(Continued from Part 1. This concludes the article.)
My thoughts on the kit, it is a good grouping of valuable broad-spectrum antibiotics. I would like to store larger quantities. I think the kit could be purchased cheaper through a local Doctor/Pharmacy if available for you.
A good emergency antibiotic kit should include the previous mentioned drugs; Augmentin 500mg or 875mg, Azithromycin 250mg Z-pack, Ciprofloxacin 500mg tablets, Doxycycline 100mg, and Metronidazole 500mg.
I would add:
Amoxicillin 500mg capsules; a broad-spectrum antibiotic, easier on the stomach than Augmentin, good for dental infections, and upper respiratory infections, pneumonia, usual dosage is 500mg 3 times a day for 10 days.
Clindamycin 150mg capsules; a gram negative, more specialized antibiotic if drugs like Amoxicillin fail. Good for bacterial infections, strep throat, dental infections, given with Quinine Sulfate for Malaria. Usual dosage is 150mg to 300mg every 8 hours for 10 days.
Cephalexin 500mg capsules: a good broad-spectrum antibiotic works well with skin infections, or wounds. A good follow up after a dose of IM Rocephin 500mg mentioned in Dr. Forgey’s kit. Bacterial infections dosage is 1000mg every 6 hours, strep throat 500mg every 12 hours x 10 days, UTI 500mg every 6-12 hours for 3-7 days, Skin/sutures infections 250mg to 500mg every 6 hours for 5-7 days.
Cefadroxil 500mg capsules or Cefdinir 500mg: A good substitute for Cephalexin, same indications, but dosed 500mg every 12 hours for 7-10 days, requiring less quantity for each round of therapy.
Topical antibiotics
No kit would be complete without a supply of topical antibiotics. Triple Antibiotic Ointment with pain relief is my go-to choice. It is OTC and cheap. An RX example of a topical antibiotic is Mupirocin 2% ointment, a good choice if a patient is allergic to Neomycin one of the ingredients in Triple Antibiotic Ointment. Dosage is 3 times a day for 7-14 days.
While Dr. Forgey recommended Tobramycin/Dexamethasone we use a lot of Neomycin/Polymyxin/Dexamethasone which comes in a 5ml suspension. Dosage in ears is 5 drops in affected ear(s) twice daily for 7-10 days, dosage for eyes: 1 to 2 drops in eye(s) every 4-6 hours x 5 days. It also comes in an eye ointment.
More Topicals:
Triamcinolone 0.1% cream & ointment; a good cheap all around steroid cream, not as strong as Dr’s recommended generic Topicort, but stronger than OTC Hydrocortisone 1%. Usual dosage is apply 3 times a day.
Clotrimazole/Betamethasone Cream; a good combination of antifungal and steroid cream, good to treat the common fungus associated with poor hygiene especially after the ‘crunch’. Usual dosage is twice a day for 2 weeks.
Nystatin cream and powder: Also good for yeast and fungus, apply 2-3 times daily
SSD 1% (Silver Sulfadiazine) Cream; The gold standard for 2-3rd degree burns, maybe one of the most important RX creams to have. Usual dosage is a thin layer (don’t rub in) applied twice a day.
Cyclobenzaprine 10mg tablets, Tizanidine 4mg tablets; These are RX muscle relaxers, usual dosage is 1 tablet 3 times a day. Anyone that works outside or lives on a farm knows how valuable these can be.
Meloxicam 15mg tablets, Celecoxib 200mg capsules; These are potent NSAID drugs more powerful than Ibuprofen, for pain and inflammation. Meloxicam is dosed once a day, and Celecoxib can be once or twice a day.
OTCs to consider for your kit
Topical Pain:
Lidocaine 4% this comes as a cream or in patches.
Trolamine Salicylate 10% cream
Antihistamines/Allergies:
As mentioned by Dr. Forgey you want to include Diphenhydramine, probably the best for an allergic reaction either bee sting or plant. I would consider Loratadine 10mg and/or Cetirizine 10mg both would be daily medications for seasonal allergies like Ragweed or dog or cat allergies. Both are cheap and available in very large quantities. Fluticasone nasal spray is a nasal steroid that can give relief of seasonal allergies. Zaditor (Ketotifen) Ophthalmic drops are good for eye allergies.
Cough/Cold:
Robitussin DM (Guaifenesin & Dextromethorphan) Syrup or Mucinex DM or generic tablets; a basic cough suppressant and expectorant. Delsym cough syrup is dosed twice a day, lasts longer. A stockpile of cough drops might come in handy if you are in a situation that a cough might compromise your position.
