7.0 . Medications

The next two sections contain a significant amount of technical information. It is intended as a very brief overview and introduction of the subject area. I accept no responsibility for the accuracy or otherwise of this material. The following are more specific references for these topics :

Antibiotics

Microbiology Laboratory Medicine

No ideal book in this section, but these are a couple of suggestions.

7.1 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.

7.2 Antibiotics

7.2.1 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.

  1. A Broad spectrum Penicillin (e.g.-- Amoxycillin+ Clavulanic Acid)
  2. A Quinolone (e.g.-- Ciprofloxacin)
  3. 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.

7.2.2 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

  1. Gram positive ( + ve )
  2. Gram negative ( - ve )
  3. Anaerobes
  4. 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)

Gram Negative Bacteria ( Gram -ve ) Anaerobes Others The Drugs NOTE

In pregnancy Penicillins and Cephalosporins are safe. Many others are not (or only during certain parts of the pregnancy). You should always check if any drug you are using is safe, before using in pregnancy and breast feeding. The PDR will tell you. If you want a specific reference try "Drugs in Pregnancy", Ed D.F Hawkins.


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