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Sunday, August 22, 2010

A Doctor's Thoughts on Antibiotics, Expiration Dates, and TEOTWAWKI, by Dr. Bones

As a recently-retired physician who is married to a nurse-midwife, my preparedness group looks to us as the post-TEOTWAWKI hospital and medical staff. Medical progress has been exponential and even just the last decade of scientific breakthroughs can equal a century of improvement in medical treatments, surgical techniques and pharmaceuticals. However, in the years (months?) ahead, the crumbling of the infrastructure and devolution of society in general will very likely throw us back to a medical system that existed in the 19th Century.

Let’s take an example: When the U.S. was a young nation, the average woman could expect to be pregnant 10-12 times during her reproductive lifetime (no reliable means of birth control). One out of four women would not survive the pregnancy, either from issues relating to blood loss from miscarriage or childbirth or Infection (no antibiotics) following same. A myriad of other complications occurred which are treatable today but weren’t back then. I collect old medical books, and even relatively modern obstetric textbooks devoted entire chapters on how to crush a fetus’ skull in order to expedite its removal from a critically ill mother, with instruments that clearly had no other purpose. When childbirth was successful, she could expect perhaps 3-4 of her children to survive to become adults, on average, with many minor children succumbing to simple infections that had no known effective treatment at the time.

This is the grim reality that we, in modern times, will face when the inevitable happens and current medical technology and treatments are unavailable to us.

There is an interesting post-TEOTWAWKI series by History Channel called “After Armageddon” which can be viewed on YouTube. Interestingly enough, it doesn’t appear on History Channel’s list of shows). In it, a family seeks refuge in the aftermath of an apocalyptic event. The father of the family, who is a trained EMT, falls sick and dies from a simply cut on his hand because the antibiotics ran out. It shows that the lack of accumulated stores of antibiotics could mean a shortened life span for even the most prepared individual.

Given the new situation that we will have thrust upon us, it behooves every aware individual to begin to stockpile medications that will be needed in the future, and to become trained one way or another in basic and disaster first aid. Even if your group has a designated “medic”, you have an obligation to be able to handle medical issues in a catastrophic scenario for the sake of your group and your family. Just as the designated “medic” should be trained to handle security issues and should accumulate food and other supplies, so should you accumulate medications and medical supplies. Cross-training is essential for when the medic needs a medic!
Accumulating medications may be simple when it comes to procuring aspirin and other non-prescription drugs but may be problematic for those who cannot write their own prescriptions or don’t have a relationship with a physician who can. I would like to focus on the issue of procurement of antibiotics for the treatment of infection in this essay, as there are already a number of good essays on this site that discusses various aspects of medical care in the post-SHTF era. I heartily recommend that everyone read these in detail.

For all intents and purposes, it is highly unlikely that even basic antibiotics like Penicillin will be actively manufactured in an apocalyptic scenario due to the complexities in said manufacture. Those who say, “it’s just bread mold” are na├»ve if they think just making prepper bread and letting it sit will produce anything That would cure an infection (penicillin is actually made from liquid that the mold produces under certain man-made conditions. And, no, Ginger Root and other “home antibiotics” probably won’t either.

The reason that I consider this a major issue is that there will be a much larger incidence of infection when people start to fend for themselves, and injure themselves as a result. Simple cuts and scratches from chopping wood can begin to show infection, in the form of redness, heat and swelling, within a relatively short time. Treatment of infections at an early stage improves the chance that they will heal quickly and completely. However, many preppers, being the rugged folk that they are, are most likely to ignore the problem until it gets much worse and spreads to their entire body, causing fever and other systemic problems that could eventually be fatal. Have antibiotics already on hand in their retreat would allow them to deal with the issue until medical help (if available at all) arrives.

Now, what I am about to tell you is contrary to standard medical practice, and is a strategy that is best used in the event of societal collapse that causes the unavailability of conventional medical care for extended periods of time. This line of thought that I am presenting is that “sumpthin” is better than “nuttin” and is not meant to serve as official medical advice for any circumstance but a catastrophic breakdown of our infrastructure and ability of our country to provide medical care for its citizens. If there is modern medical care available to you, seek it out.

Small amounts of medications such as antibiotics could be procured by anyone who is willing to tell their physician that they are going out of the country and would like to avoid “Montezuma’s Revenge”. Ask them for Tamiflu for viral illness and Z-packs, Amoxicillin or Keflex for bacterial diarrhea. Stockpiling of these antibiotics is more of a problem. After searching far and wide, I have come across the best option for the prepper: Aquarium Fish antibiotics.

