Fish Antibiotics – Where to Start: Cephalexin

If you’ve given up on getting your doctor to prescribe extra antibiotics for stockpiling or perhaps merely want to supplement your limited stores, you may be considering the “fish antibiotic” route.

This series of articles in aimed at discussing the value of acquiring specific antibiotics.  You should, of course, make sure the product you intend to acquire is a USP grade A-B rated generic (as discussed elsewhere on this site).

With so many products available, where does one begin?  The answer depends on the “bugs” (bacteria) you expect you’ll need to kill.  With no easy way of knowing this at TEOTWAWKI (and lacking a background in medical microbiology) how can the layman make an informed decision?

Antibiotics are generally divided into “broad spectrum” and “narrow spectrum” classifications.  If you’re going to acquire a single antibiotic, you’ll want a broad spectrum antibiotic, that is, one that kills a variety of bacteria, especially the most common ones (Staph, Strep, Pneumococcus, E. coli).  These bacteria are commonly implicated in causing sore throats, respiratory infections, ear infections, pneumonia, urinary tract, and skin infections.  In the old, old days, plain old penicillin fit the bill nicely, and in fact was a “wonder drug” when first discovered.  At that time bacteria had not been exposed to penicillin and resistant mutations were rare in the bacterial population.  As the use of antibiotics has increased, bacteria have become less and less sensitive to penicillin, as the easy targets (penicillin-sensitive bacteria) are killed off and only the resistant “mutants” can survive and thrive.  Because penicillin and amoxicillin are, therefore, less likely to be effective, I would not choose either of these as my first choice antibiotic.  (Nowadays doctors practically use these as placebos.)

(One side note here:  at TEOTWAWKI, antibiotic use will sharply fall, leaving the bacterial population to adjust to a new norm.  In general, mutant (resistant) bacteria are inferior to non-mutated bacteria in the natural environment lacking antibiotic exposure. Therefore over multiple generations of microbial reproduction the bacterial population may well regain its original sensitivity to the killing effects of the penicillins.  So although penicillin and amoxicillin are currently ineffective against many bacteria, this will likely change once their use diminishes.  Stockpiling these drugs for future use, perhaps years from now, is therefore reasonable, with the above in mind.  At some point they may again be wonder drugs.)

Although no antibiotic kills every germ, cephalexin is a good choice as the first antibiotic to stockpile.  Currently it is reliably effective (a good 80% of the time) against most bacteria which cause respiratory infections, sore throats, middle ear infections, bacterial pneumonia, and skin infections.  It is not effective against C. diff (Clostridium difficile) or MRSA (methicillin-resistant Staph. aureus).  It is not first-line treatment for urinary infections, but would likely be effective at least half the time.  It is a cousin of the penicillin group of antibiotics and people who are allergic to penicillin run about a 10% risk of being allergic to cephalexin.  Patients allergic to the class of cephalosporin drugs (Ceclor, Duricef, Omnicef, Suprax, Ceftin, Cefzil and others) should not take cephalexin.  Overall, however, the drug is quite well-tolerated, causing little gastrointestinal distress, and may be safely used in children and is generally safe in pregnancy.

The usual adult dose of cephalexin ranges from a total of 1 to 4 gm daily, spread out over 2 to 4 doses per day (250–500 mg every 6 hours, or 500 mg every 12 hours).  Dosage in children is 25–50 mg/kg per day, divided into 2 to 4 separate doses.  For severe infections (and some ear infections) the dose may be doubled.  Generally 10 days of therapy is advised, although for minor infections 5 days may be sufficient.

Of course, I would not recommend using your precious antibiotic stockpile for a minor infection UNLESS you are quite sure it will nip an infection “in the bud” and prevent the need for additional antibiotics.  The most common example of this would be a woman with recurrent urinary tract infections who knows that taking a single day of antibiotics prevents the development of a full-blown bladder or kidney infection.  Another exception would be a contagious disease that could be confined to a single individual by the early and judicious use of an antibiotic, thus preventing the spread to the community at large.

The next installment of this series will focus on ciprofloxacin.



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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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5 Responses to Fish Antibiotics – Where to Start: Cephalexin

  1. Ruth says:

    Dr. K: can’t find cephalexin at Wal-Mart. Is it in the pharmaceutical dept. or in aquarium supplies? Or no longer available?
    Called stores don’t know what I’m talking about. Online it’s much more expensive.

    [I have not found it in local pet stores, but only online under fish antibiotics. They do charge more than when the same medicine is prescribed for humans. – Doc Cindy]

  2. Dr. Ron L. K says:

    Well written and full of solid information. Thanks, Doc

  3. Charlotte says:

    What should I stock up on instead of penicillin? Everyone in my family is allergic.

    [Erythromycin (or azithromycin) is the normal alternative. Clindamycin is good, too, but harder to come by and more expensive. About 10% of penicillin-sensitive individuals cross-react with cephalexin and similar cephalosporins. Doxycycline is also useful, but stains forming teeth in children. – Doc Cindy]

  4. Mactex says:

    Good information, well written although I would have liked a little more detail on what it treated (but realize space restrictions).

    Thanks for sharing, keep up the good work

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