Three Letters Re: Sources for Prescription Medications?

Mr. Rawles,
As a physician I take significant offense to Lawrence R.’s letter regarding antibiotics. The fact is over 90% of infections presenting to US hospitals are antibiotic resistant in some form or other.
He is correct that some of the older medications may be effective and that is why bacterial cultures are performed to determine antibiotic resistance. He is sadly misinformed regarding the idea that we prescribe the most expensive or newest antibiotic available. We prescribe the least expensive antibiotic that is effective against the specifically cultured infection as long as a patient is not allergic to that class of antibiotic.

I wish him luck using penicillin for 90+ percent of soft tissue infections obtained outside of the hospital as the large majority of community acquired soft tissue infections are resistant to penicillin.
A good broad spectrum antibiotic which can be obtained very inexpensively is Sulfamethoxazole/trimethoprim otherwise known as Septra or Bactrim. This can be had at large chain stores for $5 for a two week supply and is widely used as there is low resistance to this class of antibiotic as of this time. This applies to localized soft tissue infections only, such as a cut, scratch, abscess or boil.
I had to correct this misinformation posted on your superlative blog. Thank you for your time, – Kevin C.

After reading the suggestion from Lawrence R about antibiotics, I think this email that I sent you back in 2007 bears repeating, with just a few changes.

Terramycin is a trade name for tetracycline, a common antibiotic. It’s value has changed over the years due to antibiotic resistance (not drug company lies)….but it’s useful as

* an alternative in PCN-allergic patients: syphilis, yaws, Vincent’s infections, and infections caused by N. gonorrhoeae, B. anthracis, L. monocytogenes, Actinomyces sp., and Clostridium sp.
* URI and lower respiratory tract infections; skin and soft tissue infections; Granuloma inguinale;psittacosis caused by Chlamydia psittaci.
* Typhus infections,Rocky Mountain Spotted Fever, rickettsial infections, and Q Fever.
* Infections caused by Chlamydia trachomatis.
* Urinary tract infections.
* Infections caused by Borrelia sp., Bartonella bacilliformis, H. ducreyi, F. tularensis, Y. pestis, V. cholerae, Brucella sp., C. fetus.
* Adjunctive to intestinal amebiasis cause by E. histolytica.
* Infections caused by susceptible strains of E. coli, Enterobacter aerogenes, Shigella sp., Acinetobacter sp. Klebsiella sp., Bacteroides sp.


* H. pylori-related peptic ulcer disease (in combination with bismuth subsalicylate and metronidazole – a very large percentage of ulcers are caused by this bacterial infection).
* Gingivitis/periodontitis
* Acne vulgaris

As you can see, it’s useful for specific infections…..

There is no ‘one best antibiotic’ for all purposes. Antibiotics have to be administered based on the specific type of bacteria causing an infection. Administering the wrong antibiotic doesn’t just NOT work, it causes different bacteria that are not killed outright to become resistant to it – which can cause problems down the road. People have pathogenic bacteria in and on them all the time, when something causes them to go out of balance and cause disease. At the very basic level, antibiotics are based on the cell wall of the bacteria (which determines if it will stain pink or blue with the Gram microscopic stain process), and their shape. Once that determination is made, certain bacteria have been shown to be sensitive to certain drugs, for example Gram-negative bacillus (say, E. coli) is usually sensitive to the fluoroquinolones like ciprofloxacin (Cipro).

If I were to recommend a basic armamentarium of oral antibiotics, I’d have to pick at least five different ones. I actually carry these, plus 4 or 5 IV/IM only drugs, and pick the best drug for the problem at hand, because once again, the wrong drug isn’t just not as good, it’s no good and a waste of valuable, scarce resources that might be needed more appropriately for another patient.

1. Ciprofloxacin (Cipro) 500mg twice a day
for infectious (bacterial) diarrhea (5 days max), anthrax prophylaxis (x60 days),uncomplicated UTI (7 days max), gonorrhea (1-2 tabs, once)

Given the incidence of certain bacteria that are resistant to ciprofloxacin, it is also wise now to also carry azithromycin

2. Azithromycin 250mg Comes in packs of 6 for 5 days dosage, take 2 the first day, then 1 a day until gone.
for bronchitis, pneumonia, or serious throat infection.

3. Ampicillin 500 mg 4 times a day for , or
amoxicillin-clavulanate 875 mg twice a day (Augmentin, very $$$)
for sinus infection, skin infection, or ear infection, GI, GU,

4. Trimethoprim-sulfamethoxazole 160/800mg (double strength) twice a day, 7-10 days or
doxycycline 100 mg twice a day, for 7 days for methicillin-resistant Staphylococcus aureus (MRSA) infection, UTI, otitis media, sinusitus, bronchitis

Doxycycline is also a chloroquine-resistant malaria prophylaxis, take 1 daily starting 2 days before travel until 4 weeks (28 days) after return from endemic area, effective against Rickettsials (Rocky mountain spotted fever)

5. Metronidazole 500mg 4 times a day for 7-14 days
effective against Giardia lamblia and for dental infections, trichomoniasis

Augmentin is very good for animal (especially cat) bites, but is quite expensive. Amoxicillin is a synthetic penicillin, the clavulinic acid (clavulanate) contributes penicillinase (an enzyme some bacteria produce that inhibits penicillin effectiveness) resistance.

This list is in no way comprehensive, nor are the indications the only possible uses for the drug, or the only drug for a condition.

