If you had to pick one antibiotic...

[dallas]

This thread has illustrated one of my pet peeves about the ZS forums, and the First Aid forum in particular:

Here is what happens in a nutshelll, all the time:

Person one: "Hey I'm preparing for disasters that might mean my doctor and walgreens/CVS are unavailable what should I do to learn about and stock (insert medical thing here)"

Persons two, three, four: "OH NO SEE IM A TRAINED PROFESSIONAL AND THAT SHIT IS SIMPLY TOO HARD FOR YOU TO COMPREHEND YOU HAVE TO DO THE TRAINING LIKE I DID TO UNDERSTAND IT".



I think that is pure B.S., and counter to the spirit of trying to get people to prepare. Whether its a layman wanting to know how to run an IV or insert an OPA/NPA, or someone wanting to know what antibiotics to have on hand (hint: they're all in the fish supplies aisle at the petco/petsmart), or what-have-you.

We are preparing for a time when we cannot get to you, and cannot benefit from your specialized training, and need to do something on our own other than curl up and die. Sorry if it offends you that we'd want to do that, but stop acting like a secret guild. "Do no harm" doesn't count if you just tell someone how they might hurt themselves.

What would make it easier, at least for me, is if you would study some on your own then ask questions about what you are learning. I don't know where to start on the answer if I don't know what you currently know. If you notice, I usually give references and ask questions. That is what I do with my students. I rarely give them an answer. I lead them to the answer. They remember better that way. Look up what I ask then ask some more questions.

I really want to help, but I can not spoon feed you an education. I do not even do that with my students and residents. Study some of the references given then come and ask for more. I think some of us here will be glad to help you.

Here are some government guidelines for antibiotic therapy.
http://guidelines.gov/search/search.asp ... ntibiotics

[duodecima]

A Very Long Post (go up 2 posts, omitted for brevity)

Excellent info up to and including the link to the NIH.

I have some issues with a few statements thereafter...

The main problem is general practitioners (family doctors) who hand antibiotics out like it is candy for a headache or stopped up nose. Another problem is when someone has a real infection they under treat it by only giving the patient 10 days of antibiotics.

1) I think it's a bit unfair to single out any one specialty for overuse of antibiotics, (as family docs, pediatricians, internal medicine docs, urologists, ENT's, infectious disease docs, surgeons, and ob/gyn's all commonly prescribe antibiotics, to give you a partial list). Especially when they are aided and abetted by patients who say things like...

In my opinion, if you have an infection it is better to over treat it than under treat it.

2) need for antibiotic treatment and proper length of treatment depends on what condition you have. 10 days is overkill for some things (simple UTI), appropriate for many others (uncomplicated pneumonia) and not enough for yet others. Details matter. (I think ironsheik7 may have meant his statments with regards to chronic prostatitis alone, but since they were generally phrased I just wanted to point out that they are not generally applicable.)

I'm sorry that a lot of good folks are frustrated by the fact that we can't boil antibiotics down into something simple. This isn't arrogance (or not arrogance alone, depending on your opinion of me & others.) There's an entire forum subsection for firearms, discussing use, fixing, sights, uppers, lowers, calibers, loading, problems, and a lot of other stuff I don't know enough about to appreciate. We'd have to have something like that to get at antibiotics. Please see the last page for the disagreements that experienced folks who work in the field can have. Somebody who's never fired a gun comes in asking about what AR to get - somebody's going to say, rightly, go get a .22 as well to learn with. And it is fortunately not possible to go from reading firearms forum to running around a combat theater thinking you're qualified to do so - but thanks to the internet, "leftover" antibiotics, and the occasional human use of veterinary antibiotics, it's not that uncommon in health care to meet people who demonstrably do think they're qualified to jump in and practice based on what they've read - because they've done so. This doesn't count the ones we never meet, who figure they got it right since they got better. The folks in this thread would likely not do so - but there's all sorts of folks who read this that we never hear from.

My respected colleagues in the teaching profession don't tell me I can't teach my kid - they usually tell me that as a parent I am very important. I certainly would never tell people that they weren't critically important in managing their own health. But if I asked for a single thread telling me the one best method to pick to teach my child with an unspecified learning problem, I think it would end up looking a lot like this one.

(I have failed at my previous statements that I'd try to come up with some indications that things were moving from simple to serious, and other useful wwyd's. Sorry. It's on my to do list...)