For evaluation purposes (and because I am an aquarium hobbyist), I decided to purchase online a variety of these products and found them to be identical (unlike some Dog and Cat medications) to those used to treat humans with a doctor’s prescription. I was able to purchase them without any demand for medical licensure, etc. The drugs are listed below and the bottles list the antibiotic as the sole ingredient. They are:
  • FISH-MOX (amoxicillin 250mg)
  • FISH_MOX FORTE (amoxicillin 500mg)
  • FISH-CILLIN (ampicillin 250mg)
  • FISH-FLEX Keflex 250mg)
  • FISH-FLEX FORTE (Keflex 500mg)
  • FISH-ZOLE (metronidazole 250mg)
  • FISH-PEN (penicillin 250mg)
  • FISH-PEN FORTE (penicillin 500mg)
  • FISH-CYCLINE (tetracycline 250mg)
These medications are available usually in plastic bottles of 100 tablets for much less than the same prescription medication at the pharmacy (some come in bottles of 30 tablets). The dosages are similar to that used in humans, and are taken two to four times a day, depending on the drug. The 500mg dosage is probably more effective in larger individuals. Of course, anyone could be allergic to one or another of these antibiotics, but not all of them. (Note that there is a 10% cross-reactivity between "-cillin" drugs and Keflex, meaning that, if you are allergic to Penicillin, you could also be allergic to Keflex). FISH-ZOLE is an antibiotic that also kills some protozoa that cause dysentery.

NOTE: It should be emphasized that FISH-CYCLINE [and other tetracycline antibiotics of various names] can become toxic after its expiration date, unlike most of the other medications listed. So consider acquiring the other ones listed, first.

Which brings me to a question that I am asked quite often and to which my answer is, again, contrary to standard medical recommendations but appropriate in a post-TEOTWAWKI environment where no medical care is otherwise available. The question is: What happens when the medications I stockpiled pass their expiration date?

Since 1979, pharmaceutical companies have been required to place expiration dates on all medications. Officially, this is the last day that the company will certify that their drug is at full potency. Some people take this to mean that the medicine in question is useless or in some way harmful after that date. With few exceptions (tetracycline being one previously mentioned), this is what I delicately term as “a bunch of hooey”!

Studies performed by the Food and Drug Administration (FDA) revealed that 90% of medications tested were perfectly fine to use 8-to-15 years after the expiration date. There was apparently no danger in the grand majority of cases. The FDA tested more than 100 medications, both prescription and non-prescription, and continues to study the issue today. The exceptions were mostly in liquid form (antibiotics included, but also insulin, nitroglycerine and some others). What is true is that the potency of an antibiotic could possibly decrease over time, so it is important that your medication cache is in a cool, dry place if at all possible. Refrigeration is an excellent method to maintain the full potency of many drugs.

Many people gauge their preparedness on the number of full ammo boxes in their closet. I’ve got them too. However, preparedness doesn’t mean going out in a blaze of glory; it means going on, in the best health and condition, to re-establish a peaceful and productive society. Every prepper should have antibiotics as part of their medical supplies. They’re available, they’re cheap and they could save your life.


  1. In fact the effectiveness of antibiotic drugs depends on how we use them. Unfortunately, even some health care providers forgot that antibiotics are not effective treatment for fighting viruses or fungal infections. Antibiotics should only be taken as prescribed for bacterial infections. Antibiotics overuse creates drug resistance.
    However, it is in our hands to remedy the situation and here are the main recommendations:
    Never save unused antibiotics for later use or take antibiotics which have been prescribed for someone else. Antibiotics misuse causes serious consequences.
    Remember: antibiotics won't help against non-bacterial infections like cold or flu (both caused by viruses).

  2. Emma's line is on the face of it fine however it is sometimes difficult to distinguish between a virus and a bacterial infection when a test is not available.

    Last year my wife almost died due to an NHS doctor wrongly assuming a bacterial infection to be a virus. Had I not argued with the doctor concerned and insisted that antibiotics were prescribed I doubt that she would have survived.

    Fortunately I had had considerable previous experience of antibiotic usage (albeit in veterinary situations) and this helped me argue the case for antibiotics very convincingly.