Water in Adverse Environments (Part 4 of 4)

Thanks again to  Pete Farmer for the following post.  Don’t forget to read the rest of the series Pete has so graciously shared.  (See http://armageddonmedicine.net/?cat=229)

* * *  

In the previous three installments of this series, we considered at length the chemical and physical properties of water, the human physiology of fluid balance, including recognizing and treating dehydration, and finding and treating water in adverse environments. To conclude the series, the following article will consider a few additional aspects of water and survival in adverse environments not previously covered, as well as tie up some loose ends. 

Animals as diagnostic indicators of water 

In part 3 of the series, we discussed finding water in the wilderness settings, specifically

using local terrain features and plant life as guides to lead you to water. However, an important facet of these techniques was omitted – animal life as a guide to finding a reliable water source. John Wiseman’s indispensable “SAS Survival Handbook” (Harper Collins, 2009) notes that local wildlife may be used as a diagnostic indicator of the presence/absence of water (p.42), but with the caveat that different varieties of wildlife do not necessarily indicate the same things regarding water. Most mammals require water at regular intervals, or at least at dawn or dusk; grazing animals generally congregate near and do not stray far from water. Game trails often converge downhill upon springs, watering holes, and the like. However, some species migrate seasonally to mate, or provide themselves with reliable food, water, and cover – and may thus be seen far from water at times.

Carnivores, which get much of their hydration from their prey, can go for long periods without water and are not reliable indicators of a nearby source (an exception is that they often track prey by hunting near watering holes). Birds are unreliable indicators of water, except for grain-eating species such as finches and pigeons, which do not stray far from water. When heading for water, they fly straight and low. Reptiles can go long periods without water, and are thus also unreliable indicators. Insects are usually good indicators, especially bees and ants. Bees generally go no further than four miles from their hives, and need a reliable source of water, as do ants. Flies generally go no further than 100 yards from water or a source of moisture. 

 Plants and animals as sources of water 

Wiseman notes that safe drinking water can be obtained from a variety of plant and animal species, depending on the local flora and fauna. SAS personnel are trained to operate in virtually every environment found on Earth, and are thus expected to improvise using whatever natural resources are on-hand. Parasitic plants of the tropics, such as members of the bromeliad family, are often cup-shaped and thus catch water. Bamboo can trap water in its hollow joints, which can be drained by cutting into the stalk. Some species of woody vines entrap water, though Wiseman cautions that some varieties have poisonous sap. Some types of palm trees contain a sugary fluid which is drinkable. Coconut milk is safe and nutritious – but avoid over-ripe coconuts, as their milk acts as a laxative. Desert plants and roots can yield moisture – Wiseman recommends having an experienced guide show you which ones are best to use. Some desert and dry-adapted plants, such as the famed saguaro cactus, produce liquid that looks safe but is poisonous; others such as the barrel cactus, yield watery sap and pulp laden with safe-to-drink water. The prickly pear cactus can also be harvested for its pulp and fruit. Again, knowledge of the local plant life is critical; forewarned is forearmed. 

Moving on to animal sources of moisture, Wiseman notes that most animal eyes contain fluid which can be consumed in an emergency. Fish, especially larger species, tend to accumulate a reservoir of fresh water alongside their spines; by carefully dressing the fish, this can be collected and consumed. Certain amphibians/frogs can be squeezed to collect water. 

The above methods for harvesting water are obviously a last resort, when more reliable methods are not possible. It should be stressed again that not all plants are safe sources of moisture. Many plants produce potent alkaloids or other poisons to ward off predators. In some plants, the leaves and stems are safe to consume, but the fruit is poisonous; in others, the opposite obtains. There is no substitute for knowledge of the local flora and fauna. 

Melting snow and ice for water

 Wiseman recommends melting ice rather than snow, if you have a choice, given that ice produces more volume of water with less heat. More densely-packed snow will yield more water than freshly fallen layers. 

Conclusion 

Unless you are a seasoned field biologist, outdoorsman, or wilderness survival expert, who can rely upon years of accumulated experience, knowledge and training – you are probably operating at a knowledge deficit when  you find yourself in the wilderness. If you are caught in such circumstances by chance, you will have to rely on good judgment, resourcefulness and knowing your limitations to pull you through. However, if you plan to travel into the wilderness, it is essential that you do your homework beforehand in case you find yourself in dire straits unexpectedly. Mother nature can punish you when you least expect it. Do not be too proud to hire an experienced guide or other party with appropriate experience; such a person can mean the difference between walking out and being carried out. Know thoroughly the area and region in which you will be traveling, including the local flora and fauna. Plan thoroughly, equip yourself well, and notify others of your exact route, time and expected place of return, and other vital information, and things should turn out well. Happy travels… and don’t forget to bring plenty of water!

