06-22-2007, 01:34 PM
Storage and Rotation of Medications
Medications can be one of the more expensive items in your storage
inventory and there can be a reluctance to rotate them due to this cost
issue and also due to difficulties in obtaining new stock.
Unfortunately, drugs do have limited shelf life. It is a requirement
for medications sold in the US (and most other first world countries) to
display an expiration date. It is my experience that these are usually
very easy to follow, without the confusing codes sometimes found on
food products, e.g. -- Exp. 12/00=December 2000.
I cannot endorse using medications which have expired. But having said
that it is my understanding that the majority of medications are safe
for at least 12 months following their expiration date. A colleague
recently did some aid work in the Solomon islands and a local
pharmaceutical warehouse gave him a number of expired drugs. They stated that the
drugs were safe to use for at least another 18 months. As with food the
main problem with expired medicines is not that they become dangerous,
but that they lose potency over time, and the manufacturer will no
longer guarantee the dose/response effects of the drug. The important
exception to this rule is the tetracycline group of antibiotics, which can
become toxic with time, there may be others that I am unaware of but it
is very difficult to obtain this information. Let the buyer beware, the
expiry dates ARE there for a reason.
In addition, I recommend that if you are acquiring medications on a
doctor's prescription that when you have the prescription filled you
explain the medications are for storage (you don't need to say exactly what
for), and request recently manufactured stock with distant expiration
dates.
The ideal storage conditions for most medications is in a cool, dark,
dry environment. These conditions will optimize the shelf life of the
drugs. A small number of drugs require refrigeration to avoid loss of
potency. These include insulin, ergometrine, oxytocin and some muscle
relaxants. Others such as Diazepam rapidly lose potency if exposed to the
light.
Antibiotics
Antibiotic Recommendations
Antibiotic Recommendations. In some cases access to antibiotics may be
very limited. The following is my preferred list of antibiotics. If
your limited in what you can get, I suggest you purchase and expand in
this order. All are good broad spectrum antibiotics and have different
strengths and weakness. I suggest you purchase an antibiotic guide, most
medical book shops have small pocket guides for junior doctors detailing
which drug to use for which bug and outlining sensitivities.
A Broad spectrum Penicillin (e.g.-- Amoxycillin+ Clavulanic Acid)
A Quinolone (e.g.-- Ciprofloxacin)
A Cephalosporin (e.g.-- Cefaclor)
NOTE: If allergic to Penicillin, I would advise A Quinolone as a first
choice with some Metronidazole as a anerobe back-up. Alternative would
be Erythromycin.
Antibiotic Summary
The Bugs:
A basic understanding of how bugs (read bacteria) cause infections is
required to appropriately use antibiotics. I will not discuss viral or
other infective agents here. This is not the forum for a proper
discussion, so consider this a brief introduction. There are HUNDREDS of
bacteria, I will only discuss common disease causing ones in man.
Four Classes of Bacteria
Gram positive ( + ve )
Gram negative ( - ve )
Anaerobes
Others
Gram positive bacteria stain blue and gram negative bacteria stain
pink, when subjected to a gram staining test. It is related to the presence
or absence of a coating in the cell wall of the bacteria. Anaerobic
bacteria are ones which require no oxygen to grow. Bacteria are also
described by their shape (cocci = round, bacilli = oval) and how they are
grouped together (chains, clusters, pairs)
Gram Positive Bacteria ( Gram +ve)
Staphylococcus: Commonest pathogen is S. aureus. Gram + cocci in
clumps. Causes boils, abscesses, impetigo, wound infections, bone infections,
pneumonia (uncommonly), food poisoning and septicaemia. Generally very
sensitive to Flucloxacillin as first choice and Augmentin and the
Cephalosporins. A strain which is resistant to the above, known as MRSA and
is currently treated with vancomycin.
Streptococcus: Gram + cocci in pairs or chains. Most are not pathogenic
in man, except Strep pneumoniae and the Strep pyogenes. Strep
pneumoniae causes pneumonia, ear infections, sinusitis, meningitis, septic
arthritis, and bone infections. Strep pyogenes causes sore throats,
impetigo, scarlet fever, cellulitis, septicaemia and necrotising fascitis.
