Monday, 28 December 2015

07:56 – One of the most frequent prepping-related queries I get has to do with antibiotics: Are animal antibiotics safe for human use? Are antibiotics safe to use after their “expiration dates”? Which specific antibiotics should I store, and how should I store them? And so on.

First, I’ll emphasize that I’m not a physician or pharmacist. What follows is just my own opinion, so take it for what it’s worth. But fish and bird antibiotics sold by companies like Thomas Labs are apparently identical to the same antibiotics labeled for human use, right down to the capsule colors and identification numbering. They almost certainly come from the same manufacturing plants in the same batches. So, yes, in my (very) qualified lay opinion fish/bird antibiotics that are also sold for human use are safe to use in humans. I’ve done titers/assays of several of several of these drugs in human versus bird/fish forms and found that activity levels are within allowable limits. There’s probably more variation from one batch to the next than there is in human versus animal forms.

As to expiration dates, the federal government has required them since the late 70’s, but like food best-by dates they’re pretty meaningless. Numerous rigorous studies have determined that these drugs remain safe and effective for years or decades past their “expiration dates”, and that’s when they’re stored at room temperature. Frozen, their useful lives are essentially unlimited. All those dates really mean is that the manufacturer doesn’t guarantee anything if the drug is used after the date on the label.

Back in the early 60’s, there were some problems with toxicity in outdated tetracycline, but that appears to have been a manufacturing issue that was soon resolved. As best I can determine from an exhaustive literature search, tetracyclines produced in the last 50 years or so have not exhibited toxicity when used after their expiration dates. In an emergency, I wouldn’t hesitate for even a millisecond about using 20-, 30-, or 40-year old antibiotics, particularly if they’d been stored frozen. In a long-term emergency, having any antibiotics available may well mean the difference between life and death.

As to which antibiotics to store, it’s a question of depth versus breadth. I’d love to have a thousand courses of a dozen different antibiotics available, but that’s simply not practical in terms of cost, storage space, and so on. For most people, the best option will be to have a lot of a few antibiotics and a little of several others.

The trick is to decide which classes of antibiotics to store in quantity, and which member of each class. For example, unless you or someone in your family has a penicillin allergy–and maybe even if someone does–you’ll probably want to store larger amounts of β-lactam antibiotics (penicillins, cephalosporins, and carbapenems). Within that class, there are dozens of specific antibiotics, including penicillin itself, amoxicillin, ampicillin, various generations of cephalosporins (Keflex, etc.) and so on. Broadly speaking, most antibiotics in a class have similar spectra, and differ mainly in things like dosage frequency and amount, and so on. One member of the class may be the preferred option. For example, doxycline is the first choice for treating Lyme Disease, but other tetracyclines are also active against that bacteria. In other words, if you find yourself without doxycycline but have tetracycline or oxytetracycline, you can generally substitute one of them successfully.

Drug resistance is also an issue, and one way of dealing with it is to use combinations of drugs. For example, resistance to amoxicillin is so widespread that many physicians now treat it almost as a placebo. But many bacteria that are resistant to plain amoxicillin can be treated successfully with a combination of amoxicillin and potassium clavulanate (AmoxiClav). Similarly, many bacteria that are resistant to plain sulfa drugs can be treated with a combination such as SMZ/TMP (sulfamethoxazole/trimethoprim). Unfortunately, with the exception of SMZ/TMP, most combinations are not sold for bird/fish use. Still, these are the versions that you really want.

Still another issue is the chemical form of the drug. Antibiotics sold for veterinary use are not necessarily usable for humans because of differences between species. For example, penicillin G potassium in oral form is widely used by vets to treat infections in cattle, sheep, goats, horses, and so on. It works great in ruminants and horses because their digestive systems work on cellulose and other plant matter. In humans and other carnivores/omnivores, penicillin G potassium can’t be used orally because our stomach acids destroy the drug before it can be absorbed. (Regardless, I keep a large amount of this antibiotic on hand, because it can be used successfully in humans if administered by injection, retention enema, or suppositories.) For some forms of some other antibiotics, the issues are similar. For example, erythromycin for use in livestock is usually supplied as the phosphate salt, which is also destroyed by human stomach acid. Erythromycin intended for oral use in humans is supplied either in enteric-coated form or as the stearate salt, which is resistant to stomach acid. But again, the phosphate salt can be used successfully in humans via injection or by retention enema or suppositories.