Coyright © 2011 Peter Farmer

Enhanced by Zemanta
Posted in Contributors, Dehydration, Medical archives, Pete Farmer, Preparation, Water | Tagged , , , , , , | Leave a comment

Protected: Tooth Extraction – Part 2 – Mandibular Anesthesia

This content is password protected. To view it please enter your password below:

Posted in Dental, Dental - MPO, Dental anesthesia, Medical archives, Medical Professionals Only, Tooth extraction, W Hampton - Tooth Doctor | Tagged , , , , , , , | Enter your password to view comments.

Potassium Iodide to Protect the Thyroid from Nuclear Fallout – Reader’s Questions

With recent nuclear power plant crisis in Japan, everyone’s asking about taking potassium iodide.

Since the CDC and FDA offer detailed information, I will not duplicate that information (see references below), but rather focus here on questions readers have asked.  I may add to this post as time goes on, depending on future questions.

* * *

Question from MP: Regarding this article from SurvivalBlog ( http://www.atsdr.cdc.gov/csem/iodine/treatment_management2.html), it indicates Potassium Iodide is not needed for anyone over age 40 if exposed to high levels of radiation since their risk of thyroid cancer is low. Is this true?

Answer: Per the CDC: Adults older than 40 years should not take KI unless public health or emergency management officials say that contamination with a very large dose of radioactive iodine is expected. Adults older than 40 years have the lowest chance of developing thyroid cancer or thyroid injury after contamination with radioactive iodine. They also have a greater chance of having allergic reactions to KI.”

Doc Cindy adds: The statement is half-true, or at least needs further explanation.  Part of the question here is the amount of (potential) exposure, which you probably won’t know unless a health or government official can tell you.  With a minimal exposure, adults over 40 years of age need not be treated.  With a high dose, they should be treated, however.  In between is not specified, though your supply of KI may determine what you decide to do.  If you have kids and limited KI available, protect them first. One dose is better than none, but if the need for KI exists at all, the need will probably persist for several days.  It makes more sense to protect susceptible children over several days than to treat adults unlikely to suffer with eventual radiation-related thyroid cancer (even though overall thyroid cancer is more common with increasing age.)

However, though the risk of side-effects is increased in these middle-aged and older adults, since the protective effect is primarily from the first dose, and since the CDC advises a single dose for pregnant and nursing women anyway, it seems reasonable for adults to protect themselves with a single immediate dose of potassium iodide, especially since there are no second chances.  Once the damage is done, there’s no going back.  If the iodine is concentrated in the thyroid, it cannot be removed, without removing the entire gland, which is not going to be feasible.  It also makes no sense to treat a person who has inadvertently been exposed for days.  Late treatment is ineffective.

* * *

Question from TQ: Should patients with underlying thyroid disease take potassium iodide to prevent thyroid cancer?

Answer: Per the CDC: “People with thyroid disease (for example, multinodular goiter, Graves’ disease, or autoimmune thyroiditis) may be treated with KI. This should happen under careful supervision of a doctor, especially if dosing lasts for more than a few days.”

Doc Cindy adds: The most common form of thyroid disease in adults in hypothyroidism.  The second article below discusses how hypothyroidism worsens with higher iodine intake.  At least theoretically, ingesting potassium iodide may worsen your underlying thyroid condition in a dose-dependent manner.  Personally, I doubt if a single dose would cause an observable problem in any non-allergic individual.  The patients in the article below (whose TSH levels improved with iodine restriction) only had a TSH of 21.9 to begin with, meaning they were unlikely to have clinical (noticeable) hypothyroid symptoms.

The CDC advice also says the KI should be administered under the supervision of a doctor, meaning frequent and on-going assessment of thyroid function, including blood testing.  Whether such would be available is questionable.  Again, I’d go with my original answer and say a single early dose is advisable.


Click links below for more information

Potassium Iodide, under Emergency Preparedness and Response at http://emergency.cdc.gov/radiation/ki.asp

Effect of Iodine Restriction on Thyroid Function in Patients With Primary Hypothyroidism at http://www.medscape.com/viewarticle/459924

Frequently Asked Questions on Potassium Iodide (KI) at http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072265.htm

Enhanced by Zemanta
Posted in Hyperthyroidism, Hypothyroidism, Medical archives, Nuclear radiation exposure, Perennial Favorites, Potassium Iodide KI, Stockpiling medications, Thyroid cancer, Thyroid disease, Thyroid preparations | Tagged , , , , , , , | 2 Comments

Protected: Japan Nuclear Threat – Fallout in the US?

This content is password protected. To view it please enter your password below:

Posted in Education, Medical archives, Medical Professionals Only, Preparation | Tagged , , , , , , , | Enter your password to view comments.