Very sensitive to penicillins, cephalosporins, and the quinolones.
Gram Negative Bacteria ( Gram -ve )
Neisseria meningitidis: Gram -ve cocci in pairs. Common cause of
bacterial meningitis, may also cause pneumonia and septicaemia. Can be
rapidly fatal. Sensitive to penicillins, cephalosporins, quinolones,
cotrimoxazole and tetracyclines.
Neisseria gonorrhoeae: Gram -ve cocci in pairs. Causes gonorrhea.
Sensitive to high dose amoxycillin (single dose), Augmentin and also
cephalosporins and quinolones.
Moxella catarrhalis: Gram -ve cocci in pairs. Common cause of ear and
sinus infections, also chronic bronchitis exacerbations. Sensitive to
Augmentin, Cephalosporins, Quinolones and Cotrimoxazole and
tetracyclines.
Haemophilus influenzea: Gram -ve cocco-bacilli. Can cause meningitis
(esp. in children under 5), epiglottis, cellulitis and a sub group cause
chest infections. Sensitive as M.catarrhalis
Escherichia coli: Gram -ve bacilli. Normally found in the bowel. Causes
Urinary infections, severe gastroenteritis, peritonitis (from bowel
injury), septicaemia. Drug of choice is a quinolone or cephalosporin.
Proteus sp.: Gram -ve bacilli. Lives in the bowel. Causes UTI's,
peritonitis (from bowel injuries), wound infections. Drug of choice is the
quinolones.
Anaerobes
Bacteroides sp. gram negative bacilli. Normal bowel flora. Commonly
causes infections following injury to the bowel or wound contamination,
causes abscess formation. Treated first choice with metronidazole or
second with chloramphenicol or Augmentin.
Clostridium sp. Gram positive species. produce spores and toxins.
C. perfringens/C.septicum - common cause of gangrene, treat with
penicillins or metronidazole
C.tetani - tetanus - For tetanus and botulism, the damage is from
toxins, not the bacteria themselves
C. botulinum - botulism
C. difficille - causes diarrhea following antibiotics. treat with
metronidazole
Others
Chlamydia sp: Includes C.pneumonia, responsible for a type of atypical
pneumonia and C.trachomatis, responsible for the sexually transmitted
disease chlamydia. It is best treated with Tetracyclines or as second
choice a macrolide.
Mycoplasma pneumoniae: A cause of atypical pneumonia. Treated best with
a Macrolide, with a second choice of a tetracycline.
The Drugs
Penicillins - These act by preventing replicating bacteria from
producing a cell wall. A number of bacteria produce a enzyme which inactivates
the penicillins ( B-lactamase).
A number of varieties:
Benzyl Penicillin: Injectable preparation. Antibiotic of choice against
severe Strep pneumoniae and Neisseria sp infections such as chest
infections, meningitis and cellulitis.
Phenoxymethylpenicillin (Penicillin V): Oral preparation of above.
Usually used only for the treatment of sore throats (strep throats), in
other infections largely replaced by amoxycillin which is better absorbed.
Flucloxacillin: Oral and IV drug of choice for Staph infection such as
cellulitis, boils and abscess and bone infections. Also usually
effective against Strep, but not first choice.
Amoxycillin: (newer version of ampicillin): Oral and IV. Effective
against most gram positive and negative bugs. Limited use secondary to
B-lactamase resistance in many bugs. This is overcome with the addition of
Clavulanic Acid ( e.g. Augmentin). Overcoming this resistance, makes
this combination my ideal survival antibiotic, with good gram positive,
negative and anaerobic cover. This drug I feel is the best "broad
spectrum" antibiotic commonly available, other AB's may be better for
specific infections but this is the best all purpose one.