[engr-rn]

This question really has no value. As Liff pointed out, you can not work on a car with only one wrench. You need different sizes.

For example, quinolones and Azithromycin are not good against MRSA here.

Quinolones can also cause tendon ruptures. My orthopod friend does at least a couple of tendon repairs a week from it. He does not think it is rare. Azithromycin can also cause fatal heart attacks as can erythromycin.

As others have pointed out, prevention is critical. There is no magic bullet. I teach my students to identify the most likely causative agent and prescribe for it.

Rough thing to have to choose. I agree. Vancomycin (oral or IV) would probably be my go-to. It's broad spectrum (kills most bugs including MRSA and C-Difficile), doesn't have the above mentioned side effects, and allergies are much rarer than with pennicillin,cephlosporin or sulfa types.

Tina

[duodecima]

Vancomycin (oral or IV) would probably be my go-to. It's broad spectrum (kills most bugs including MRSA and C-Difficile), doesn't have the above mentioned side effects, and allergies are much rarer than with pennicillin,cephlosporin or sulfa types.

Tina

Sigh. I gotta disagree completely. Oral vancomycin is not systemically absorbed, and is therefore useful only for intestinal c-difficile and nothing else at all. Its range is limited to gram positive stuff (with the exception of non-gonococcal Nisseria sp., I think), which is why, when given IV, it's almost always used in combination with something else. Even if IV was a viable option for a bugout bag, I am afraid vancomycin will not serve well at all in a majority of infections.

It's not technically an allergy, but the "red man" syndrome side effect is kinda undesirable. This is caustic and there's an increased incidence of thrombophlebitis in peripheral IV lines. Kidney toxicity is infrequent but possible (we do peak & trough levels and adjust the dosage a lot, not practical in a bugout).

Don't get me wrong, this stuff very appropriate in many modern hospital situations, but I think vancomycin is something to cross off the list for this discussion.

[dallas]

This question really has no value. As Liff pointed out, you can not work on a car with only one wrench. You need different sizes.

For example, quinolones and Azithromycin are not good against MRSA here.

Quinolones can also cause tendon ruptures. My orthopod friend does at least a couple of tendon repairs a week from it. He does not think it is rare. Azithromycin can also cause fatal heart attacks as can erythromycin.

As others have pointed out, prevention is critical. There is no magic bullet. I teach my students to identify the most likely causative agent and prescribe for it.

Rough thing to have to choose. I agree. Vancomycin (oral or IV) would probably be my go-to. It's broad spectrum (kills most bugs including MRSA and C-Difficile), doesn't have the above mentioned side effects, and allergies are much rarer than with pennicillin,cephlosporin or sulfa types.

Tina

Bactrim kills most MRSA infections. Why are you worried about C.Diff? Will you be taking a lot of antibiotics? Why not do a just do a fecal transplant? That is the purpose of your appendix. Recolonize the gut.

What infections are you most likely to get? Taylor your antibiotic choices to them.

[GunsUp]

OK... so it is obvious that one antibiotic does not cover everything. Most low grade infections can be survived by an otherwise healthy adult without antibiotics, and taking antibiotics without a diagnosis could make things worse. I knew all this before reading the last 5 pages of this thread.

However, I have a more specific question, I probably should start a new thread, but I'll try here first. If you answer this question, please note if your answer is based on actual medical training and experience, if you have a reliable reference, or if you are just guessing.

Scenario:
SHTF, phones not working, there is no doctor to go to, I don't have any advanced medical skills or equipment.
I get a full thickness, dirty wound, perhaps I got careless with a knife or perhaps I got shot.
Stage 1: I stop the bleeding, scrub hands with soap, put on gloves, wash the skin adjacent to the wound with 10% PI, low pressure high volume flush the wound with 1% PI, debride the tissue, pack with 1% PI soaked gauze or sugardyne (if appropriate), apply sterile gauze dressing.
Stage 2: I change packing and dressing 3-4 times daily. Over the next day or two the wound gets hot, red and and I notice light white puss in the cavity when changing dressings.
Stage 3: I continue to change the packing and dressing, performing additional debriding or flushing if necessary, but the swelling and tenderness spreads, I develop a fever.
Stage 4: The puss is heavier and darker, the wound stinks, there are dark black streaks several inches from the original wound site, I want to die.

(1)What antibiotic would you take for this, what dosage and for how long?
(2)What stage would you begin treating at? Would you begin at a different stage if it was the only course of antibiotics for your whole family?
(3)If you get to stage 4 do you put on a tourniquet and attempt an amputation at the next joint with a kitchen knife?

