Dear Mr. Rawles:
I recently read through the cluster of articles regarding preparation measures for antibiotic storage and use on your blog, starting with A Doctor’s Thoughts on Antibiotics, Expiration Dates, and TEOTWAWKI, by Dr. Bones. As the medic for my family resilient survival group and an EMT paramedic, I have learned of some resources relevant to this discussion that will be useful to your readers.
The first is the Sanford Guide. This is a book used daily by physicians and other healthcare providers worldwide to assist with empiric antibiotic treatment of infectious diseases. Empiric therapy means that you’re not sure exactly which bug is causing the disease, but based on the location of the infection and other characteristics (like patient age and other illnesses), you can make an educated guess about what antibiotic you should choose. This is akin to going hunting and not knowing exactly which guns to use, but since you are in a farmer’s field or marsh, for example you might expect to run into birds instead of deer and so you bring a shotgun with birdshot instead of a slug gun or rifle.
There is a similar book published by Emergency Medicine Residents Association but this is expensive and hard to find. I have found Sanford Guides in used bookstores in bigger cities. The knowledge in these books changes slowly, so a copy that is two or three years out of date will probably be fine for most purposes. You can also web-search “empiric antibiotic therapy” and surf away.
This brings up the issue of the meds Dr. Bones lists (Z-packs, Amoxicillin or Keflex.) These are not great for diarrhea, but are narrow spectrum drugs that may help some skin and respiratory infections. If you are going to the trouble to get antibiotics and keep them on hand, consider that you either need a big stable of “narrow spectrum” drugs or a smaller, appropriate group of a few “broad-spectrum” drugs.
Mel Tappan wrote a lot about the need for having a selection of useful guns that are relatively specific to given tasks. You could think of antibiotics in the same manner, having a drug for each type of infection. Getting adequate coverage for a wide range of diseases would be more logistically challenging and terribly costly than a few broad-spectrum drugs. You might instead choose to have a “formulary” of a few drugs that should cover most of your needs. Unfortunately, some of the antibiotics recommended by Doc Bones and others seem limited in their utility for serious infections.
The formulary approach was suggested in a recent book entitled “When There Is No Doctor”. I would make one change to this author’s list, adding moxifloxacin in place of levaquin; I base this on the fact that “moxi” (brand name Avelox) has been put in the “combat pill pack” of front-line combat troops in the Sandbox: they are told take a moxi pill (which covers gut bugs, skin bugs, MRSA etc.) for any open wound while waiting for evac. It is absorbed almost as well as an IV dose. In short, moxi covers a broader spectrum than levaquin and cipro, which are in the same family.
Regarding obtaining and choosing antibiotics, another resource is the “Orange Book”. Published by the FDA, this book is really the only source I could find that talks about the effectiveness and safety of generic formulations. It has been mentioned in a prior post in SurvivalBlog, and allows you to search by drug name, ingredient or maker.
Basically, when you find a generic drug, you can check in the Orange Book to see if the generic manufacturer’s formulation tests like the more expensive brand formulation. The tests are not too sophisticated, and the FDA is hoping that looking at how a drug looks and behaves (in simple tests like dissolving in water) compared to the brand-name drug it is copying. Bare bones, but I’m told other testing would be way to expensive.
I would almost never use medicines made for animals on humans, and I think you should look very seriously into the safety of this. As an example, I can’t find the “fish-mox” nor any of the other fish drugs Doc Bones mentions in the Orange Book by its manufacturer, which I consider the minimal safety check. I do this check when thinking of getting drugs from overseas, too. Dr. Doyle covers some of the other safety concerns in these alternative approaches to obtaining medicines in the book mentioned above.
Start, within the limits of OPSEC, with your own doctor, dentist, Nurse Practitioner (NP) or Physician’s Assistant (PA). Be aware, though, that if you ask your doctor for specific medications by name, he/she will (a) wonder what you’re up to and (b) likely be less willing to do this. If you are honest, and aren’t asking for narcotics, you might stand a better chance. Disaster prep is coming more into vogue, at least among many of the docs I work with in the ER now, anyway, because of the recent H1N1 ramp-up.
Finally, I heartily concur with the suggestion of getting as much training as you can. I worked with a surgeon who stated he could train a monkey how to operate in two years, but it takes much longer to train people when to operate. Having a few fish tank drugs won’t do a lot for some conditions, and you need to know what you’re treating. More importantly, you need to know when to expend your precious resources, especially when re-supply may not be coming anytime soon.
One last resource to help with deciding when to treat is the CDC antibiotic usage guidelines, published for things like upper respiratory infections, sore throats and bronchitis. We all love to leave the doc’s office with a prescription but after TSHTF we need to be much more realistic.
Medical Corps and other courses are good for this kind of training, although I hope to attend a physician assistant school in the future. I’m too old and have too many family commitments for medical school, but being trained in two years as a PA will allow me access to much of the same basic knowledge while being afforded the opportunity to learn on actual sick and injured patients rather than just “book learnin’” the theory. Regards, – Ron L.