Cephalosporins - Same method of action as penicillins. Developed in
three generations (now four, but not widely available). The third
generation e.g., Cefotaxime (Claforan, IV only) and Ceftriaxone (Rocephin, IV
only) have the most broad spectrum. They are effective against most gram
positives and negatives and some variable anaerobic cover. The second
generation e.g., Cefuroxime (Zinacef, oral and IV) and Cefaclor
(Ceclor, oral only) also have good general cover, but are not as effective
against some gram negative bacilli. This loss of gram negative cover
expands to most gram -ve cocci and bacilli in the first generation
cephalosporins e.g., Cephalexin (Keflex, oral only) and Cephazolin (Kefzol, IV
only). The third generation is ideal for use in those with very severe
generalized infection, meningitis or intra-abdominal sepsis (e.g.,
penetrating abdo wound or appendicitis, with metronidazole added in) and the
second generation offer a good broad spectrum antibiotic for general
use in skin, wound, urinary and chest infections.
Quinolones - Acts by inhibiting DNA replication in the nucleus of the
replicating bacteria. New generation of antibiotics. Most common is
Ciprofloxacin. Very broad spectrum cover, except anaerobes. Excellent
survival AB, but my second choice due to amoxycillin + clavulanic acids
better cover of anaerobes. Effective for most types of infections except
intra-abdominal sepsis and gangrene.
Macrolides - Acts by inhibiting protein synthesis in the replicating
bacteria. Includes Erythromycin and the newer Roxithromycin and
Clarithromycin. Often used in people with a penicillin allergy, however it does
have a reduced spectrum (esp. with Gram negatives), but is an
alternative to tetracycline in Chlamydia. First choice in atypical pneumonias
e.g., with Mycoplasma pneumonia.
Co-Trimoxazole - Acts by interfering with folate metabolism in the
replicating bacteria. Previously a very broad spectrum antibiotic, now has
a much more variable response rate due to resistance. Still useful for
urinary and, mild chest infections.
Metronidazole - Acts by directly damaging the structure of the DNA of
the bacteria/protozoa. Drug of choice for anaerobic infection. Should be
used with another broad spectrum AB in any one with possible fecal
contamination of a wound or intra-abdominal sepsis (such as severe
appendicitis). Also the drug of choice for parasitic infections such as
Giardia.
Others - There are many other antibiotics available. I have only
discussed the common ones above. For further information I refer you to any
Antibiotic guide, of which there are many.
www.survival-center.com/med-faq/med-7.htm
Medications can be one of the more expensive items in your storage
inventory and there can be a reluctance to rotate them due to this cost
issue and also due to difficulties in obtaining new stock.
Unfortunately, drugs do have limited shelf life. It is a requirement
for medications sold in the US (and most other first world countries) to
display an expiration date. It is my experience that these are usually
very easy to follow, without the confusing codes sometimes found on
food products, e.g. -- Exp. 12/00=December 2000.
I cannot endorse using medications which have expired. But having said
that it is my understanding that the majority of medications are safe
for at least 12 months following their expiration date. A colleague
recently did some aid work in the Solomon islands and a local
pharmaceutical warehouse gave him a number of expired drugs. They stated that the
drugs were safe to use for at least another 18 months. As with food the
main problem with expired medicines is not that they become dangerous,
but that they lose potency over time, and the manufacturer will no
longer guarantee the dose/response effects of the drug. The important
exception to this rule is the tetracycline group of antibiotics, which can
become toxic with time, there may be others that I am unaware of but it
is very difficult to obtain this information. Let the buyer beware, the
expiry dates ARE there for a reason.
In addition, I recommend that if you are acquiring medications on a
doctor's prescription that when you have the prescription filled you
explain the medications are for storage (you don't need to say exactly what
for), and request recently manufactured stock with distant expiration
dates.
The ideal storage conditions for most medications is in a cool, dark,
dry environment. These conditions will optimize the shelf life of the
drugs. A small number of drugs require refrigeration to avoid loss of
potency. These include insulin, ergometrine, oxytocin and some muscle
relaxants. Others such as Diazepam rapidly lose potency if exposed to the
light.
Antibiotics
Antibiotic Recommendations
Antibiotic Recommendations. In some cases access to antibiotics may be
very limited. The following is my preferred list of antibiotics. If
your limited in what you can get, I suggest you purchase and expand in
this order. All are good broad spectrum antibiotics and have different
strengths and weakness. I suggest you purchase an antibiotic guide, most
medical book shops have small pocket guides for junior doctors detailing
which drug to use for which bug and outlining sensitivities.
