Monday, 24 October 2016

09:54 – Barbara is off to the gym. This afternoon, she’s volunteering at the Friends of the Library bookstore, and tomorrow evening she’s volunteering at the annual library Quiz Bowl. Yesterday, her new friend JoAnne from the historical society stopped by with her husband, Jeff, and their son, Colin, who’s 15. They have roots in Sparta and have owned a vacation home here for 15 years, but they’re just now in the process of moving here from New Jersey to live full-time. Jeff is 55 and just retired as manager of a waste water treatment plant after a 33-year career in water treatment.

After numerous email questions to me and Jen’s husband, David (a veterinarian), Brittany has decided what antibiotics to order for her, her husband, and their two young children. I suggested and David concurred (in his role as a layman) that Brittany and her husband should read the detailed data sheets for each antibiotic on before deciding. Brittany also asked my advice on where to order, expecting that I’d know who offered the best prices and quality. I suggested as an inexpensive source of good-quality antibiotics.

After careful consideration, mainly because of the side effects in children, Brittany decided to order two 50-packs of these ($30 total), which is five courses of doxycycline. She also decided to order two 50-packs of these ($30 total), which is five to seven courses of SMZ/TMP, five 50-packs of these ($67.50 total) or a total of 100 grams, which is 2.5 courses at 4,000 mg/day for ten days, or ten courses at 2,000 mg/day for five days of metronidazole, and one 24-pack of these ($32 total), which they’ll use in combination with ordinary 500-mg amoxicillin capsules they already had to provide three courses of amoxicillin/clavulanate. They decided to pass on the ciprofloxacin entirely, and instead buy two 30-packs of these ($42 total), which is four to six courses of levofloxacin. Levofloxacin is a more expensive later-generation fluoroquinolone, similar to ciprofloxacin but with fewer resistance issues.

The idea of self-prescribing antibiotics scares the hell out of Brittany, which is good. It scares the hell out of me, too, even more so because I know a fair amount about them and their side effects. But Brittany intends to store these medications in the freezer against a truly catastrophic emergency, using them only as an absolute last resort. She looks at this purchase as a one-time outlay of $200+ on insurance.

Brittany’s first job in high school was working at a local pharmacy. As she said, most people who walk into a pharmacy and see hundreds or thousands of large bottles of drugs on the shelves behind the counter probably just assume that means the pharmacy keeps enough drugs on hand to fill prescriptions for weeks or months on end. She knows the truth is different. Most pharmacies get daily or more frequent deliveries of drugs, and what they have on hand of any particular drug at any given time may be a one-week supply, or less. If the transportation chain breaks down for any reason, a community may have at best a week’s or ten days’ supply of most critical drugs. That’s counting everything: pharmacies, hospitals, emergency-care clinics, doctors’ offices, veterinarians’ offices, everything. As Brittany said, a doctor without access to drugs is severely hampered in what he can do. But if the patient can provide his own drugs based on the doctor’s recommendation, there’s a much better chance of a good outcome.