So, which antibiotics should you stock in larger quantities? I’d recommend at least a couple of full courses of each of the following, more if you’re prepping for more than just a couple of people:

  • Amoxicillin/clavulanate – Buy 875/125 mg capsules. In adults, a typical course of treatment would be one capsule every 12 hours for 10 days, so you’d need 20 per course. Because Amoxiclav is much more expensive than plain amoxicillin, you might want to modify the course to five days of Amoxiclav at 1,000 mg twice a day followed by five more days of plain amoxicillin at 1,000 mg twice a day.
  • Sulfamethoxazle/Trimethoprim (SMZ/TMP) – Buy 400/80 mg or 800/160 mg tablets, which can be split. In adults, the usual course is one 400/80 mg tablet twice a day for ten days.
  • Metronidazole – Buy 400 mg tablets. Metronidazole is effective against many bacteria, particularly anaerobes, as well as many protozoa like giardia. Adult dosage amounts and frequencies vary with the disease being treated, but a typical dosage is a total of 2,000 to 4,000 mg per day, divided into three or four doses, for five to ten days.
  • Ciprofloxacin – Buy 500 mg tablets. Typical adult dose is 500 mg twice a day for seven to fourteen days, although some serious diseases like anthrax require that dosage for 60 days or more.
    Which should be enough to get you started.


41 thoughts on “Monday, 28 December 2015”

  1. I like the fact that the source you linked to advertises that:

    “All aquarium products are imported from countries that DO NOT wish to destroy us!”

    Sounds like my type of guy.

  2. I’ve done titers/assays of several of several of these drugs

    That’s why we love you, Dr. Bob. I hope this is just a sampling of what will be in your book. Fantastic post by a true scientist. I cannot wait for this book. I hope you also offer supplemental material for download.

    Keep up the good work, sir!

  3. Is there a loaded machine gun in every closet in Switzerland? I had that impression at one point, just like Israel and Sweden.

    I can’t speak to other countries, but here it’s a lot less extreme than that. First, even though it’s a militia system, only about half of young guys wind up doing military service; the others do some sort of civilian service, have health problems, or whatever. Those who do go through the military are allowed to keep their military rifle permanently. I expect that most of those rifles have years of dust on them in the back of some closet.

    Part of the problem is that there just aren’t many (any?) open shooting ranges. There are lots of shooting clubs with ranges, but you have to join the club. And lots of those are specialized – the closest one to me practices competitive target shooting and only allows specialized .22 target rifles on their range. Anyhow, I don’t want to join yet another club (I already belong to two). Clubs are formal things here: if you join, you are expected to participate regularly – casual members are generally not welcome.

    With my youngest now in military service, I hope seriously that he will find us a local place to shoot when he gets out. There has got to be one, but my few attempts have all wound up in dead ends.

  4. Just went to the Social Security office to apply for Medicare as I will be forced to participate in about three months. Talk about some dregs of society. Most on some sort of disability, moms with a couple of kids in tow. Disability only because they found some lame excuse to not work (hurt their back at work which is hard to disprove). Fat as hell so apparently they get paid enough to spend a lot on food. Probably collecting welfare at the same time while they search for the true father of their children through the many “social” contacts they have encountered every Friday and Saturday night at the local bar.

  5. “Fat as hell so apparently they get paid enough to spend a lot on food.”

    They don’t know it yet but they’re being fattened up for those rusty truck-axle BBQ spits. Long pork fed for decades on Cheetos, Krispy Kremes and frozen tee-vee dinners.

  6. Render the fat and burn the oil in our lamps.

    The meat, marbled, but fat is not tasty.

    nick

  7. For example, doxycline is the first choice for treating Lyme Disease, but other tetracyclines are also active against that bacteria. In other words, if you find yourself without doxycycline but have tetracycline or oxytetracycline, you can generally substitute one of them successfully.

    Are you using Doxycline for Doxycycline?

    Doxycycline is also good for PLC (Pityriasis Lichenoides Chronica). I have had PLC about ten years or so and have been in remission for about 6 years now. I take 50 mg/day of doxycycline just as a preventative measure as my doc is very concerned about it coming back. I used to take tetracycline but it went off the market for a couple of years back in the late 2000s.

    My daughter just started taking doxycycline again yesterday as her Lyme disease came back for the 4th or 5th time (we’ve lost count over the four years). She was clear of the Lyme disease for five months this time. She takes 2,500 mg/day and can stand that amount for roughly six weeks, then her doc will switch her to amoxicillin until her numbers go down again.