A Broad spectrum Penicillin (e.g.-- Amoxycillin+ Clavulanic Acid)
A Quinolone (e.g.-- Ciprofloxacin)
A Cephalosporin (e.g.-- Cefaclor)
NOTE: If allergic to Penicillin, I would advise A Quinolone as a first
choice with some Metronidazole as a anerobe back-up. Alternative would
be Erythromycin.
Antibiotic Summary
The Bugs:
A basic understanding of how bugs (read bacteria) cause infections is
required to appropriately use antibiotics. I will not discuss viral or
other infective agents here. This is not the forum for a proper
discussion, so consider this a brief introduction. There are HUNDREDS of
bacteria, I will only discuss common disease causing ones in man.
Four Classes of Bacteria
Gram positive ( + ve )
Gram negative ( - ve )
Anaerobes
Others
Gram positive bacteria stain blue and gram negative bacteria stain
pink, when subjected to a gram staining test. It is related to the presence
or absence of a coating in the cell wall of the bacteria. Anaerobic
bacteria are ones which require no oxygen to grow. Bacteria are also
described by their shape (cocci = round, bacilli = oval) and how they are
grouped together (chains, clusters, pairs)
Gram Positive Bacteria ( Gram +ve)
Staphylococcus: Commonest pathogen is S. aureus. Gram + cocci in
clumps. Causes boils, abscesses, impetigo, wound infections, bone infections,
pneumonia (uncommonly), food poisoning and septicaemia. Generally very
sensitive to Flucloxacillin as first choice and Augmentin and the
Cephalosporins. A strain which is resistant to the above, known as MRSA and
is currently treated with vancomycin.
Streptococcus: Gram + cocci in pairs or chains. Most are not pathogenic
in man, except Strep pneumoniae and the Strep pyogenes. Strep
pneumoniae causes pneumonia, ear infections, sinusitis, meningitis, septic
arthritis, and bone infections. Strep pyogenes causes sore throats,
impetigo, scarlet fever, cellulitis, septicaemia and necrotising fascitis.
Very sensitive to penicillins, cephalosporins, and the quinolones.
Gram Negative Bacteria ( Gram -ve )
Neisseria meningitidis: Gram -ve cocci in pairs. Common cause of
bacterial meningitis, may also cause pneumonia and septicaemia. Can be
rapidly fatal. Sensitive to penicillins, cephalosporins, quinolones,
cotrimoxazole and tetracyclines.
Neisseria gonorrhoeae: Gram -ve cocci in pairs. Causes gonorrhea.
Sensitive to high dose amoxycillin (single dose), Augmentin and also
cephalosporins and quinolones.
Moxella catarrhalis: Gram -ve cocci in pairs. Common cause of ear and
sinus infections, also chronic bronchitis exacerbations. Sensitive to
Augmentin, Cephalosporins, Quinolones and Cotrimoxazole and
tetracyclines.
Haemophilus influenzea: Gram -ve cocco-bacilli. Can cause meningitis
(esp. in children under 5), epiglottis, cellulitis and a sub group cause
chest infections. Sensitive as M.catarrhalis
Escherichia coli: Gram -ve bacilli. Normally found in the bowel. Causes
Urinary infections, severe gastroenteritis, peritonitis (from bowel
injury), septicaemia. Drug of choice is a quinolone or cephalosporin.
Proteus sp.: Gram -ve bacilli. Lives in the bowel. Causes UTI's,
peritonitis (from bowel injuries), wound infections. Drug of choice is the
quinolones.
Anaerobes
Bacteroides sp. gram negative bacilli. Normal bowel flora. Commonly
causes infections following injury to the bowel or wound contamination,
causes abscess formation. Treated first choice with metronidazole or
second with chloramphenicol or Augmentin.
Clostridium sp. Gram positive species. produce spores and toxins.
