Week 1 – Question of the Week: Which 3 medicines matter most?

Week 1:  2011-03-10

A reader asks:

Which 3 medicines matter most? 

What 3 would you choose for a desert isle (or TEOTWAWKI)?

I’m inviting our professional panel to weigh in on the question.

Check back soon to read their comments below.

– Doc Cindy
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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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18 Responses to Week 1 – Question of the Week: Which 3 medicines matter most?

  1. Chris MD says:

    Having given it some more thought, I think I would ditch one of the orals antibiotics (probably Amoxicillin) and substitute a triple antibiotic ointment. In a true [end of civilization] situation, prevention will be far better than treatment. In previous centuries, infected wounds were a common cause of M&M. A little Neosporin applied at the time of injury could prevent the need for large amounts of systemic antibiotics later.

  2. DD, MD says:

    1) Ceftriaxone (Rocephin) – injected. Kills just about anything worth killing. Can’t vomit it up or spit it out. One dose lasts 24 hours.
    If it had to be an oral medication: azithromycin (Zithromax) – covers a huge amount of common infections. Expensive. If money was an issue I’d choose amoxicillin.

    2) Ibuprofen – does the job without clouding your thinking. Cheap (although the brand name Advil seems to have almost a year longer expiration date the last few times I’ve shopped for this). Pills can always be crushed for kids.

    3) Epinephrine (in the form of an Epi-pen Jr. – adults can be given two, kids can get one) – life-saver in anaphylaxis or asthma. Know how to use it. Occasionally people accidently inject this into their finger. It doesn’t work well that way. Also expensive. Cheap if you get a vial of the 1:1000 concentration and syringes – if you go this route you want a long enough needle to get the medicine into the muscle.

    All can be used in children and in pregnancy, although ibuprofen is not generally recommended in children less than 6 months of age (due mainly to a lack of studies on this age group). It is also not recommended for women late in pregnancy due to possible premature closure of the ductus arteriosus (a heart issue in the baby).

  3. Jeff says:

    Sorry for the delay… getting DMAT crews up and ready for Japan deployment…

    I picked three prescription and three OTC
    1. Cipro
    2. Keflex
    3. Epinephrine
    I’m only worried about things that will kill me. Otitis media will likely not kill me (make me poke a hole in my ear, yes – but kill me – probably not). Epinephrine is such an amazing “cure all”… Anaphylaxis, severe asthma, bradycardia, hypotension… if it could only clean my house…

    1. Neosporin (triple antibiotic cream)
    2. naproxen sodium or acetaminophen (depending on med allergies)
    3. mega multi-vitamin
    Was mostly thinking about the antipyretic affects of a NSAID or acetaminophen… pain relief would be handy too… ASA would be great depending on allergies / reye’s risk…
    Having watched the effects of living off goat meat and rice for a several months, the need for “monster” MVI seems really crucial…

  4. Amy CRNP says:

    I started to read my peer’s comments but thought it might be interesting to read them after my own thoughts are posted….

    If I were on a desert island I would take the following:

    1) Lortab or Percocet-both of these narcotic combination meds that have acetaminophen in them doubling as an antipyretic.
    2) Benadryl for allergic reactions, insomnia
    3) probably Bactrim as the ABX of choice to cover any MRSA carrying monkeys 🙂
    * Xanax is my alternate to keep us from not panicking!

  5. I hesitate in being one of the first people to respond to “Which three medicines matter most?” First the disclaimer, am not a medical professional. As a wilderness guide having patched up my share of wounds and treated assorted sickness when far from help.

    First, I think you need to assess the context of where you would likely be treating your patients using these three medicines. I don’t take literally the desert isle scenario but more likely TEOWAWKI or some mission trip or business/pleasure trip to a foreign country. If you were planning such a trip, you would hopefully have CDC recommended shots as well as malaria meds if appropriate.

    Here’s three choices:

    1. Povidone-Iodine: great for cleaning cuts and larger wounds. I have yet to find a wound getting infected after a thorough cleaning and therefore no need for antibiotics.

    2. Antihistamine: for allergic reactions – I once had a young man react from black-fly bites on a Labrador canoe trip. We were a 100 miles from any help – very scary!

    3. Cipro: reasonably broad spectrum antibiotic – good for traveler’s diarrhea, realizing it’s not ideal for wounds/cuts.

  6. DB, RN says:

    The three medications that matter the most start off with any that you might be taking. If you take insulin or any other medication that enables you to live a normal life, that medication is by default #1 on your list.