Have a good blood pressure machine and pulse ox device.
Topical antifungals:
If the ‘crunch’ is anything like 2 weeks of Boy Scout camp, we will need to stock up on topical antifungals like Terbinafine cream, Clotrimazole 1% cream, Miconazole 2% cream, Gold Bond powder are all products that can help. A fungus likes to grow in dark damp places, so keep the area open to the air, and dry and clean. Fungus take a long time to kill, apply several days after the rash is gone to make sure it is dead.
Vaginal & UTI products:
Keep in stock some vaginal cream like Miconazole, and some urinary relief tablets with the ingredient Phenazopyridine. Don’t forget tampons.
Stool softeners/Laxatives:
I recommend Senna-S or sometimes called Senna-Plus, it is a combination of a vegetable laxative Senna, and a stool softener Docusate. Stocking some Bisacodyl (Dr. Forgey’s recommendation) and Docusate Sodium (DSS) a stool softener would be more complete. Consider a Fleet Enema also.
First Aid supplies:
Everyone knows to stock up on gauze, flex wrap, and Band-Aids, here are a few more items. Newskin, Poison Ivy treatments like Domeboro, Hydrocortisone 1%, Tecnu Ivy cleanser (after exposure), Steri-strips (I found them work better than butter-fly bandages and easier than stitches). Nex-Care wrap, self-adhesive, Epsom salts, Betadine, Hibiclens, plenty of gloves. Don’t forget the Acetaminophen and Ibuprofen.
Vitamins to consider:
Everyone has their personal choice on vitamins, here are a few everyone should have based on humanity’s need for them in the past. Vitamin C 500mg, Vitamin B Complex.
Personal Hygiene:
Soap, shampoo, deodorant, tooth paste & brushes should all be included.
Be sure to pick up a quality pill cutter, many of the strengths I suggested require precision cutting to get the correct dose.
Forming your own ‘post-crunch’ clinic with like-minded health-care professionals would be a life saver for those around it but would be a huge endeavor to set up. Here is a list of common RX medications we dispense (non-controlled) that would represent common drugs used by a clinic. In addition to the drugs mentioned above, I would consider stockpiling the following:
Eliquis 5mg tablets: Used to treat thromboembolism/stroke prevention, dosage 5mg twice a day. DVT/PE prophylaxis: 2.5mg twice a day. (very expensive)
Losartan 100mg tablets: Used to treat high blood pressure, in 25mg, 50mg or 100mg once daily.
Lisinopril 40mg tablets: Used to treat high blood pressure, in doses of 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg once daily.
Pantoprazole tab 40mg: Used to treat GERD, Hypersecretory conditions, in 20mg, 40mg usually dosed once a day, may be dosed 40mg twice daily with hypersecretory conditions.
Furosemide 40mg tablets/Potassium Cl 10meq tablets: A common diuretic with the needed potassium supplement to treat edema, usually dosed 20mg to 80mg daily with 10-20meq potassium.
Tamsulosin 0.4mg capsules; Used to treat prostrate issues, BPH, dosage is 1-2 capsules daily.
Wellbutrin (Bupropion Hcl) 150mg XL tablets; A common drug to treat depression and will help with smoking cessation. Usual dosage 150mg to 300mg once daily (don’t crush or cut).
Gabapentin 300mg capsules: This drug was originally indicated for seizures, but now is mainly used for neuropathic pain. Can be dosed very high, seizures dosage & neuropathic pain is 300mg to 1200mg 3 times a day, Fibromyalgia is 400mg to 800mg 3 times a day.
Clopidogrel 75mg tablets: Could be used as a low-cost alternative to Eliquis, or once the patient is tapered off Eliquis. Acute Coronary Syndrome dose is 75mg daily with 81mg aspirin. Thrombotic event risk reduction dosage is 75mg daily.
Levothyroxine 100mcg tablets: Used to treat hypothyroidism in dosages 25mcg to 200mcg daily. Picking one strength and using a pill cutter allows more the clinician some options when available is limited.
Metoprolol 50mg ER: A beta-blocker with many indications, one of the few ER tablets that are scored and can be cut for dosing. Hypertension dosage is 50mg to 200mg daily. Angina is 100mg to 400mg daily. Heart Failure is 200mg daily. Atrial Fibrillation is 50mg to 400mg daily or twice daily. Migraine prophylaxis is 50mg to 200mg daily.
