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Old 09-03-2014, 18:26   #31
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Re: Looking for a broad spectrum antibiotic

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Originally Posted by amytom View Post
So what happens to the efficacy as the various antibiotics expire? Just get weaker or actually dangerous to take?
Most antibiotics just lose potency. Tetracycline is the one exception I know of, as it can lead to renal tubular acidosis.

Annals of Internal Medicine | Renal Tubular Acidosis Secondary to Degraded Tetracycline.
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Old 09-03-2014, 18:48   #32
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Re: Looking for a broad spectrum antibiotic

Find a doctor who does Travel Medicine.

Cipro is good for traveler's diarrhea, probably the most likely infectious disease you will encounter. Also you only need take 3 days. Beyond that you can't likely make a correct diagnosis on your own and will end up taking an antibiotic needlessly. i.e., vast majority of ear aches, sore throats, coughs (even productive ones) are viral in origin and antibiotics are more likely to produce adverse reactions than cure. Skin infections should be treated with Bactrim and or Doxycycline, and you can make that diagnosis yourself, the only trick being knowing when you've developed an abscess (when antibiotics no longer work) and it is time to lance it.

As others have mentioned above your best bet is to have the various meds at your disposal and some way to communicate with your (presumably competent) family doctor to determine which would be best. Some way to transmit images can be very helpful in that case.
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Old 09-03-2014, 19:16   #33
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As an MD, I'd suggest you think about what you're likely to need antibiotics for. Tailoring antibiotics to the likely source makes them more likely to work:

1. Skin infections
2. Dental infections
3. Maybe traveler's diarrhea although antibiotics are not essential, just shortening course.

For land exposure skin infections, Bactrim (sulfa med) is the best coverage against staph because it covers MRSA. Clindamycin is a close second but has emerging MRSA resistance. Bactrim also treats UTIs. Augmentin works well as long as not MRSA, which is becoming increasingly common in populated areas.

Many boating skin infections are water exposure infections, which are a bit more complex.

For water exposure skin infections, staph, strep, and some serious bacteria (vibrio, aeromonas,mycobacterium marinum, and some others) can be nasty.
For those,
Clindamycin+ levofloxacin. You also need to get to hospital quickly if infection don't respond, or if you are having serious fevers and chills, as vibrio needs ICU care with IV antibiotics. Hopefully these meds would slow things to get you time to get to care.

So assuming no allergies, I would personally pack:
1. Bactrim DS tablets
2. Clindamycin 300mg capsules
3. Levofloxacin 750mg tabs (a broader cousin of cipro, better for skin, and also covers pneumonia)
4. Augmentin (amoxicillin/clavulonate) which is much better for soft tissue infections than plain amoxicillin. Also works for dental.

# 1 is best for simple dry land skin infections, UTIs
#2 for skin infections, dental infections, and combined with #3 for serious water borne soft tissue infections
#3 for pneumonia, sinus infections, bad bronchitis
#4 for dental infections, some skin infections not involving MRSA


Usual disclaimers apply. This is only for adults, and only represents my advice to myself, not you. You should speak to your doctor about your own conditions and suitability for these meds. Also self-diagnosing and taking them on your own is likely a crapshoot, but perhaps buys you time to get help.

Can you tell I practice medicine in the US?
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Old 09-03-2014, 20:10   #34
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Re: Looking for a broad spectrum antibiotic

Quote:
Originally Posted by malbert73 View Post
As an MD, I'd suggest you think about what you're likely to need antibiotics for. Tailoring antibiotics to the likely source makes them more likely to work:

1. Skin infections
2. Dental infections
3. Maybe traveler's diarrhea although antibiotics are not essential, just shortening course.

For land exposure skin infections, Bactrim (sulfa med) is the best coverage against staph because it covers MRSA. Clindamycin is a close second but has emerging MRSA resistance. Bactrim also treats UTIs. Augmentin works well as long as not MRSA, which is becoming increasingly common in populated areas.

Many boating skin infections are water exposure infections, which are a bit more complex.

For water exposure skin infections, staph, strep, and some serious bacteria (vibrio, aeromonas,mycobacterium marinum, and some others) can be nasty.
For those,
Clindamycin+ levofloxacin. You also need to get to hospital quickly if infection don't respond, or if you are having serious fevers and chills, as vibrio needs ICU care with IV antibiotics. Hopefully these meds would slow things to get you time to get to care.

So assuming no allergies, I would personally pack:
1. Bactrim DS tablets
2. Clindamycin 300mg capsules
3. Levofloxacin 750mg tabs (a broader cousin of cipro, better for skin, and also covers pneumonia)
4. Augmentin (amoxicillin/clavulonate) which is much better for soft tissue infections than plain amoxicillin. Also works for dental.

# 1 is best for simple dry land skin infections, UTIs
#2 for skin infections, dental infections, and combined with #3 for serious water borne soft tissue infections
#3 for pneumonia, sinus infections, bad bronchitis
#4 for dental infections, some skin infections not involving MRSA


Usual disclaimers apply. This is only for adults, and only represents my advice to myself, not you. You should speak to your doctor about your own conditions and suitability for these meds. Also self-diagnosing and taking them on your own is likely a crapshoot, but perhaps buys you time to get help.