Free Download – Medication Dependence and Stockpiling

Here’s your free offer:

{You must click on the link below, THEN AGAIN on the page you’re transferred to.}

Template for requesting extra medication from your physician PDF

Template for requesting extra medication from your physician

Use the above template to take to your physician to initiate a discussion regarding dispensing extra medication.  Please don’t wait until your doctor is about to go out the door to express your request. Your doctor will be much more receptive if you ask at the very beginning of an office visit. Remember, breaking your word about returning for regular check-ups is a deal-breaker, and your doctor will likely never prescribe extra medication again.

If you need multiple medications, it would be best to make an appointment just for this reason, as it may take 10-15 minutes to write out several prescriptions by hand.  You probably won’t be submitting these prescriptions through your insurance, if they go beyond the next 3 months, and you may want to take them to a discount pharmacy.

If you find the template useful, please leave a comment below.

Enhanced by Zemanta
Posted in Expired medications, FREE OFFERS, Medications, Prescription Medications, Shelf life, Stockpiling medical supplies, Stockpiling medications | 2 Comments

Multi-use antibiotic for stockpiling: azithromycin

In response to our first Question of the Week, KF sent this detailed information in support of her choice of the broad-spectrum antibiotic azithromycin.
* * *
Azithromycin in Brief
  • Azithromycin

    Image via Wikipedia

    Active ingredient: Azithromycin

  • Common brand names: Zithromax, Sumamed, Azasite
  • Drug class: Antibiotic, Macrolide, Azalide group
  • Pregnancy Category: B
  • Habit forming? No
  • Originally discovered: 1981, Pliva, Croatia Croatia
Introduction

Azithromycin is the first macrolide antibiotic belonging to the azalide group. Azithromycin is derived from erythromycin by adding a nitrogen atom into the lactone ring of erythromycin A. Azithromycin is sold under the brand names Zithromax and Sumamed, and is one of the world’s best-selling antibiotics.

History

Since the 1970s, PLIVA’s (Croatian pharmaceutical company, based in Zagreb, Croatia) research team, led by Dr Slobodan Dokic, had been working in the area of macrolide antibiotics1. In 1981, his team of researchers, Gabrijela Kobrehel, Zrinka Tamburasev and Gorjana Radobolja-Lazarevski, synthesised a novel antibiotic named azithromycin, the first member of a new class of macrolide antibiotics, termed azalides. Azithromycin dihydrate was obtained from the erythromycin molecule and demonstrated superior properties.

It was patented in 1981, and was later found by Pfizer’s scientists while going through patent documents. In 1986 Pliva and Pfizer signed a licensing agreement which gave Pfizer exclusive rights for the sale of azithromycin in Western Europe and the United States. Pliva brought their azithromycin on the market in Central and Eastern Europe under the brand name of Sumamed in 1988, and Pfizer under the brand name Zithromax in 1991.

Because of its exceptional therapeutic properties, azithromycin revolutionised antibiotic treatment and became one of the most successful drugs worldwide. From its early trials, it proved to be an extremely efficient antibiotic with expanded and enhanced antibacterial activity (particularly against gram-negative pathogens), prolonged and higher tissue concentration and a low incidence of gastrointestinal side effects compared to other similar antibiotics.

FDA approved uses

Azithromycin is indicated for the treatment of the following infections due to susceptible strains of sensitive organisms:

  • Upper respiratory tract infections: pharyngitis/tonsillitis, sinusitis, otitis media
  • Lower respiratory tract infections: bronchitis, acute exacerbation of chronic bronchitis, community acquired pneumonia of mild severity.
  • Sexually transmitted diseases: uncomplicated urethritis, uncomplicated cervicitis due to Neisseria gonorrhoeae or Chlamydia trachomatis.
  • Chancroid (genital ulcer disease in men).
  • Skin and soft tissue infections: erysipelas, impetigo, secondary pyoderma, erythema migrans.
  • Mycobacterial Infections.
Off-label & Investigational uses

Off-label and investigational uses of Azithromycin include:

Infectious diseases:

  • Pelvic inflammatory disease (PID)
    PID comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis are the major pathogens causing PID. Azithromycin provides a short simple treatment option for PID3.
  • Infectious diarrhoea
    Infectious diarrhoea is the most common cause of diarrhoea worldwide. Azithromycin is a good choice for pregnant women and children, for whom fluoroquinolones are not approved, and for patients who cannot otherwise tolerate fluoroquinolones4.
  • Dental infections
    Azithromycin is given to people allergic to penicillins and those who have abscesses and other dental infections, especially those extending into the sinuses, gums and bone, and for whom other antibiotics have proved ineffective.
  • Acne
    Acne vulgaris is a common inflammatory disorder of the skin. Azithromycin is a safe and effective alternative in the treatment of inflammatory acne with few side-effects.
    A randomized study6 compared the efficacy of azithromycin with doxycycline. Facial lesions significantly improved with both drugs. Neither drug was shown to be more effective than the other. The beneficial effect continued until 2 months after treatment. This study indicates that azithromycin is at least as effective as doxycycline in the treatment of acne.
  • Pertussis
    Azithromycin is as effective as and better tolerated than erythromycin for the treatment of pertussis7.
  • Prostatitis
    Azithromycin is used in the treatment of chronic prostatitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae.
  • Syphilis
    Azithromycin has been successfully used as a multidose treatment in persons who have early syphilis8.
  • Mediterranean spotted fever (Rickettsiosis)
    Mediterranean spotted fever, also known as boutonneuse fever, is transmitted by the dog tick Rhipicephalus sanguineus and has a characteristic rash and a distinct mark, a tache noire (black spot) at the site of the tick bite. Azithromycin is effective treatment in children and can be used as alternatives to doxycycline in adults9.
  • Endocarditis
    Azithromycin is used for prophylaxis of bacterial endocarditis in persons who are allergic to penicillin and undergoing surgical or dental procedures10.

