So, You Bought Fish Antibiotics. Now What?, by TX ER DOC

First, the disclaimers:  Nothing in this article constitutes medical advice.  It is for information purposes only.  It is not meant to diagnose or treat any disease.  Fish antibiotics are not for human consumption.  Never take any medication that was not prescribed specifically for you by your physician.  Hopefully, this information can help you be a more informed and involved patient.  Short of a true post-SHTF scenario, I strongly advise you not to self-diagnose and treat.  (Health care professionals are especially notorious for doing this.)  I have seen significant harm come to many patients because of this.  Recently, someone killed off their kidneys because they took cow doses of antibiotics.  As long as doctors, nurses, and other providers exist, please use them!  I say this not to drum up business (believe me, if anything I want less business in my emergency department), but rather for concern for the significant harm that I have seen happen to patients time and again.

I have just received my order of fish antibiotics.  (For my fish, of course!)  As a physician, I could easily hit up one of my colleagues to write me a prescription for any number of medicines.  So, why order fish antibiotics from the internet?  I live in a state with a medical board who likes to go on witch hunts for “non-therapeutic prescribing,” and I would not want to cause one of my co-workers to be the target of an investigation.  (This is a common reason your physician might not be too willing to prescribe medications for your personal preparations.)  Also, I was curious to see if they would come as advertised.

When the bottles arrived, I dug out my photographic drug reference and found that these are indeed the same pills that are given to humans, right down to the tablet color and markings.  It makes business sense.  It costs less for drug manufacturers to have one production line for each drug, rather than to build a separate process exclusively for veterinary medicines.  These are the same generic antibiotics that can be found on many pharmacy formularies on the “4 dollar” list.  They cost more to purchase as veterinary antibiotics, but are not prohibitively expensive.  (Please remember SurvivalBlog advertisers when shopping around.)

After checking my order, I placed the bottles in airtight bags and put them in the fridge.  The general consensus is that antibiotics will still retain most of their potency for years after their expiration date, especially if kept cool and dry.  The notable exceptions are tetracycline antibiotics, including doxycycline.  These can cause kidney damage if taken after their expiration dates.

The antibiotics I ordered were (US brand name in parentheses, if in common usage):
Amoxicillin (Amoxil)
Cephalexin (Keflex)
Metronidazole (Flagyl)
Clindamycin (Cleocin)
Ciprofloxacin (Cipro)
Trimethoprim/sulfamethoxazole (Bactrim, Septra)
Doxycycline
Erythromycin

Judicious use of antibiotics

First, we must know when not to use antibiotics.  When they become a precious commodity they will need to be used very wisely.  Many of the patients I see in the adult emergency department, and most of the patients I see in the children’s Emergency Department for various types of infections do not need antibiotics.

There is also a growing and very real danger with antibiotic resistance.  It is a very legitimate fear that we may use antibiotics to the point that they are no longer effective, at which point it will be just like it was in the pre-antibiotic age.

Also, antibiotics are not completely innocuous.  They have the potential to cause harm.  (All medicines do, including the “safe, natural” remedies.)  Allergic reactions are common, and the only way to become allergic to a medication is to be exposed to it in the first place.  Drug reactions are also very prevalent, and range from the annoying (e.g. rash, diarrhea), to the life-threatening (e.g. skin sloughing off in sheets, causing the equivalent of a bad total body burn.)

Most infections involving the nose, sinuses, throat, and respiratory tract are viral and will not respond to antibiotics.  Even some presumptive bacterial infections like otitis media (the common middle ear infection) will usually do just fine without antibiotic usage.  If you have one of the following, think twice before using your precious antibiotic supply:

Cold, cough, runny nose
Sinus pain or pressure
Bronchitis (coughing up phlegm)
Ear pain or pressure
Sore throat (there is debate about whether even strep throat needs antibiotics)

Obviously, this list is oversimplified.  For example, a middle ear infection can spread to the bone around it and cause mastoiditis.  The difference between a viral bronchitis (not requiring antibiotics) and a bacterial pneumonia (requiring antibiotics) can be difficult to distinguish.  Doctors, lab tests, and x-rays frequently get this wrong.  If symptoms persist for an extended period, or if you are getting worse, it may be more complicated than a simple viral infection.

When and how to use antibiotics

Which antibiotics to use is always a big subject of debate.  A roomful of physicians will seldom agree on the proper treatment of any disease, much less antibiotic use.  In fact, there is a medical specialty (Infectious Disease) in which physicians train for 5 years after medical school so they can run around the hospital and tell other physicians what antibiotics they can and cannot use.

If you are going to use antibiotics, remember some guidelines.  (Again, for information purposes only.)  Dosages are given in milligrams (mg).  Pediatric doses are given in milligrams per kilogram (mg/kg).  All dosing notations here assume they are taken orally.

What follows is a list of common diseases and the antibiotics that treat them, limited to the list available above.  Remember that there are many antibiotics, most of which are not listed here.