Can you tell I practice medicine in the US?
this is a keeper, thanks, filed for the next trip!
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Old 09-03-2014, 20:13   #35
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Re: Looking for a broad spectrum antibiotic

Quote:
Originally Posted by malbert73 View Post
As an MD, I'd suggest you think about what you're likely to need antibiotics for. Tailoring antibiotics to the likely source makes them more likely to work:

1. Skin infections
2. Dental infections
3. Maybe traveler's diarrhea although antibiotics are not essential, just shortening course.

For land exposure skin infections, Bactrim (sulfa med) is the best coverage against staph because it covers MRSA. Clindamycin is a close second but has emerging MRSA resistance. Bactrim also treats UTIs. Augmentin works well as long as not MRSA, which is becoming increasingly common in populated areas.

Many boating skin infections are water exposure infections, which are a bit more complex.

For water exposure skin infections, staph, strep, and some serious bacteria (vibrio, aeromonas,mycobacterium marinum, and some others) can be nasty.
For those,
Clindamycin+ levofloxacin. You also need to get to hospital quickly if infection don't respond, or if you are having serious fevers and chills, as vibrio needs ICU care with IV antibiotics. Hopefully these meds would slow things to get you time to get to care.

So assuming no allergies, I would personally pack:
1. Bactrim DS tablets
2. Clindamycin 300mg capsules
3. Levofloxacin 750mg tabs (a broader cousin of cipro, better for skin, and also covers pneumonia)
4. Augmentin (amoxicillin/clavulonate) which is much better for soft tissue infections than plain amoxicillin. Also works for dental.

# 1 is best for simple dry land skin infections, UTIs
#2 for skin infections, dental infections, and combined with #3 for serious water borne soft tissue infections
#3 for pneumonia, sinus infections, bad bronchitis
#4 for dental infections, some skin infections not involving MRSA


Usual disclaimers apply. This is only for adults, and only represents my advice to myself, not you. You should speak to your doctor about your own conditions and suitability for these meds. Also self-diagnosing and taking them on your own is likely a crapshoot, but perhaps buys you time to get help.

Can you tell I practice medicine in the US?
Malbert,

Thank you for a very informative post.

I would like to add that the doctors in the foreign countries you visit will know what best treats skin infections in their area; a call in at the nurses' station can be quite informative. The experience that informs this opinion is observation of the efficacy of ampicillin against skin staph in Fiji, where flucloxacin (sp?) worked and the former did not. Perhaps it was a wrong application of the ampicillin? (not intended for skin?) In the main, they're always amazed at the drug stores of American yachties, who can ask, "which would be better of what I have, "x" or "y"?

What I think the Canadian GP had in mind was that if the OP's destination is the tropics, a consulting phone call to a tropical medicine specialist might inform his requests; and I think it was a generous offer to provide what the OP found out about that is different from practice north of 48 North.
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Old 09-03-2014, 21:28   #36
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Re: Looking for a broad spectrum antibiotic

If I was gonna carry 2 scripts they would be Mupirocin ointment. (Bactroban) This is for skin infections which are some of the most dangerous and Ciprofloxacin (gut problems) General antibiotic.

If Malaria is problem Doxycycline
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Old 09-03-2014, 22:28   #37
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Re: Looking for a broad spectrum antibiotic

I'd try to make sure you knew how you reacted to any medications you took with you.

I for one would stay away from Cipro, unless I really had to take it. I had huge achilles tendon problems with it, as well as quite severe cramps. A friend ended up with a severed achilles. Of course YMMV.
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Old 09-03-2014, 23:13   #38
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Quote:
Originally Posted by Ann T. Cate View Post

Malbert,

Thank you for a very informative post.

I would like to add that the doctors in the foreign countries you visit will know what best treats skin infections in their area; a call in at the nurses' station can be quite informative. The experience that informs this opinion is observation of the efficacy of ampicillin against skin staph in Fiji, where flucloxacin (sp?) worked and the former did not. Perhaps it was a wrong application of the ampicillin? (not intended for skin?) In the main, they're always amazed at the drug stores of American yachties, who can ask, "which would be better of what I have, "x" or "y"?

What I think the Canadian GP had in mind was that if the OP's destination is the tropics, a consulting phone call to a tropical medicine specialist might inform his requests; and I think it was a generous offer to provide what the OP found out about that is different from practice north of 48 North.
A very good point- localities can vary in predominant organisms in water (really depending on sewage treatment). That said, staph is staph, and strep is strep. The big question is whether there is resistance to standad antibiotics. dicloxacillin is one of the best oral agents we could use for strep/staph skin infections, but in North america the emergence of MRSA (methicillin resistant staph aureus) has rendered it too risky to try, even though it actually works better and more quickly for MSSA (methicillin susceptible staph aureus) than bactrim or clindamycin.

So the best question for the places you are visiting are if they have heard of MRSA. If not, then dicloxacillin (or flucloxacillin if available) would be worth packing. In more remote areas, where folks haven't had the superbugs like MRSA naturally selected by antibiotic overuse in the population, there probably isn't much resistance.

To answer others- cipro (and levofloxacin) do have tendon issues including rupture among possible adverse effects. I always tell folks to take it easy if they must use. Bactrim makes you sun sensitive. Clinda may give pretty nasty GI upset. And so on, so best to avoid taking med frivolously. And yes, I actually had one of my patient's wives die suddenly after taking azithromycin (not prescribed by me)- before the FDA black box warning came out in 2013 about heart arrythmia potential. So taking the famous zpack for a viral cold, or cipro for a benign traveler's diarrhea, could lead to more serious effects and should be considered carefully....

All negatives aside, good luck and happy sailing!!
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