Non-infectious diseases:

  • Atherosclerosis
    Azithromycin appears to reduce the risk of Chlamydia pneumoniae-induced atherosclerosis11.
  • Cystic fibrosis
    According to the studies2, azithromycin significantly improves quality of life, reduces the number of respiratory exacerbations, and reduces the rate of decline in lung function in persons with cystic fibrosis.
    While the exact mechanisms are unknown, anti-inflammatory rather than antimicrobial properties of macrolides seem to be responsible for the beneficial effects.
Azithromycin “pros” and “cons”

Advantages:

  • Excellent efficacy. Many scientific studies have shown that azithromycin is better or equally effective compared to other antibiotics.
  • Low potential for drug interactions. Azithromycin, unlike the majority of macrolides, does not bind to cytochrome P-450 in the liver, resulting in low potential for drug to drug interaction.
  • Low rate of side effects. Side effects with azithromycin are mild to moderate, mostly gastrointestinal.
  • Sustained antimicrobial activity. Azithromycin reaches high and sustained tissue concentrations that results in sustained antimicrobial activity.
  • Active against intracellular bacteria (Chlamydia pneumoniae, Chlamydia trachomatis, Mycoplasma pneumoniae, Legionella spp.). Since azithromycin is a weak base, it easily penetrates the cell membrane and stays within the cell.
  • Targeted activity at the site of infection. Because of the transport with white blood cells, azithromycin possesses a unique property – targeted activity at the site of infection. In infected tissues, azithromycin achieves high and sustained therapeutic concentrations that last five to seven days after the last dose.
  • Suitable choice for empirical therapy. Since azithromycin has a good activity against the most common pathogens it is used as a choice for empirical therapy.
  • Good compliance: short once daily dosing regimen. Azithromycin’s short dosing regimen is convenient and improves patient compliance. For the majority of infections, azithromycin is administered once daily for three days. In the treatment of sexually transmitted diseases, azithromycin is administered as a single dose.
  • Active against most respiratory tract infections. Betalactams lack activity against atypical pathogens. Among macrolides, azithromycin shows the best activity against H. influenzae.

Disadvantages:

  • Food reduces azithromycin absorption rate. Azithromycin capsules should not be mixed with or taken with food, however tablets may be taken without regard to food.
Mode of action

Azithromycin acts by interfering with bacterial protein synthesis. Although this mechanism is considered bacteriostatic, concentrations several times higher than minimum inhibitory concentrations (MIC) contribute to the bactericidal activity of azithromycin.

Non-antibiotic properties: immunomodulating effect

Data indicate that macrolides may have immunomodulatory activities: in vitro and ex vivo studies clearly show that macrolides can influence cytokine production by several cell types; furthermore, macrolides can alter polymorphonuclear cell functions in vitro and ex vivo. Although immunomodulation may serve as one explanation for the beneficial effects of macrolides in patients with chronic pulmonary inflammation, the effect of low-dose macrolide therapy on biofilm-formation may form a second explanation for the positive effects of long-term low-dose macrolide therapy.

Time for Azithromycin to clear out the system

The half-life of Azithromycin is about 68 hours. So it takes about 16-17 days to clear out of the system.

Azithromycin for Chlamydia

Chlamydia trachomatis is the most common sexually transmitted infection worldwide, especially among adolescents and young adults. Chlamydia is a very guileful infection because many cases of infection are asymptomatic. Untreated infection can progress to persistent infection, which may initiate pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, and chlamydia-induced arthritis.

The importance of azithromycin comes from its highly favorable pharmacokinetic properties: acid stability, high tissue penetration, low serum levels and a very long half-life. Anti-chlamydial levels of the drug are readily achieved inside cells or tissues. Adequate intracellular levels may be sustained for several days because of the slow efflux from cells.

According to the CDC Guidelines azithromycin is a first-line treatment for chlamydial genital infections. Azithromycin is also recommended by the CDC for the treatment of pregnant women.