My answer (derived from several internet sources, as I know fuck-all about pharmacology):
(1) bactrim 160/800 PO bid x5 days. I would go with the bactrim, because it's what I have, what I was prescribed for a flesh wound in the past, and it is relatively easy to obtain (from prescription, from mexico or from the evil aquarium shop).

(2)I'd treat stage 1 if I had plenty, stage 2 if it was my only course (this is a complete guess).

(3) Probably, but who knows what the fever hallucinations will be telling me by that point.

[IANMCDEVITT]

OK, can we lock it now?

[Liff]

For the dose to every medicine that is approved by the FDA, please Google the following search term, "[name of drug] prescribing information" and click on one of the links that leads to a PDF document.

Like this.

Buried in the pages would be this this. (Normally you would want to go to a manufacturer's site, and unfortunately, that isn't always the first link.) The first hit is ok too.

Please read the entire thing, even if there are parts that you do not understand. Ask a medical professional for help with the parts that you do not understand. Look for the section titled, "Dosage and Administration" (page 9). Not always, but normally, follow that guidance.

This information is based off of primary research and approved by the egg-heads at the FDA.

Fake edit: I agree with abelru completely in his last post. Go Kings!! (I have no idea who the Kings are. I meant the rest of the post.)

[GunsUp]

Thank you for those keywords to search for, i have been looking for the full drug notes but couldnt find them easily without those specific words. One source of confusion i have is that i was prescribed bactrim for a dirty wound on my toe 5 years ago and the 2007 ranger medic handbook lists bactrim ds as an alternative to cleocin and avelox for prophylactic treatment of dirty lacerations, but this info is not in the prescribing info sheet. Is this a commonly used but unapproved application or was this once approved and no longer recommended for some reason?

[Liff]

Is this a commonly used but unapproved application or was this once approved and no longer recommended for some reason?

Approved us unapproved indication (or Off Label Use).

Approved would be something that there would be a clinical trial showing that the medicine is safe and effective. Unapproved is a bunch of people just doing it and obtaining positive anecdotal clinical outcomes.

Did you notice that MRSA is not an approved indication for those two manufacturer's Bactrim DS? Yet, Bactrim DS is used for some sites of MRSA infections. Just because something is not approved does not mean unsafe or ineffective, just that that indication isn't approved.

Great question also.

[duodecima]

Scenario:
SHTF, phones not working, there is no doctor to go to, I don't have any advanced medical skills or equipment.
I get a full thickness, dirty wound, perhaps I got careless with a knife or perhaps I got shot.
Stage 1: I stop the bleeding, scrub hands with soap, put on gloves, wash the skin adjacent to the wound with 10% PI, low pressure high volume flush the wound with 1% PI, debride the tissue, pack with 1% PI soaked gauze or sugardyne (if appropriate), apply sterile gauze dressing.
Stage 2: I change packing and dressing 3-4 times daily. Over the next day or two the wound gets hot, red and and I notice light white puss in the cavity when changing dressings.
Stage 3: I continue to change the packing and dressing, performing additional debriding or flushing if necessary, but the swelling and tenderness spreads, I develop a fever.
Stage 4: The puss is heavier and darker, the wound stinks, there are dark black streaks several inches from the original wound site, I want to die.

(1)What antibiotic would you take for this, what dosage and for how long?
(2)What stage would you begin treating at? Would you begin at a different stage if it was the only course of antibiotics for your whole family?
(3)If you get to stage 4 do you put on a tourniquet and attempt an amputation at the next joint with a kitchen knife?

1) Bactrim is a decent choice for this. Length of treatment would depend a bit on how bad it looks and how it does with treatment.
2)I would NOT treat at stage 1 unless there was some other indication to do so (human bites...). Stage 2 if I was well supplied, stage 3 if I was preserving my antibiotics like gold.
2a) Also - this is where details come in again - is the whitish stuff in the wound a reaction to infection, or is it exudate from the healing tissue? It's pretty common for folks to come to me thinking exudate is infection when it's not. But, assuming it looked like pus and infection, Stage 2 would be a good time to treat.
3) No, if things are that bad, in the conditions you describe, amputation's not the way I would go.

Also - wound care - I would not put iodine on the packing, that was done traditionally but turns out to have no real advantages to offset the risks. OTOH if the only sterile packing you have is iodoform, use it.