C. perfringens/C.septicum - common cause of gangrene, treat with
penicillins or metronidazole
C.tetani - tetanus - For tetanus and botulism, the damage is from
toxins, not the bacteria themselves
C. botulinum - botulism
C. difficille - causes diarrhea following antibiotics. treat with
metronidazole
Others
Chlamydia sp: Includes C.pneumonia, responsible for a type of atypical
pneumonia and C.trachomatis, responsible for the sexually transmitted
disease chlamydia. It is best treated with Tetracyclines or as second
choice a macrolide.
Mycoplasma pneumoniae: A cause of atypical pneumonia. Treated best with
a Macrolide, with a second choice of a tetracycline.
The Drugs
Penicillins - These act by preventing replicating bacteria from
producing a cell wall. A number of bacteria produce a enzyme which inactivates
the penicillins ( B-lactamase).
A number of varieties:
Benzyl Penicillin: Injectable preparation. Antibiotic of choice against
severe Strep pneumoniae and Neisseria sp infections such as chest
infections, meningitis and cellulitis.
Phenoxymethylpenicillin (Penicillin V): Oral preparation of above.
Usually used only for the treatment of sore throats (strep throats), in
other infections largely replaced by amoxycillin which is better absorbed.
Flucloxacillin: Oral and IV drug of choice for Staph infection such as
cellulitis, boils and abscess and bone infections. Also usually
effective against Strep, but not first choice.
Amoxycillin: (newer version of ampicillin): Oral and IV. Effective
against most gram positive and negative bugs. Limited use secondary to
B-lactamase resistance in many bugs. This is overcome with the addition of
Clavulanic Acid ( e.g. Augmentin). Overcoming this resistance, makes
this combination my ideal survival antibiotic, with good gram positive,
negative and anaerobic cover. This drug I feel is the best "broad
spectrum" antibiotic commonly available, other AB's may be better for
specific infections but this is the best all purpose one.
Cephalosporins - Same method of action as penicillins. Developed in
three generations (now four, but not widely available). The third
generation e.g., Cefotaxime (Claforan, IV only) and Ceftriaxone (Rocephin, IV
only) have the most broad spectrum. They are effective against most gram
positives and negatives and some variable anaerobic cover. The second
generation e.g., Cefuroxime (Zinacef, oral and IV) and Cefaclor
(Ceclor, oral only) also have good general cover, but are not as effective
against some gram negative bacilli. This loss of gram negative cover
expands to most gram -ve cocci and bacilli in the first generation
cephalosporins e.g., Cephalexin (Keflex, oral only) and Cephazolin (Kefzol, IV
only). The third generation is ideal for use in those with very severe
generalized infection, meningitis or intra-abdominal sepsis (e.g.,
penetrating abdo wound or appendicitis, with metronidazole added in) and the
second generation offer a good broad spectrum antibiotic for general
use in skin, wound, urinary and chest infections.
Quinolones - Acts by inhibiting DNA replication in the nucleus of the
replicating bacteria. New generation of antibiotics. Most common is
Ciprofloxacin. Very broad spectrum cover, except anaerobes. Excellent
survival AB, but my second choice due to amoxycillin + clavulanic acids
better cover of anaerobes. Effective for most types of infections except
intra-abdominal sepsis and gangrene.
Macrolides - Acts by inhibiting protein synthesis in the replicating
bacteria. Includes Erythromycin and the newer Roxithromycin and
Clarithromycin. Often used in people with a penicillin allergy, however it does
have a reduced spectrum (esp. with Gram negatives), but is an
alternative to tetracycline in Chlamydia. First choice in atypical pneumonias
e.g., with Mycoplasma pneumonia.
Co-Trimoxazole - Acts by interfering with folate metabolism in the
replicating bacteria. Previously a very broad spectrum antibiotic, now has
a much more variable response rate due to resistance. Still useful for
urinary and, mild chest infections.
Metronidazole - Acts by directly damaging the structure of the DNA of
the bacteria/protozoa. Drug of choice for anaerobic infection. Should be
used with another broad spectrum AB in any one with possible fecal
contamination of a wound or intra-abdominal sepsis (such as severe
appendicitis). Also the drug of choice for parasitic infections such as
Giardia.
Others - There are many other antibiotics available. I have only
discussed the common ones above. For further information I refer you to any
Antibiotic guide, of which there are many.
www.survival-center.com/med-faq/med-7.htm