The treatment consists of a single 1 gram dose.

Recurrent Chlamydia
Relapsing or persistent chlamydia is a common problem, even though patients are often treated appropriately. Azithromycin may be particularly effective against persistent infection4.


References
  • 1. SUMAMED – success story, from sumamed.com.hr
  • 2. Wolter J, Seeney S, Bell S, Bowler S, Masel P, McCormack J. Effect of long term treatment with azithromycin on disease parameters in cystic fibrosis: a randomised trial. Thorax. 2002 Mar;57(3):212-6.
  • 3. Bevan CD, Ridgway GL, Rothermel CD. Efficacy and safety of azithromycin compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. J Int Med Res. 2003 Jan-Feb;31(1):45-54. PubMed
  • 4. Reveneau N, Crane DD, Fischer E, Caldwell HD. Bactericidal activity of first-choice antibiotics against gamma interferon-induced persistent infection of human epithelial cells by Chlamydia trachomatis. Antimicrob Agents Chemother. 2005 May;49(5):1787-93.
  • 5. Khan WA, Seas C, Dhar U, Salam MA, Bennish ML. Treatment of shigellosis. Ann Intern Med. 1997 May 1;126(9):697-703. PubMed
  • 6. Kus S, Yucelten D, Aytug A. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of acne vulgaris. Clin Exp Dermatol. 2005 May;30(3):215-20. PubMed
  • 7. Langley JM, Halperin SA, Boucher FD, Smith B; Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC). Azithromycin is as effective as and better tolerated than erythromycin estolate for the treatment of pertussis. Pediatrics. 2004 Jul;114(1):e96-101.
  • 8. Riedner G, Rusizoka M, Todd J, Maboko L, Hoelscher M, Mmbando D, Samky E, Lyamuya E, Mabey D, Grosskurth H, Hayes R. Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med. 2005 Sep 22;353(12):1236-44.
  • 9. Dzelalija B, Petrovec M, Avsic-Zupanc T, Strugar J, Milic’ TA. Randomized trial of Zithromax in the prophylaxis of Mediterranean spotted fever. Acta Med Croatica. 2002;56(2):45-7. PubMed
  • 10. Rouse MS, Steckelberg JM, Brandt CM, Patel R, Miro JM, Wilson WR. Efficacy of azithromycin or clarithromycin for prophylaxis of viridans group streptococcus experimental endocarditis. Antimicrob Agents Chemother. 1997 Aug;41(8):1673-6.
  • 11. Bouwman JJ, Visseren FL, Bevers LM, van der Vlist WE, Bouter KP, Diepersloot RJ. Azithromycin reduces Chlamydia pneumoniae-induced attenuation of eNOS and cGMP production by endothelial cells. Eur J Clin Invest. 2005 Sep;35(9):573-82. PubMed