Other measures to take at stage 2 - apply heat to the area and elevate it if it's a limb. You're trying to improve blood flow into and lymph drainage out of the area, taking advantage of the body's own defenses.

(primary care MD, as far as my credentials go. That doesn't make me automatically right, obviously, but I didn't just make it up.)

[LowKey]

1) Bactrim is a decent choice for this. Length of treatment would depend a bit on how bad it looks and how it does with treatment.
2)I would NOT treat at stage 1 unless there was some other indication to do so (human bites...). Stage 2 if I was well supplied, stage 3 if I was preserving my antibiotics like gold.
2a) Also - this is where details come in again - is the whitish stuff in the wound a reaction to infection, or is it exudate from the healing tissue? It's pretty common for folks to come to me thinking exudate is infection when it's not. But, assuming it looked like pus and infection, Stage 2 would be a good time to treat.
3) No, if things are that bad, in the conditions you describe, amputation's not the way I would go.

Also - wound care - I would not put iodine on the packing, that was done traditionally but turns out to have no real advantages to offset the risks. OTOH if the only sterile packing you have is iodoform, use it.

Other measures to take at stage 2 - apply heat to the area and elevate it if it's a limb. You're trying to improve blood flow into and lymph drainage out of the area, taking advantage of the body's own defenses.

(primary care MD, as far as my credentials go. That doesn't make me automatically right, obviously, but I didn't just make it up.)

Thanks for this response....I think this the type of information most of us (the laypersons) are really interested in knowing, and the tips on elevating and applying heat are likewise outstanding. I also really appreciate the graduated response on antibioc use based on how limited supplies might be.
More answers like this from the medical pros would be lovely. Many, many thanks1

[GunsUp]

duodecima: thank you so much for the thorough response, I really appreciate the information.

What would you do with significant tissue necrosis that despite antibiotics and wound care seemed to continue to worsen? Continue antibiotic treatment and basic wound care and hope for a reversal? Surgical debridement (with minimal tools, training and no local anesthetic )?, start trying to attract flies?

[Doctorr Fabulous]

I love how every medical thread gets into a discussion that could be solved with one disclaimer:

Get proper training BEFORE attempting and medical procedure.

Now, for those of us who feel that text on a forum does not, in fact, constitute proper training, what's the best way to begin learning the woundcare skills so that we aren't scrambling for the forum or WebMD archives when we need the information? Ya know, short of a degree and sixty thousand dollars. How does "Where There Is No Doctor" or other books stack up for this?

NB: Not trying to practice medicine without a license, or encourage such practice, but trust me when I say that I do not want to rely on trying to reach a medical professional in a disaster scenario.

Secondly: Instead of focusing on drugs only, should we open this up to "Wound care and Related Questions" with a thread title change, or continue to focus on what, in my minutely limited experience, seems to be a slice of whole figurative pie? I've noticed that in other threads, some people seem to think that improper application of a bandaid is a big deal. Feel free to tell me to fuckoff, and I'll make a different thread if we want to keep this one just for drug questions.

[rhi]

(primary care MD, as far as my credentials go. That doesn't make me automatically right, obviously, but I didn't just make it up.)

Thank you for contributing to this discussion. This is exactly how I'd hoped this thread would shake out.

Any indications on how to tell normal wound exudate from puss? I'm guessing color (clear/light white=OK, yellow/green=bad), smell (none=good, bad=uh... bad) and consistency (watery=OK, thick=bad).

Also, presuming some topical antibiotic ointment (neosporin/polymyxin B/bacitracin) was available, when would be a good time to employ it in this scenario (if ever)?

[LowKey]

I love how every medical thread gets into a discussion that could be solved with one disclaimer:

Get proper training BEFORE attempting and medical procedure.

One of the issues that seems to crop up time and time again in First Aid is that according to a great many of the people in the medical field there isn't anything that constitutes proper training shy of the $60,000 (and up) figure you mentioned. It's a mantra of "scope of practice, scope of practice, scope of practice" by a great many. I'm truly grateful when someone in the field does share.

[abelru]

What would you do with significant tissue necrosis that despite antibiotics and wound care seemed to continue to worsen? Continue antibiotic treatment and basic wound care and hope for a reversal? Surgical debridement (with minimal tools, training and no local anesthetic )?, start trying to attract flies?