Take care, and keep up the good work. – FlightER, MD

Mr. Editor,
I feel compelled to write you about a couple of recent medical posts by other SurvivalBlog readers. One writer stated that Cipro is good for sinus infections. Generally this is not true. Given a severe infection and no other antibiotic options, [if it is] TEOTWAWKI, then sure go head and try it, but think of Cipro as a below the diaphragm antibiotic, urinary tract infections, diverticulitis (preferably combined with Flagyl, an inexpensive antibiotic/antiparasitic), and so forth. Physicians will sometimes try it for skin and soft tissue infections, such as cellulitis, but the results with this generally are quite poor in my first-hand experience.

The real reason I take keyboard in hand, however, is to reply to the posting of Lawrence R.. It pains me to see someone who appears to be a former Coastie (Semper Paratus) making the claims he does about antibiotic resistance. It is not my intention to start an argument or negatively toned debate on your excellent blog, but to state that antibiotic resistance is a lie is patently false. Resistance among some of the most common pathogenic bacteria to penicillins, cipro, and other commonly used antibiotics is a substantial problem physicians contend with every day. An internet search using the terms antimicrobial resistance and the name of their state, community, and perhaps even a local hospital may reveal tables of statistics with the frequencies of resistance to common pathogens to readers. Additional light reading may be found here. Lawrence’s comments that ranchers and farmers treating themselves with antibiotics devoid of trained medical advice is done “with no deleterious effects” is a disingenuous and potentially dangerous statement. Certainly, people – with or without physician advice, often in today’s world, will take antibiotics when they are not needed, and suffer no apparent harm. The lack of direct, obvious and immediate consequences does not turn this uneducated practice into a virtue. This practice is one of the primary reasons for the significant levels of antibiotic resistance prevalent today.

Further, complications from partially treated infections, delays in seeking proper medical attention for medical problems because one thought the antibiotic in the cupboard would take care of it, and direct consequences of antibiotics on the human system are all problems physicians help patients with every week. Ask the next woman you see about yeast infections with antibiotics and you may begin wondering how much Diflucan to stock at the retreat. Or, instead of that common but relatively minor example, ask one of my patients who now must be on antifungal medicines for the rest of his life because prior to seeing me he partially treated a series of sinus infections until a yeast infection took hold, ate into the bones of his skull, creating an infection in his skull which can be contained, yet never cured. Also, ask anyone who has had C. dificle colitis after an antibiotic course if antibiotics have no deleterious effects. C. dificile colitis can emerge up to a year after the last course of antibiotics. In a TEOTWAWKI situation this makes stockpiling some Flagyl especially helpful, though I have seen patients have to take it for up to 3-6 months for the colitis to be resolved. There are other antibiotics which can be used for this problem, but they are cost-prohibitive for stockpiling. Oh, BTW, think that the appendix has no meaningful function? It’s use is as a reservoir of normal colon flora to be used to repopulate the colon after a severe diarrheal illness. Since this discovery was made I have noted that the distinct majority of patients I have seen with C. dificile have undergone previous appendectomies. In either case, with or without your appendix, it is an unnecessary risk of health and “antimicrobial OPSEC” to randomly treat oneself without medical input from someone with relevant training.

In another vein however, my personal opinions about the ongoing prevalence of antibiotic resistance in TEOTWAWKI may be of interest. Most forms of antibiotic resistance mounted by bacteria require the expenditure of energies and resources by the bacteria themselves. Because we live in a world in which antibiotic exposure is unnaturally common, from prescription medications as well as the indiscriminate use of antibiotics in our food supply – reference Lawrence’s own assertion that the local feed store is an easy and ample source of antibiotics. (I have close family members and patients who are livestock farmers and have witnessed flagrant misapplication of antibiotics to livestock first-hand as well.) This environment creates a scenario in which a survival advantage for the bacteria who express the resistance factors is generated. Interestingly, in TEOTWAWKI, the world-wide presence of antibiotics in the ecosystem should rapidly revert back to the natural state, where microbes such as fungi, for example, who release penicillin naturally (the original source of the “discovery” of penicillins), will be the only source of organic antimicrobials. In this scenario the bacteria who are consuming their energies and resources to make antibiotic resistance defenses will be at a survival disadvantage to other bacteria who are not dividing their resources between survival & replication and antibiotic resistance. Thus, in relatively short order, measurable declines in resistant antibiotic populations could be expected. If this theory pans out, then the utility of Penicillin, Cipro and other stockpiled antibiotics, when recommended by your survival group’s medical officer, could be greater than present day patterns of resistance would suggest. Certain microbes will always be resistant to certain antibiotics, as inherency of their natures, but reviewing such examples may be tedious and unhelpful to those of us surviving, as the tools and opportunity to perform gram stains, cultures and sensitivity testing may not be practical.

On a final note, in addition to my specialty specific text books, Harrison’s Internal Medicine being the most well known of the comprehensive ones, I also keep for emergency/survival scenarios copies of Auerbach’s Wilderness Medicine and Goldfrank’s Toxicologic Emergencies as well as DOD field manuals. Those two books are rather thick and heavy, so may be worth reading through and pre-positioning at the bug out site, or having at the site for the designated medical officer of your group. There is a field guide version of Wilderness Medicine which is easier on the wallet. The Washington Manual General Internal Medicine is another portable resource which should be excellent for your group’s medical officer. Medical libraries at medical schools and hospitals often have second hand sales of books that are outmoded by new editions and lightly used copies of these books can sometimes be found at bargain prices there. OBTW, other medical books at these sales can also make very convincing “book safes” if one has glue, sharp instruments, and time on one’s hand.

In parting, common sense is essential, but it isn’t a substitute for medical experience and training. Make sure your survival group has at least one experienced medical person, be they medic, physicians’ assistant, ARNP, physician or surgeon. The life they save may be your own! – Dr. G.