you are doing a lot of manual labor, or out in the hot sun, you are less resistant to skin infections. This includes the feet. If you sweat a lot, take your shoes and socks off twice daily and fan dry them to prevent fungal infections. If your feet are dry and scaly, then use a good moisturizing cream.

Use insect repellant to prevent insect borne infections.

Make sure you have had a recent tetanus booster. In TEOTWAWKI, vaccinations will be difficult to obtain, so make sure you are up to date. You should update your tetanus vaccine every 10 years. The current tetanus vaccine includes diphtheria, and pertussis (whooping cough). Make sure you get this triple vaccine, called Tdap ("T-DAP"). All three of these are rare in the US because of our vaccination campaigns. In some parts of the world where vaccines are not available, these are major killers. Also get your influenza vaccine every year, and ask your Doctor for the pneumonia vaccine. Pneumonia is one of the most common, serious infections, and prevention is always best.

TREATING THE MOST COMMON INFECTIONS (Adults)

PLEASE NOTE THERE ARE MANY DRUG INTERACTIONS, SIDE EFFECTS, AND POSSIBLE ALLERGIC REACTIONS. I CANNOT DETAIL ALL THE POSSIBILITIES IN THIS SHORT ARTICLE, SO ALWAYS CONSULT A PHYSICIAN IF POSSIBLE. A PDR IS A GOOD RESOURCE TO HAVE IN TEOTWAWKI. PREGNANT WOMEN SHOULD NEVER TAKE DOXYCYCLINE, CIPRO, AVELOX, LEVAQUIN, AND BACTRIM. THE SAFEST ANTIBIOTICS IN PREGNANCY GENERALLY ARE AMOXICILLIN, AUGMENTIN, ERYTHROMYCIN, CEPHALEXIN, MACRODANTIN.


If prevention fails, these are the infections you are most likely to encounter.

1. Common cold. Symptoms are: runny nose, sore throat, cough. You might get a little achy, fatigued, even have a low grade fever up too 100.5 or so. Just take some cough and cold meds. It will go away by itself. Please do not take antibiotics for this. It is a total waste of your resources. Antibiotics will not help, and may make you worse if you have an adverse reaction.

2. Cellulitis . This is a potentially serious infection. It usually arises from an injury, like a cut, or puncture wound. It is easily recognizes as an expanding area of redness. It is warm, and tender to touch. As it enlarges, you will eventually develop a fever, and have chills. Swollen lymph glands may appear nearby. This may also develop into the classic "red streak" going up an arm or leg. This is called "lymphangitis," but is a type of cellulitis. The idea is that it is expanding/enlarging, usually quickly, over hours you can see a difference. This is life threatening, and requires antibiotics. It might have been prevented by washing a wound, and applying antibiotic ointment, but now it is too late for that. Systemic antibiotics are necessary. This is usually a type of streptococcus ("strep") infection, similar to what causes strep throat. It is sometimes Staph. The best antibiotic for this is Cephalexin (Keflex), or Erythromycin if you are allergic to Penicillin.

3. Sinusitis You will know you have a sinus infection if you have sinus pressure or pain, discolored drainage, and swollen glands in the neck. Sometimes a fever will be present. Usually Amoxicillin will work for this, or Augmentin. If you are allergic to penicillin, then Bactrim is a good choice.

4. Bronchitis This is almost always viral, and does not require antibiotics, unless you have chronic lung disease, or if you are a smoker. In that case, Amoxicillin will work for this, or Augmentin. If you are allergic to penicillin, then Bactrim is a good choice.

4. Pneumonia Pneumonia is not easy to diagnose, even for a Medical Doctor without x-rays, but if you have a cough, and fever above 101 degrees F, I would assume it is pneumonia, especially if you are having chest pain or shortness of breath. The best choices here are Avelox, Levaquin, and Azithromycin. If these are not available due to cost, Amoxicillin, and Augmentin will usually work, as will Erythromycin.

4. Urinary tract infections (UTIs) The symptoms are painful urination, and the feeling of needing to urinate frequently, and an urgent feeling to urinate. In women, this is usually a bladder infection, and three days of Cipro, Bactrim, or Macrodantin will usually work. If there is also flank pain, and fever, I would assume it is a kidney infection, and treat with Cipro or Bactrim for two weeks. For men, unless you have some abnormality in your bladder or kidneys, it is almost always a prostate infection (prostatitis). A fever may or may not be present. This requires 30 days of either Bactrim or Cipro.

5. Gonorrhea and chlamydia For men, the symptoms are painful urination, and a discharge. We always assume both gonorrhea and chlamydia are present, and treat for both. Ideally, this would be treated with an injection of ceftriaxone, or oral Suprax (cefixime) 400mg, and a week of doxycycline. In TEOTWAWKI, I would try a single dose of Cipro 500mg orally for the gonorrhea, and a week of Doxycycline 100mg twice daily. Resistance to Cipro is being reported, so it is not ideal treatment. If you have Azithromycin, a single oral dose of 1 gram (1000mg) will take care of Chlamydia, so the simplest regimen would be Cipro 500mg orally, and Azithromycin 1000mg orally as a single dose. For women, the symptoms are pelvic pain and discharge (PID), and sometimes fever. Please do not treat this at home unless you have no alternative. This is a serious infection, and it is easy to confuse this with appendicitis, or other serious, life threatening conditions. The only oral regimen recognized for PID is Levofloxacin 500mg daily for 14 days.