Albuterol HFA inhaler: A common rescue inhaler. Usual dosage is 1-2 puffs inhaled every 4-6 hours.
Metformin 500mg tablets: Once insulin is gone, type 1 diabetics (need insulin to live) and some type 2 diabetics that can’t control their diabetes without insulin, won’t be with us any longer. Metformin is cheap, available in 1000ct bottles, it could allow some diabetics to survive without going blind, having heart or kidney complications.
Diflucan (Fluconazole) 150mg tablets: Used to treat vaginal candidiasis with 150mg once or daily for 3 days. Very effective and cheap. Should be stocked with your antibiotics.
The reader may wonder, I am not opening a clinic, and not a health care professional, just a small family with children. What should a family with children stock?
Adult antibiotics and topicals listed above, but include:
Amoxicillin 400mg/5ml 100ml bottle, Bacterial infection dosage for 0-3 months old is 20-30mg/kg/day by mouth in divided doses every 12 hours. Max is 30mg/kg/day. Dosage for over 3 months is 25-45 mg/kg/day by mouth in divided doses every 12 hours. Acute Otitis Media dosage is 80-90mg/kg/day by mouth every 12 hours for 7-10 days.
Cefdinir 250mg/5ml 60ml, Bacterial infection dosage is 6 months to 12 years 14mg/kg/day by mouth in divided doses every 12 hours (max 600mg/day). Otitis media, acute dosage is 6 months to 12 years 14mg/kg/day by mouth every 12 hours for 7-10 days (max is 600mg/day)
Cephalexin 250mg/5ml 100ml dosage for bacterial infection is 25-50mg/kg/day by mouth in divided doses every 6-12 hours. Dosage for strep throat is 40mg/kg/day by mouth every 12 hours for 10 days. UTI dosage is 25-50mg/kg/day by mouth divided every 12 hours for 7-10 days, may also be given every 8 hours.
These are powdered antibiotics that are mixed with water before dispensing. Ask your pharmacist to dispense them unmixed, with the mixing directions visible. That way the original expiration date will be valid, and you can mix them when needed. A graduated cylinder or measuring device may be needed for the correct measurement of distilled water. 1kg is 2.2 pounds, so you will need to do some math, remember the daily dose is one calculation, and the mg per dose is another calculation since the dosage is more than once a day.
Neomycin/Polymyxin/Dexamethasone eye/ear drops mentioned above, good to have on hand for children. Another is Ofloxacin 0.3% 5ml dosage is 1 drop in affected eye(s) 4 times a day for 7 days, 5 drops in affected ear(s) twice daily for 7 days.
Stock up on a quantity of OTC Ibuprofen liquid and Acetaminophen liquid, and a cough syrup like generic Robitussin DM or Delsym. If you child has ear tubes or is often sick and, on a medication, not listed, stock up on that one. The above along with the topical antifungals, antibiotics and topical steroids (listed above) will cover most children’s needs. Keep on hand a good supply of multi-vitamins, and vitamin C.
In Closing
I will close with a few thoughts on controlled substances. There are many patients that take controlled substances daily. These will disappear the fastest. Most pharmacies have a very low stock of controlled substances, the DEA since the ‘Opioid Crisis’ has really cracked down on the manufacture, wholesale distribution to pharmacies, and the pharmacies distribution to the patient. Quite simply the DEA won’t allow the wholesaler or the pharmacy to stock up on these drugs. They are even limiting the manufacturers. That is why you see so many shortages in December. So, in the event of a crisis in just a day or less they will be gone, without resupply.
The reason they are controlled is because they are addictive. For people that are serious about long term prepping, a different solution must be your plan. Being addicted to a drug that you can’t get or really can’t stockpile will be a problem. Solutions might be weaning yourself slowly off the pain pills and substituting Acetaminophen or Ibuprofen. Having the surgery, you have been putting off, instead of relying on pain pills to manage the symptoms. Weaning off the benzodiazepine like Xanax (Alprazolam) and substituting Hydroxyzine, Buspirone, or Diphenhydramine.
Learning non-drug ways to manage stress and anxiety
Alcohol has been made by humans for centuries, long been used as medicine. We have all seen the westerns wear the guy getting his tooth pulled takes a couple of shots of whiskey first (for pain relief). Substituting one vice for another might not be sound advice, but at least you could make it during the ‘crunch’ if you stockpiled the needed materials.