Published: March 31, 2008
Last updated: October 25, 2010

Azithromycin (Zithromax) versus Other Medications

Azithromycin (Zithromax) vs. Clarithromycin (Biaxin)
  • Pneumonia
    Azithromycin (3-day, once-daily course) is as effective and well tolerated as clarithromycin (10-day, twice-daily course) in the treatment of mild to moderate community-acquired pneumonia.
    Randomized, multicentre study7 compared azithromycin versus clarithromycin in the treatment of adults with mild to moderate community-acquired pneumonia. A satisfactory clinical response was recorded at the end of therapy in 83 of 88 (94%) evaluable azithromycin-treated and 84 of 88 (95%) evaluable clarithromycin-treated patients. At day 19-23, only one patient in each treatment group had relapsed. Thirty-one of 32 (97%) pathogens isolated from patients in the azithromycin group were eradicated, compared with 32 of 35 (91%) isolated from clarithromycin patients. Incidences of treatment-related adverse events were similar for the two groups. Two (2%) clarithromycin patients discontinued therapy due to severe treatment-related adverse events; none in the azithromycin group did.
  • Acute exacerbation of chronic bronchitis
    Three-day treatment with azithromycin 500 mg once daily is equivalent to a 10-day treatment with clarithromycin 500 mg twice daily in adults with acute exacerbation of chronic bronchitis (AECB).
    Randomized, double-blind, multicenter study6 compared the efficacy and safety of oral azithromycin 500 mg once daily for 3 days with those of oral clarithromycin 500 mg twice daily for 10 days. The clinical cure (based on direct observation of the patient) rates were equivalent in the two treatment groups at 85% with azithromycin and 82% with clarithromycin. Bacteriologic success rates were also equivalent between the azithromycin and clarithromycin treatment groups at test of cure for S. pneumoniae (90.6% and 85.2%, respectively), H. influenzae (71.4% and 81.3%, respectively) and M. catarrhalis (100% and 86.7%, respectively). The overall incidence of treatment-related adverse events was similar in the azithromycin and clarithromycin groups (20.9% and 26.8%, respectively), with the most common being abdominal pain (6.3% and 6.1%, respectively), diarrhea (4.4% and 5.5%, respectively), and nausea (4.4% and 3.7%, respectively).
  • Otitis media (infection of the middle ear)
    Both azithromycin and clarithromycin are effective for the treatment of children with acute otitis media.
    A randomized, open clinical trial8 compared the efficacy, safety and tolerance of azithromycin and clarithromycin in pediatric patients with acute otitis media. Of 100 patients enrolled, 97 were considered evaluable. The most common middle ear pathogens were Streptococcus pneumoniae (60%), Haemophilus influenzae (15%) and Staphylococcus aureus (13%). Fifty patients (100%) treated with azithromycin and 45 (95.7%) patients treated with clarithromycin had a satisfactory clinical response. Rates of persistence of middle ear effusion and possible drug related side effects were comparable.
Azithromycin (Zithromax) vs. Doxycycline
  • Chlamydia trachomatis infections
    In clinical trials2, the bacteriological cure rate of single dose azithromycin 1000 mg (95 to 100%) was similar to that of oral doxycycline 200 mg/day for 7 days (88 to 100%).
    However, according to the recent research1 Azithromycin may be particularly effective against persistent chlamydial infection. In contrast, doxycycline may not be as effective in treating persistent infection.
    Chronic chlamydial infections such as pelvic inflammatory disease or trachoma involve persistent infection and uncomplicated infections are a mixture of acute and persistent infections. Therefore azithromycin would be more effective for the treatment of chlamydial infections than doxycycline1.
  • Endocervicitis
    Both azithromycin and doxycycline are effective in the treatment of non-gonococcal endocervicitis.
    Prospective-randomised study3 compared azithromycin versus doxycycline in the treatment of non-gonococcal mucopurulent endocervicitis. The eradication rate of bacteria in the azithromycin group was 71.4%, and 77.3% in the doxycycline group.
  • Acne
    Azithromycin 500 mg once a day for four days per month appears to be as effective as daily doxycycline 100 mg4.
  • Lyme disease (Erythema migrans)
    Azithromycin is equally effective as doxycycline in the treatment of Lyme disease.
    A randomized, multicenter, open clinical trial5 compared the effectiveness of azithromycin and doxycycline in the treatment of Lyme disease associated with erythema migrans. Clinical success (based on direct observation of the patient) was observed in 95.8% azithromycin- and 82.5% doxycycline-treated patients.
Azithromycin (Zithromax) vs. Minocycline
  • Acne
    Acne vulgaris

    Image via Wikipedia

    Azithromycin is at least as effective as minocycline in the treatment of facial comedonic and papulopustular acne.
    An open study10 compared the clinical efficacy and tolerability of azithromycin and minocycline. Azithromycin was administered as a single oral dose (500 mg/day) for 4 days in four cycles every 10 days and minocycline was administered 100 mg daily for 6 weeks. Improvement was assessed 6 weeks after initiation of treatment with a four-graded scale. A satisfactory clinical response was observed in 75.8% of the patients treated with azithromycin and in 70.5% of those treated with minocycline. Both agents were well tolerated and mild side effects were reported in 10.3% of azithromycin and 11.7% of minocycline treated patients.