6. Boils These are easily recognized. They are enlarging, painful cysts. Like giant pimples, they usually come to a head eventually, and open and drain pus. The best treatment is to open them, and drain using a scalpel. Do not squeeze them, because if they rupture internally, you have converted a minor thing into a serious thing. It is best to apply heat, and take antibiotics until the boil is "mature." It will come to a head (have a white point in the center) and can be easily drained, or will become fluctuant (mushy feeling) where you can lance it open to drain. The best antibiotic today is Bactrim, as this is almost always a Staph infection, and many are resistant to other antibiotics. These are MRSA Staph infections.

7. Impetigo These are superficial skin infections. They are weepy, crusted patches on the skin. Children are most prone, but adults can get it also. It is usually strep or staph infections, and the best antibiotic is Cephalexin, or Augmentin. Erythromycin will work also.

8. Middle ear infection The symptom is a painful ear. Sometimes also a fever. It is not always easy to differentiate it from "swimmers ear," which is an infection in the ear canal. If the ear hurts, and there is not obvious swelling and tenderness in the ear canal, I would assume it is a middle ear infection. Amoxicillin, Bactrim, Augmentin, Cephalexin would all work.

9. Swimmers ear This is the other "earache." The ear hurts, and if you look in the ear canal, and compare with the normal ear, the canal will be obviously swollen, sometimes swollen shut. If you gently wiggle the ear, to put some traction on the ear canal, it will be very tender. Middle ear infections will not be tender. Antibiotic ear drops are needed here. If you want to conserve money for supplies, have some antibiotic eye drops on hand. These can be used for eye infections, and will also work in the ear. DO NOT TRY THE REVERSE. DO NOT PUT ANTIBIOTIC EAR DROPS IN THE EYE. IT REALLY HURTS!!!

10. Toothache This is always caused by mouth bacteria. They are always sensitive to penicillin, so Amoxicillin is best. Erythromycin is a good alternative if you are allergic to Penicillin .[JWR Adds: But of course don't ignore treatment for any underlying cause of the ache such as impaction!]

11. Pink eye This is usually viral. So cold compresses, and artificial tears will do. If the drainage is especially foul, discolored, then it could be bacterial, and antibiotic eye drops may help. Sulfacetamide ophthalmic solution is inexpensive and should work fine. Ofloxacin if you are allergic to Sulfa.

12. Diarrhea illnesses These are usually viral infections, and will resolve on their own in a few days if left alone. Just take Imodium, and drink plenty of fluids. If you are having a lot of abdominal pain with the diarrhea, or are having blood tinged diarrhea, and running a fever, it could be a bacterial infection, so in TEOTWAWKI, I would try Cipro. This will treat most of the bacterial causes of diarrhea. Remember also, these are usually sanitation failures. So good sanitation, and hand washing are good preventatives.

13. Cold sores/ genital Herpes These are caused by essentially the same virus. They are easily recognized as clustered small blisters, and are very painful. The blisters are easily ruptured, so sometimes all you see are small ulcers. The key thing is that they are very painful. Acyclovir is effective for cold sores on the lip, and genital herpes. Acyclovir also works for shingles.

14. Influenza Influenza is usually only seen in the "flu season." It is also easily recognized. It is like a cold on steroids. It is a respiratory illness, causing a cough, sore throat, runny nose, headache, muscle aches, and fever. Fever is usually 101 F or higher. One hallmark of influenza is extreme fatigue. If you are not exhausted, you are not likely a "flu" victim. Tamiflu is effective, but must be started within 48 hours of onset of illness to be effective.

15. Animal bites Animal bites are considered infected from day one. Most Doctors initiate antibiotics immediately. The best thing to try to prevent infection is to thoroughly cleanse the wound. If the wound is open, that is actually better, because you can more easily irrigate copiously with water. Sterile saline is not necessary. If you have clean tap water, that is fine. Use liters of irrigation. Bandage the wound, apply antibiotic ointment, and immediately start antibiotics. Augmentin is usually used because of the bacteria which usually cause the infection.


Antibiotic Medications to have on hand in TEOTWAWKI

OTC antibiotic medications

1. Bacitracin or Double antibiotic ointment (do not use Triple antibiotic, or Neosporin ointment, these are highly allergic).
2. Povidine (Betadine) is a great solution to cleanse wounds. It contains iodine. Those who are allergic to iodine should avoid.
3. Hibiclens This is a good alternative as a cleansing solution for those allergic to iodine. Several gallons would not be too much.



Prescription antibiotic medications

1. These antibiotics are relatively inexpensive, and would be effective for almost anything you would encounter: Amoxicillin, Cipro, Bactrim DS, Doxycycline, Erythromycin, Cephalexin, and Sulfacetamide Ophthalmic solution.

2. If you have antibiotic allergies, or if you want a more complete armamentarium of medications, I would include: Augmentin, Zithromycin, Avelox, Suprax, Macrodantin, Acyclovir, and Tamiflu.


This is the usual doses for adults of the antibiotics mentioned

Amoxicillin 500mg three times daily for 10 days

Augmentin 875/125 twice daily for 10 days

Cipro 500mg twice daily for 10 -30 days

Azithromycin 250mg take 2 tablets the first day, then 1 tablet daily after that for 4 days.

Avelox 400mg daily for 10 days

Suprax 400mg as a one time dose

Macrodantin 100mg twice daily for 7-10 days

Acyclovir 400mg three times daily for 5-14 days

Tamiflu 75mg twice daily for 5 days

Doxycycline 100mg twice daily for 10 days

Bactrim DS 1 tablet twice daily for 10-30 days

Erythromycin 333mg three times daily for 10 days

Cephalexin 500mg four times daily for 10 days

Sulfacetamide eye drops 1 drop in affected eye four times daily for 7 days. For the ear, 3-4 drops in the affected ear 4 times daily for 7 days


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