    The second most important medication should probably be a broad spectrum antibiotic. One won’t kill all the bugs out there, but the right broad spectrum antibiotic may save your life.

    Number three would be a good NSAID. Because studies show that it has the least chance of side effects (stroke), I like Naproxen Sodium.

    That being said, it’s tough to pick three since no category was given. If I had to choose three medications that were obtainable without a prescription, it would be a triple antibiotic cream, a good NSAID, and a good all around cold medicine.

    I would add another category. “Supplements”. The most important of these being a vitamin D3 supplement and a high quality, whole food multivitamin, because an ounce of prevention is worth a pound of cure!

    • DB RN says:

      Add Primatene Mist. It’s just epinephrine. Get it now, as it will be removed from OTC in December.

      {Per the Armstrong Pharmaceuticals site, they’re planning to get a CFC-free Primatene inhaler out by then. The current inhaler uses a CFC propellant and will no longer be available after 12/31/11. – Doc Cindy}

  7. Amanda says:

    As a RN, I would pick medications that can multitask since I can only have 3!

    1. Acetaminophen- analgesic and antipyretic
    2. Broad-spectrum antibiotic- I don’t really have a fave
    3. Imodium- anti-diarrheal

    If I could pick just one more…..probably a multivitamin, as malnutrition could pose a risk and being rundown makes you more likely to succumb to infection.

  8. KF says:

    From KF

    The three meds of priority that I would grab-and-go in an austere environment on a desert isle or, if bugging out in haste in a TEOTWAWKI situation are:

    Lidocaine aqueous 500ml. – has multiple primary and secondary usages for treatment ) Anesthetic, topical use for burns, skin injury, injected into a hematoma for an effective site block to repair or set a bone fracture, dislocation, displacement, dental anesthesia for removal of tooth/teeth, injected for effective nerve block of digits, limbs, injected for effective spinal nerve block for emergency field surgery, ie; appendectomy, deep tissue shrapnel removal, c/section. Injected for treatment. of symptomatic cardiac arrhythmia’s. [Note – most of the above requires professional experience – Doc Cindy]

    Antidiarrheal: Loperamide:
    Food and water sources will be suspect for dysentery, giardia, and cholera-form bacteria causing infectious diarrhea. The loss of body fluids due to diarrhea leads rapidly to hypovolemia. If severe, prostration and eventual shock and death. Also, used to treat secondary effects of antibiotic therapy.

    Azithromycin – broad-spectrum antibiotic, effective for respiratory, skin, and many genito-urinary infections

    [KF sent a detailed report on azithromycin, to be included in a full post soon. – Doc Cindy]

    • pa4ortho says:

      Would you consider marcaine 1% for nerve blocks and water it down to 0.25% for local block? Slower onset but lasts a lot longer.

  9. pa4ortho says:

    3 best drugs for a deserted island question by pa4ortho


    1. desert island is in the tropics just without Gilligan and crew.
    2. for some unknown reason we are actually PLANNING to go to a deserted island with only 3 meds.
    3. general survival equipment is well covered.
    4. although I am an orthopedist I am now the everything doc/dentist/plumber/farmer/sanitation/hunter/and my own worst enemy!

    Risk assessment:

    1. viral infection is low as we are alone and not exposed to pandemics
    2. bacterial infection risk is high to include specialized infections from coral
    3. environmental toxin risk is moderate to include insects, snakes, fish spines
    4. parasite infection risk is high due to malaria, roundworms, protozoa, amoeba
    5. blunt trauma risk is high due to use of hand tools, surf, construction, etc…
    6. environmental stresses include heat, dehydration, sun.
    7. psychological stress of isolation is significant. At least Tom Hanks had Wilson.

    Here we go:

    1. Pain meds. Percocet 5/325. Pain sucks and is demoralizing and disabling. That = death when you are on your own and you must work for food. Besides I cheated and got Tylenol for fevers along with good cough medicine all in one pill.

    2. Diarrhea. Loose stools are a common problem. They lead to dehydration and disability. Usually I would take Imodium along with a quinolone to get back to work. If that fails then Flagyl and Imodium. Outside the first world, without antibiotics I would hesitate to use Imodium. Especially in this environment due to the risk of causing an overwhelming bacterial infection in the gut with reduced motility. In this case Pepto-bismol would be a better choice. The pink stuff comes in tablet form for better shelf life and portability. It also has some antimicrobial benefit.