FWIW, necrotic tissue can be debrided without local. Truly necrotic tissue is insensate.

Antibiotics will not 'revive' tissue that is necrotic. Superficial necrosis can be closely watched and monitored. If there is an adequate blood supply, granulation will occur, but only if the tissue is not ravaged by infection.

As a rule, infected tissue will not heal, and pathogenic organisms love dead tissue.

So the generic answer is to both debride the wound and to continue to fight the infection.

[dallas]

http://www.wheelessonline.com/ortho/con ... wound_care

http://www.backwoodshome.com/articles2/glade75.html

In the infected deep wound situation, you need to consider anaerobic infections.

http://www.merckmanuals.com/professiona ... tions.html

http://www.lsuhscshreveport.edu/Pharmac ... erobes.pdf

[Visionz]

Honestly, I would NEVER pick one antibiotic.
I would stock up on several. Not only do different antibiotics fight different infections, one specific antibiotic taken to often could kill your immune system and make you dependent on it.

[rhi]

http://www.wheelessonline.com/ortho/contaminated_wound_care
http://www.backwoodshome.com/articles2/glade75.html

These are very good links. I'd urge anyone following this thread to check them out.

I carry chlorhexidene gluconate (http://www.walgreens.com/store/c/hibiclens-antiseptic/antimicrobial-skin-cleanser-liquid/ID=prod352989-product) in my GHB and also keep it in my BOB.

The links that dallas provided seem to validate that it's a really good first course of treatment for a dirty wound. Even better than a triple antibiotic ointment.

[duodecima]

, one specific antibiotic taken to often could kill your immune system and make you dependent on it.

Nope. Not how they work at all. (there was an 'antibiotic' like that in Crichton's Andromeda Strain, but that was the fiction part of the science fiction.). Over use of one agent selects for strains of bacteria that are resistant to it, reducing or eliminating the usefulness of that antibiotic. But they don't hurt immune function or make you dependent on them.

But yeah, multiple options is better for a lot of reasons, see the first couple pages of this thread for the "whaddaya mean just one, that's not good!" reactions.

[Visionz]

, one specific antibiotic taken to often could kill your immune system and make you dependent on it.

Nope. Not how they work at all. (there was an 'antibiotic' like that in Crichton's Andromeda Strain, but that was the fiction part of the science fiction.). Over use of one agent selects for strains of bacteria that are resistant to it, reducing or eliminating the usefulness of that antibiotic. But they don't hurt immune function or make you dependent on them.

But yeah, multiple options is better for a lot of reasons, see the first couple pages of this thread for the "whaddaya mean just one, that's not good!" reactions.

Thats not what I heard, I could be wrong though. There's about 1 million web pages that say antibiotics can kill an immune system though.
Here is just one.

www.healthiertalk.com/10-facts-you-must ... iotic-0963

[duodecima]

, one specific antibiotic taken to often could kill your immune system and make you dependent on it.

Nope. Not how they work at all. (there was an 'antibiotic' like that in Crichton's Andromeda Strain, but that was the fiction part of the science fiction.). Over use of one agent selects for strains of bacteria that are resistant to it, reducing or eliminating the usefulness of that antibiotic. But they don't hurt immune function or make you dependent on them.

But yeah, multiple options is better for a lot of reasons, see the first couple pages of this thread for the "whaddaya mean just one, that's not good!" reactions.

Thats not what I heard, I could be wrong though. There's about 1 million web pages that say antibiotics can kill an immune system though.
Here is just one.

http://www.healthiertalk.com/10-facts-y ... iotic-0963

"About a million web pages" =/= accuracy. I read the article, it was stretching to call those 10 different points but the rest of them are accurate. The "kills good gut bacteria" (quite true) to "destroys immune system" is more of a leap than I am aware of solid evidence for. It's an interesting idea and under active research, but not really answered yet. (There's so many other good reasons NOT to overuse antibiotics, that this one point being true or not doesn't make a practical difference.)

[Liff]

Static vs cidal antibiotics. Cidal antibiotics can kill the bacteria all by itself. Static antibiotics simply inhibit the growth and replication of the bacteria. Without a functioning immune system, static antibiotics are not going to clear the infection.

I would say that the blanket statement of, 'antibiotics could kill your immune system' could not possibly be accurate based on how antibiotics work. Or how the immune system works. But I understand how a person could be mislead based off of the link provided. I am pretty sure not everything on the internet is absolutely true though, and I may be mistaken.