Azithromycin (Zithromax) vs. Amoxicillin
  • Chlamydia infection
    Chlamydia infection during pregnancy. Both amoxicillin and azithromycin are effective in the treatment of cervical Chlamydia trachomatis infection during pregnancy. However, azithromycin seems to have a lower rate of recurrent infection12. Amoxicillin is slightly better tolerated than azithromycin.
    In a randomized controlled trial11 comparing amoxicillin and azithromycin there was similar treatment efficacy between amoxicillin and azithromycin (58% vs 64%, respectively). In the study 5.5% of women were intolerant to amoxicillin, compared with 10.9% to azithromycin.
  • Otitis media
    Single dose azithromycin is as effective as high dose amoxicillin for 10 days for the treatment of children with otitis media. Diarrhea occurs more frequently with amoxicillin therapy than with azithromycin.
    In a randomized, multicenter, double blind trial13 children (6-30 months of age) with acute otitis media (AOM) were randomized to treatment with single dose azithromycin (30 mg/kg) or high dose amoxicillin (90 mg/kg/d, in 2 divided doses) for 10 days. The clinical success rates for azithromycin and amoxicillin were comparable for all patients (84% and 84%, respectively) and for children < or =2 years of age (82% and 82%, respectively). The clinical efficacies among all microbiologic modified intent-to-treat evaluable subjects were comparable for patients treated with azithromycin (80%) and patients treated with amoxicillin (83%). The rates of side effects for azithromycin and amoxicillin were 20% and 29%, respectively. Diarrhea was more common with amoxicillin therapy than with azithromycin (17.5% and 8.2%, respectively). Compliance was higher in the azithromycin group (100%) than in the amoxicillin group (90%).
  • Lyme disease
    Amoxicillin is more effective than azithromycin for erythema migrans.
    In a double-blind, randomized, controlled trial14 patients treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution of disease at day 20, the end of therapy (88% compared with 76%). More azithromycin-treated patients (16%) than amoxicillin-treated patients (4%) had relapse. For patients treated with azithromycin, development of an antibody response increased the possibility of achieving a complete response (81% of seropositive patients achieved a complete response compared with 60% of seronegative patients). Patients with multiple erythema migrans lesions were more likely than patients with single erythema migrans lesions to have a positive antibody titer at baseline. Fifty-seven percent of patients who had relapse were seronegative at the time of relapse.
Azithromycin (Zithromax) vs. Augmentin
  • Otitis media
    Azithromycin and amoxicillin/clavulanate have similar efficacy in the treatment of acute otitis media in children. However, azithromycin is significantly better tolerated than amoxicillin/clavulanate.
    Randomized, double-blind study15 compared azithromycin and amoxicillin/ clavulanate for the treatment of acute otitis media in children. One hundred and eighty-eight children (mean age 3.5 years) were randomized to azithromycin and 185 to co-amoxiclav. At day 10, the clinical success rate was 153/185 (83%) in children treated with azithromycin and 159/181 (88%) in children treated with co-amoxiclav. At day 28, 134/182 (74%) of the children were cured on azithromycin compared with 124/180 (69%) on co-amoxiclav. Also at day 28, signs of acute otitis media, such as abnormal reflectometry (45% versus 59%), bulging of the eardrum (10% versus 16%) and loss of tympanic membrane landmarks (11% versus 22%) were seen less frequently in azithromycin- than co-amoxiclav-treated children, respectively. Treatment-related side effects were seen in 11% of azithromycin patients compared with 20% on co-amoxiclav.
  • Sinusitis
    Azithromycin and amoxicillin/clavulanate have similar efficacy in the treatment of sinusitis. However, azithromycin is better tolerated than amoxicillin/clavulanate.
    Randomized double-blind study16 compared 3- and 6-day regimens of azithromycin with a 10-day amoxicillin-clavulanate regimen for treatment of acute bacterial sinusitis. Clinical success (based on direct observation of the patient) rates were equivalent among patients at the end of therapy (azithromycin 3 days, 88.8%; azithromycin 6 days, 89.3%; amoxicillin/clavulanate, 84.9%) and at the end of the study (azithromycin 3 days, 71.7%; azithromycin 6 days, 73.4%; amoxicillin/clavulanate, 71.3%). Patients treated with amoxicillin/clavulanate reported a higher incidence of treatment-related side effects (51.1%) than azithromycin-3 (31.1%) or azithromycin-6 (37.6%). More amoxicillin/clavulanate patients discontinued the study (n = 28) than azithromycin-3 (n = 7) and azithromycin-6 (n = 11). Diarrhea was the most frequent treatment-related side effect.
  • Lower respiratory tract infections
    Azithromycin and amoxicillin/clavulanate have similar efficacy in the treatment of lower respiratory tract infections, but azithromycin is better tolerated than amoxicillin/clavulanate. An additional advantage of the azithromycin is the easy administration and short duration of therapy.
    Multicentre randomized double-blind, double-dummy study17 compared the efficacy, safety and tolerability of a 3 day course of azithromycin with a 10 day course of co-amoxiclav in the treatment of children with acute lower respiratory tract infection. Of 110 patients, 56 and 54 patients, respectively, were treated with azithromycin or co-amoxiclav. The percentage of patients cured or clinically improved at days 10-13 (primary endpoint) was 91% for azithromycin and 87% for co-amoxiclav. This difference of 4% was not statistically significant. Significantly more treatment-related side effects were found in the co-amoxiclav group. This was largely due to a higher percentage (43% versus 19%) of gastrointestinal complaints.