  8. From Jerry Pournelle’s link to the Guardian article on robots taking over the world:

    “Yet it’s not necessarily the low-paid jobs that will be affected – nor the high-paid ones that will be safe. The World Economic Forum published a graphic in November as part of an analysis into robots and jobs which suggests that chief executives’ jobs are probably safe – but so are those of landscaping and groundskeeping workers, despite an order of magnitude difference in their hourly payments. The emerging consensus, such as it is, seems to be that jobs requiring careful human-to-human contact – hairdresser, surgeon and so on – should be safest from the robot insurgency.”

    In other words, land baron royalty and armies of serfs and slaves. Haven’t we seen this movie before? And I’d rule out surgeons, too; surgery will be done by robots also, at least for any remaining prolecube drones and vitally necessary gardener-specialists. Also Mengele-type experiments. Actual human surgeons will be reserved for the royalty.

    What’s funny, of course, is that along with the rest of us useless eaters too unfit anymore for landscaping, gardening and hairdressing, will be all the SJWs and Progs and lefty ass-hats. Machines won’t differentiate and will cull the herds accordingly.

  9. I wonder if there will be “minority” robots seeking reparations from WHITEY! I’m looking for a robo-dachshund if you come across one.

  10. Merry Christmas from Samuel “MoFo” Jackson:

    He said that he had hoped the California attacks were carried out by some ‘crazy white dude’ because they had damaged the perception of Muslims.

    Kill WHITEY!

  11. What about antiparasitics? Is there a good “broad spectrum” one to keep on hand?

  12. I sure do hope that this page is in your book. BTW, you mentioned allergies. I am allergic to penicillin and keflex, should I stay away from any of these drugs listed above? My son is allergic to penicillin also, that really complicated their treatment of his ills in the USMC.

  13. I’ll echo Mr. Lynn on how much detail there will be on drugs in the book of books.

  14. I’ll be more than happy to include footnotes on hallucinogens though the only use for them during SHTF stuff would probably be limited to pain treatment, i.e. being so “out there” that one completely forgets one has any pain.

  15. I’ll be more than happy to include footnotes on hallucinogens though the only use for them during SHTF stuff would probably be limited to pain treatment, i.e. being so “out there” that one completely forgets one has any pain.

    Don’t they just use a shovel upside the head or something like that in the sticks? Oh wait, your old american lauger!

  16. I would have had to suck on a hose from a tanker truck full of shitty Murkan lager and the only buzz would come from fatigue and hyper-ventilation, probably.

    For a real kick sometime, try 1,000 mg of lysergic acid dipthalimide. Be in a safe place with a trusted pal close by.

  17. Are you using Doxycline for Doxycycline?

    That got garbled, right? I think you meant to ask if he was using doxycycline for his doxies.

    with a trusted pal close by

    That would be, um, no one on the face of the planet.

    Talk about some dregs of society.

    I was going to ask which side of the counter at the SS office the dregs were on, but then you clarified.

  18. “That would be, um, no one on the face of the planet.”

    True, that, now. But not so 46 years ago.

  19. I remember some years ago a news piece about two grad students at Georgia Tech who were making Phencyclidine {PCP, or angel dust} in a more pure form than the pharmaceutical company that made it as a veterinary anesthetic. That would be a really useful skill / recipe to have in any situation where the DEA wasn’t a factor.

  20. Just being able to make use of the poppies that grow natively here would be nice. But that knowledge has been systematically suppressed. (if you believe the stories.)

    nick

  21. I sure do hope that this page is in your book. BTW, you mentioned allergies. I am allergic to penicillin and keflex, should I…

    I would rather suggest that our host avoid topics like this. He isn’t an MD, and shouldn’t pretend to be one. Once you get into serious medical knowledge, you are beyond the realm of normal preparedness. It quickly becomes a topic for specialists. An MD would be a welcome addition to an prepping community, and one hopes that the MD’s library survives with him.

  22. I absolutely love the C130. Like the M2, they got the basic design _right_ the first time. Is there anything this plane cannot do? I have seen it configured as a troop transport, troop delivery, in-air fueling, ground support gunship, forest fire water delivery, and vehicle transport. Never heard of this:
    http://worldwarwings.com/hercules-is-the-only-plane-in-history-to-do-this
    I would note that these landings were apparently done during calm seas. Rough weather would make this a lot harder.

  23. I would rather suggest that our host avoid topics like this. He isn’t an MD, and shouldn’t pretend to be one. Once you get into serious medical knowledge, you are beyond the realm of normal preparedness. It quickly becomes a topic for specialists. An MD would be a welcome addition to an prepping community, and one hopes that the MD’s library survives with him.