Pneumonia/bronchitis—doxycycline 100 mg twice a day for 7-10 days, erythromycin 500 mg every 6 hours, amoxicillin (more often used in children) 45 mg/kg two times a day for 10 days.  Ciprofloxacin can be used in conjunction with another antibiotic, but it is not commonly considered a “respiratory drug.”  Its sister drugs, levofloxacin and moxifloxacin, are, but are not available without a prescription.

Ear infection—adult: amoxicillin 500 mg 3 times a day for 7-10 days, children: amoxicillin 30 mg/kg 3 times a day for 7-10 days

Sinusitis—amoxicillin 500 mg 3 times a day for 10-14 days, doxycycline 100 mg twice a day for 7 days

Sore (strep) throat—amoxicillin 500 mg 3 times a day for 10 days (child 25 mg/kg two times a day for 10 days), clindamycin 450 mg three times a day for 10 days (child 10 mg/kg three times a day for 10 days)

Intra-abdominal infections (diverticulitis, etc)— ciprofloxacin 500 mg twice a day PLUS metronidazole 500 mg three times a day for 10 days

Infectious diarrhea—ciprofloxacin 500 mg twice daily for 5-7 days

Urinary infection—child-bearing age females without a fever who are not pregnant: trimethoprim/sulfamethoxazole 160/180 mg two times a day for 3 days, ciprofloxacin 250 mg twice a day for 3 days; pregnant female: cephalexin 500 mg twice a day for 7 days, amoxicillin 500 mg three times a day for 7 days; other adults: ciprofloxacin 500 mg twice a day for 7-10 days; children: trimethoprim/sulfamethoxazole 5 mg/kg twice daily for 7 days (this dosing is based on the trimethoprim portion, which is usually 160 mg per tablet)

Bacterial vaginosis—metronidazole 500 mg twice daily for 7 days, clindamycin 300 mg twice daily for 7 days

Skin infections— trimethoprim/sulfamethoxazole 160/180 mg (child 5 mg/kg) two times a day AND cephalexin 500 mg (child 6.25 mg/kg) four times a day for 7-10 days, clindamycin 300 mg (child 10 mg/kg) four times a day for 7-10 days, doxycycline 100 mg twice a day for 7-10 days. (Methicillin-resistant staphylococcus aureus, aka MRSA, is a consideration in all skin infections nowadays.)

Not common household diseases, but possible biological weapons:

Plague (Yersinia pestis) post-exposure prevention—ciprofloxacin 500 mg twice a day for 7 days, doxycycline 100 mg twice a day for 7 days
Anthrax (Bacillus anthracis) post-exposure prevention—ciprofloxacin 500 mg twice a day for 60 days, doxycycline 100 mg twice a day for 60 days

Caution!  Do not cause harm to yourself or others.

Beware of allergies.  If you are allergic to a medication avoid any drugs in its same family.  Some of the families are related, such as penicillins and cephalosporins.  Depending on where you read, there is a 2-10% cross-reactivity.  However, as long as the reported reaction is not serious (e.g. a simple rash when someone takes penicillin), I will often give cephalosporins to penicillin allergic patients.

Antibiotic classes:

Please note that these lists are not comprehensive:
Penicillins (“-cillins”): amoxicillin, ampicillin, methicillin, dicloxacillin
Cephalosporins (“cef-”): cephalexin, cefaclor, cefuroxime, cefdinir, ceftriaxone, cefepime
Lincosamides: lincomycin, clindamycin
Fluoroquinolones (“-floxacins”): ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin
Sulfa drugs (this is a very broad category, and includes many non-antibiotics): trimethoprim/sulfamethoxazole, sulfasalazine, dapsone
Tetracyclines (“-cyclines”): tetracycline, doxycycline, minocycline
Macrolides: erythromycin, azithromycin, clarithromycin

Not all antibiotics can be used across all patient populations.  Pregnant women, breastfeeding women, and children deserve special consideration.  Although some antibiotics should be avoided in certain patients, there is always a risk/benefit consideration.  For example, if my pregnant wife developed a life-threatening pneumonia, and all I had was doxycycline, I would give it to her and accept the risk to the baby.

Avoid in pregnancy:
Ciprofloxacin (Cipro)
Trimethoprim/sulfamethoxazole (Bactrim, Septra)
Doxycycline

Avoid in children and breastfeeding women:
Ciprofloxacin (Cipro)
Doxycycline

I recommend getting some good references, mostly in EMP-proof paper editions.  These can often be picked up for free, as local physicians shed their bulky paper medical libraries in favor of putting everything on a portable smartphone or tablet.  I picked up several copies of the Physicians’ Desk Reference this way.  I think it is aptly named because it is the size of a desk.  However, it sure is good fun to shoot with various pistol calibers to see how many pages they will penetrate.  For a more portable version, I like the Tarascon Pharmacopoeia and the EMRA Antibiotic Guide.  Many of the regimens listed in this article are referenced in these books.

Be wise, be safe.  Remember with all your preps, primum non nocere—“First do no harm.”

JWR Adds: Several or our advertisers sell veterinary and aquariast antibiotics. You will be amazed at the prices, versus the cost of human antibiotic doses.