OK, you’re about to be transported to an area teaming with sharp, dirty things, vicious animals, and nasty people out to do you harm. You’re allowed to bring with you whatever you can carry, but you’re only allowed to bring along one single type of antibiotic–as much as you’d like.
Which one would you choose, and why?
I’m leaning toward Cipro.
Erythromycin. Broad spectrum. Second choice, azithromycin.
Augmentin. First line for animal bites and covers the various likely skin bugs well. Also covers lobar pneumonia and strep great.
Cipro doesn’t have the anaerobic coverage you need and erythro misses Pasteurella (common in cat bites, which being puncture wounds are hard to get cleaned out enough to prevent infection).
Zithro (azithromycin) might be okay.
Also get your immunizations updated, especially TDaP. I’d also be sure to take my inhaler - not the time to have bronchospasm.
Have a fun trip!
But only if you’ve had it before. Lots of people (I think) are allergic to penicillins. So I would stay away from them unless you know you’re not allergic. Though I don’t know what percentage of people are allergic to them (and what percentage of people are allergic to other antibiotics) The last time I had Amoxicillin I broke out in hives the day after I finished the last dose. Nothing more then some red dots, and I wouldn’t have even noticed if someone hadn’t pointed it out to me. But from what I understand that could be all I get, or it could get worse each time.
If you’ve never had it before then you are actually safer from an allergic reaction as allergic reactions are very rare on first exposure.
To the best of my knowledge true penicillin allergy is no more common per number of people exposed than any other medication. There is a lot more used than other antibiotics so there are a greater absolute number of those who have allergy to it noted. Also there are a great many people who are identified as penicillin allergic who actually do not have one, 80 to 90% of 'em. (This should not in any way be construed as a comment about your rash while on Amoxicillin.)
It’s entirely possibly I wasn’t allergic. I broke out in little red spots all over my chest an arms (didn’t itch, weren’t bumps, wouldn’t have noticed it if it wasn’t pointed out to me). I called my city’s health department and told the nurse (since it’s free). Her first question was “What antibiotic are you on?” and we went from there.
So, yeah, I very well might not be allergic to them, but for the sake of my health, I always list it as a med that I am allergic to. If I had something and the doc felt that a penicillin was the best course of action, I’d tell them what happened last time and let them make a decision. (As well as making sure I had Benadryl around and maybe ask for a script (or sample) for an Epipen just in case).
I looked up Augmentin (amoxicillin) online, and it described the typical dosage, but it didn’t say for how long I’d need to take it.
Twenty-four hours? Three days? Ten days? And, what’s the shelf life on the stuff?
I noticed the side effects, too. Too bad my own rules don’t let me also bring along something for the possibility of C. diff running amok.
I’ll send pics.
Never mind. Found it.
Augmentin is amox with clavulanic acid, which helps it work much better on a variety of bugs that would otherwise be resistent to it. Length depends on if you are using it pre-emptively on a very high risk bite (like a cat bite, again, damn deep punctures very hard to adequately clean out) or for an established infection. Preventatively just a few days will do ya; for treatment more like ten. Diarrhea the most common side effect so kill yourself some of them varmits to roast up to eat with each dose in order to decrease that risk. Save the fur to use as TP!
My guess, and just a guess, is two or three years shelf life for the pills but your supply should have an expiration date on it.
Pics? I want youtube buddy!
Doxycycline?
I too would opt for Augmentin, though given the recent increase in prevalence of CA-MRSA, I’d consider minocycline as an auxiliary. But then most CA-MRSA skin and soft tissue infections respond well to incision and drainage without the need for systemic antibiotics, so I guess I’d take augmentin and a nice sharp scalpel.
I would ask where you are going? What is the resistance patterns in the area? Is this one of those time travel hypothetical where you are going back before antibiotics were in normal use?
Also, can I bring along supplies to administer this antibiotic? If so, Zosyn (IV only), might be worth bringing.
They never said anything about anesthetics, so I’ll also bring some lidocaine.
I don’t know. All I know is that when I get back, I’ll be able to pay for everyone’s advice with some fine varmint pelts.
I hope one or more of the MD’s check back in here…
How about imepenem?
Personally I don’t want to have to go IV two or more times a day for, say, an infected bug bite or even a moderate pneumonia. Especially not in a dirty environment. Not when I’ve got something that should suffice for most likely needs po.
Another vote for Augmentin. In fact, on my doctor’s advice over here, I keep some in the house. (Sold over the counter over here.) Erythromycin is a good second choice.
I’d vote for Co-Amoxiclav 500/125 (Augmentin 625) too, with Erythromycin as a back up.
As long as it wasn’t for me…as I’m allergic to penicillins (anaphylaxis) and had a bad reaction to Erythromycin (Stevens-Johnson). I’m OK with Cephalosporins allergy wise, although the side effects are not ideal.
For me, I’d probably go with a combo and bring quinolone/tetracycline/cephalosporin to cover most bases.
The last time I needed antibiotics for a chest infection I ended up with co-trimoxazole, which hasn’t been used commonly for years, and is now almost exclusively used by patients with HIV to prevent a type of pneumonia.
Funny looks at the pharmacy, but it worked fine, and sulfa drugs seem to agree with me.
Not sure why you got funny looks. That’s better known by its brand name Bactrim and is still a great drug. A very reasonable choice as an alternate to Amox-clav in this context and a typical first line for UTIs as well as a good choice for MRSA. Used often.
This is where medical cultural differences come into play.
Bactrim isn’t used here much at all- different resistance patterns and local guidelines etc.
In 6 years of medical school and 5 years of practice I have seen it prescribed solely for Pneumocystis prophylaxis and treatment and I’ve never prescribed it myself, to anyone, ever.
We use Trimethoprim alone first line for UTIs (with Nitrofurantoin as second line), and other things for MRSA.
I agree Co-trimoxazole is a perfectly good drug, and, for me, has zero side effects, which, compared to the way I react to most antibiotics, is a serious pro.
I think I’d probably want a little info about where I was going, so as to try and get a handle on local resistance patterns.