    As I said, I’m not a physician or a pharmacist, and I’m not offering medical advice. But in an emergency, one does the best one can. Would I like to have an MD in my group? Sure. Anyone would. Or, lacking that, a veterinarian, RN, or EMT. But we don’t always get what we want, and even if we have people with medical skills, they need drugs and may not have them. So I stock various drugs in addition to food, water, firearms, etc., and I recommend that others do the same. I also recommend keeping medical reference books available: PDR, Merck Manual, Ship’s Medicine Chest, Where There Is No Doctor, etc. etc.

  24. @RBT: No question, stocking basic drugs makes a lot of sense. It was crossing over into drug allergies, etc. , where I think you should draw the line. That’s getting very specialized, and is also an area where a bit of wrong advice opens up all sorts of liability questions.

  25. @JimL – I agree with your points on the C-130, unfortunately not reproducible with today’s regulations and bureaucracy. Take a look at a generalization of just a few of the things we did in WW II: (1) went from concept to thousands of planes in battle (I am partial to the B-17 that my Dad flew (2) several of our shipyards produced a ship-a-day (3) we made the atomic bomb.

    Today it takes about 10 years just to get the environmental impact statement approved.

  26. Most of the planes the US used in WW-2 predate our entry or were in development when it started. That said, the procurement regulations back then were a lot shorter and easier to meet. Heck, the specs for much of what the Skunk Works developed (U-2, SR-71) were one page long. And during wartime, a lot of the regs go out the window – the special forces have had procurement contract with LockMart that allows the operators to call LM and have anything up to a fairly high dollar limit bought without bids. LM buys it and has it delivered to where it’s needed ASAP. Need some new civilian pistol to try out? They can get it.

    As for the Herc landing on the carrier, they did a number of off-the-wall tests back then. One of my favorite: flying a U-2 off a carrier. https://www.youtube.com/watch?v=L8HMPMYL19E IIRC, this was only declassified in the late 90s, as there had been a few operational missions using them off a carrier.

  27. I had some fun times on AC-130 Spectre gunships, as the very junior baby gunner working with senior NCOs, some of them WWII and Korea vets. They called me the kid, at 21 then, while my subordinate clowns thought of me as an old man. I never saw this personally, but I have seen videos of a gunship with a howitzer mounted in it taking vary accurate shots through specified building windows.

    “I jumped out of a C130 twice. Airborne!”

    Now why would anyone in their right mind jump out of a perfectly good airplane?

    I never jumped, but did slide down lines and rappelling from choppers in support of AF pararescue guys a few times. Under fire, which sucks unbelievably.

    Steady light snow here overnight and all day so fah; about four inches of heavy wet stuff followed by freezing rain and ice. We ain’t going anywhere and I’m here again with G-Grandma and Mrs. OFD for now. Stress here has gone WAY down since Princess finally left with our one good vehicle yesterday.

  28. I’m proud to say I’ve never landed in one. Taken off a few times.

    “Now why would anyone in their right mind jump out of a perfectly good airplane? ”
    OR
    “Only 2 things come out of the sky – bird poo & fools”.
    Heh.
    Because it scares the crap out of you, and if you can face your fears, you’ve learned something about yourself.

  29. OFD: Did you see that story about the test pilot that thought it would be cool to roll a AC-130J during a test flight? He didn’t kill his crew, but he overstressed the airframe to the point that the aircraft is a total loss. I’m guessing that $115,000,000 mistake is the end of some officer’s career.

  30. I jumped out of a C130 twice. Airborne!

    I’ve jumped three times from airplanes. I had a good parachute two times.

    (The third time, the pilot chute came out, and that’s all. I responded perfectly, rolling and deploying the reserve chute. When I was a hundred or so feet up, the main chute came out, rolled up like a streamer, and whipped around the reserve’s shrouds and collapsed the chute. I hit like a rock. Walked away, though.)

  31. “OFD: Did you see that story about the test pilot that thought it would be cool to roll a AC-130J during a test flight?”

    No, never heard of that one; very bad call on his part. They’re big slow buggers not designed in any way, shape or fashion for 1920s-style barnstorming shenanigans.

    “I hit like a rock. Walked away, though.”

    Cue up that old Bob Seger song used in the Chevy commercials; you lead a charmed life, hombre….

  32. you lead a charmed life, hombre….

    I’m pretty tough. I tell most people that I’m the toughest person you’re likely likely to meet. Won’t tell you that, nor myself, because we used to run with Green Berets and SEALs.

  33. I’m just an old, decrepit, disabled veteran, hair and teeth falling out, borderline high BP, barely able to go up and down stairs. I spend my retirement days fiddling with radios and reading military history and listening to classical music. I’m no threat to anyone.

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