    3. Antibiotics. So I’m down to one less than ideal drug for everything so its going to have to be a quinolone. While ciprofloxacin is cheapest, it lacks strong strep and staph coverage. Levaquin would be a good choice for more money but my pick would be moxifloxacin for its improved function on gram neg and strep and staph. Bacteria concerns include early strep with its light pink cellulitis around a wound, staph presenting as a boil, coral presenting as a slow healing festering wound due to retained coral calcium and living coral, (scrub hard with salt water to clean the wound) aeromonas in brackish water sensitive to quinolones as second line treatment, vibrio speces found in sea water/coral etc…respond to doxycycline but quinolones also work, (plan on aggressive surgical debridement also. This was a huge problem after the tsunami in 04)

    So looks like I will suffer parasites unless I get 3 more drugs!

    1. albendazole
    2. Flagyl
    3. doxycycline

    For a long term setting with no resupply for the next 30 years…..

    1. poppy seed for making opiates for pain control – with all the unfortunate debilitating side effects of poorly refined pain meds.
    2. Basic Surgical tools, heal with steel
    3. Artemisia annua- the closest thing to homemade antibiotics. Drug of choice worldwide for malaria, excellent anti-fungal, broad spectrum antiparasitic, proven on blood fluke, liver fluke, cryptosporidium, protozoans, lyme, moderate effect on E.coli and Staph A. Not effective on gram neg as it can’t penetrate the lipid layer. It does cross the blood brain barrier. Safe in heart liver and Kidney disease as well as pregnancy.

    Veridian-rizi MR Chemical composition and antimicrobial activity of the essential oil of artemisia annua L. from Iran. Phcog Res 2009

    Lehane L & Rawlin GT Topically acquired bacterial zoonoses from fish: a review. Med J Aust 2000; 173:256-259

  10. Polumetis says:

    As an anesthesiologist, halothane, morphine, and bupivicaine…

    Cheating because most people think of desert island meds as oral only.

    As a general physician, probably aspirin, Augmentin, and tramadol.

  11. Lorne, RPh says:

    In general…
    1. a good broad spectrum antibiotic- pick your fav
    2. acetaminophen – low side-effect profile, great shelf life
    3. loperamide – in case I drink the water (look at the “death by diarrhea” stats of 3rd world countries)

    1. anything I specifically need to keep me alive
    2. a larger bottle of #1
    3. more of #2

  12. vtxdpm says:

    I put up my 3 picks earlier, but as for “What 3 meds matter most?” I’d have to reply, “The meds you happen to need at the moment!”

    For a diabetic, it might be insulin or an oral hypoglycemic. For the person in anaphylactic shock, it may be epinephrine. The person in the midst of her asthma attack will be glad to have her inhaler. You get the idea.

    The meds that matter most are the ones you need at the moment, or are likely to need during the most plausible scenario.

  13. vtxdpm says:

    Having only three meds to rely on requires me to look for “Multi-taskers.” There are far too many diseases to cover them all but my top 3 useful meds to have are…

    #1: a simple but useful multi-tasker – aspirin (ASA). Anti-inflammatory, pain relief, anti-platelet (helps reduce the risk of heart attack (MI) and ischemic stroke), and is an anti-pyretic (fever)**.

    (**However, please note: The U.S. Surgeon General, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics recommend that aspirin and combination products containing aspirin not be given to children under 19 years of age during episodes of fever-causing illnesses. Look up “Reye Syndrome”.)

    Second pick: A broad spectrum antibiotic for skin and soft-tissue infections as well as some sinus, pulmonary and intra-abdominal infections. Avelox (moxifloxacin) is one possible choice.

    And third, metronidazole (Flagyl). In a bad situation, clean water and good sanitation may be hard to maintain and a bad case of diarrhea could dehydrate and kill you pretty quickly. Metronidazole could be very handy.

    (from the web: “Metronidazole is an antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal. It is the drug of choice for first episodes of mild-to-moderate Clostridium difficile infection.”)

  14. Wh2thdr says:

    For the dentist …. Got to have lots of Lidocaine 2% w/ 1:100,000 epi, Ibuprofen 800, and Pen V K 500 ( add E-mycin 500 if antibiotics count as a single entry)

  15. Chris MD says:

    Well, from a TEOTWAWKI situation, (or a desert isle) I would pick Bactrim (covers MRSA, most UTI’s, skin & soft tissue stuff), Amoxicillin (covers lung and upper respiratory stuff) and vitamin C (lacking access to fresh fruit, tough to get, and scurvy is a rotten way to go.)

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