Azithromycin (Zithromax) vs. Penicillin
  • Streptococcal pharyngitis/tonsillitis
    Azithromycin (10 or 20 mg/kg/day one daily for 3 days) is as safe and effective as penicillin V (4 times daily for 10 days) in the treatment of paediatric patients with acute pharyngitis/tonsillitis.
    The efficacy and safety of azithromycin and penicillin V in the treatment of acute streptococcal pharyngitis/tonsillitis in paediatric patients were compared in a double-blind, double-dummy prospective study9. A satisfactory clinical response (cure or improvement) was recorded in 99% of the 10 mg/kg azithromycin group, 100% of the 20 mg/kg azithromycin group, and 97% of the penicillin V group at the end of therapy (day 12-14). At the follow-up evaluation (day 28-30), relapse rates in patients cured or improved at the end of therapy were 6%, 5%, and 2%, respectively. Bacteriological eradication rates at the end of therapy were 98% in both azithromycin groups and 92% in patients who received penicillin V; pathogen recurrence was recorded at follow-up in 4% of the 20 mg/kg azithromycin group and in 6% of both the 10 mg/kg azithromycin and penicillin V groups. Treatment-related adverse events, the majority of mild to moderate severity, occurred in 13% of patients in the 20 mg/kg azithromycin group, 9% in the 10 mg/kg azithromycin group, and 5% in the penicillin V group.
Azithromycin (Zithromax) vs. Cefadroxil (Duricef)
  • Skin and skin structure infections
    Azithromycin may be somewhat more effective than cefadroxil for treating uncomplicated skin and skin structure infections. Also, azithromycin is better tolerated.
    Multicenter, investigator-blind study18 compared the efficacy and safety of azithromycin and cefadroxil for the treatment of uncomplicated skin and skin structure infections. Clinical and bacteriologic response was assessed between days 10 and 13 (primary end point) and between days 28 and 32. Clinical success (resolution of symptoms) rates assessed between days 10 and 13 were 97% (111/114) for azithromycin and 96% (101/105) for cefadroxil. For azithromycin and cefadroxil, corresponding rates of bacteriologic eradication for Staphylococcus aureus were 94% (64/68) and 86% (60/70), respectively, and for Streptococcus pyogenes, 80% (4/5) and 100% (6/6), respectively. Clinical success rates assessed between days 28 and 32 were 100% (82/82) for azithromycin compared with 90% (75/83) for cefadroxil. Corresponding rates of eradication for S aureus were 100% (59/59) versus 89% (56/63), respectively; and for S pyogenes, 100% (4/4) versus 83% (5/6), respectively. The incidence of treatment-related side effects was similar in the 2 treatment groups. However, 5 of the 139 patients (4%) in the cefadroxil group discontinued therapy because of treatment-related side effect compared with none of the 152 patients in the azithromycin group.
Azithromycin (Zithromax) vs. Cefdinir (Omnicef)
  • Pneumococcal pulmonary infections.
    Cefdinir or azithromycin have comparable effectiveness in the treatment of acute otitis media.
    A multicenter, prospective, single-blind study19 compared cefdinir and azithromycin in children with acute otitis media. Three hundred fifty-seven patients were enrolled in the study. The majority of evaluable children (77%) had previously received conjugated heptavalent pneumococcal vaccine (PCV7) against Streptococcus pneumoniae. At the end-of-therapy visit, clinical cure (resolution of symptoms) rates were comparable for cefdinir and azithromycin (87%, [151/174] and 85% [149/176], respectively). In addition, clinical cure rates at the end-of-therapy visit in the children who had been vaccinated with PCV7 were comparable between cefdinir and azithromycin (86% vs 83%). No significant difference in clinical cure rates was observed at the follow-up visit (76% and 86%). Parental satisfaction was similar between treatment groups with regard to ease of use, taste, compliance, health care resource utilization, and missed days of work and day-care. Both antibiotics were well tolerated; diarrhea and abnormal stools were the most common antibiotic-related side effects.
Azithromycin (Zithromax) vs. Cefuroxime axetil (Ceftin)
  • Exacerbations of chronic obstructive pulmonary disease
    Both azithromycin and cefuroxime are effective treatments for exacerbations in patients with chronic obstructive pulmonary disease. Azithromycin has a lower rate of side effects.
    A randomized study20 compared 3 days of azithromycin treatment and 10 days of cefuroxime treatment in exacerbations in patients with chronic obstructive pulmonary disease. 50 patients were treated with azithromycin and 51 with cefuroxime. The evolution of the symptoms was similar although with a trend to greater improvement in those treated with azithromycin. Functional and gasometric evolution was similar in the two schedules. Three patients treated with azithromycin required hospital admission, as did 5 treated with cefuroxime. A greater number of treatment-related side effects were observed in patients treated with cefuroxime (18%) than in those receiving azithromycin (10%), with gastrointestinal side effects being the most commonly observed.
Azithromycin (Zithromax) vs. Ciprofloxacin (Cipro)
  • Chronic prostatitis (Chlamydia trachomatis)
    Azithromycin is significantly more effective than ciprofloxacin 21.
    Significantly higher eradication and a significantly higher clinical cure were achieved in the group of patients treated with azithromycin than in the ciprofloxacin group.
  • Shigellosis
    Ciprofloxacin is somewhat more effective than azithromycin in the treatment of Shigellosis (a type of infective diarrhea) 22.
    In a double-blind, randomized, controlled trial azithromycin therapy was clinically successful in 28 (82%) patients and ciprofloxacin therapy in 32 (89%) patients. Therapy was bacteriologically successful in 32 (94%) patients receiving azithromycin and 36 (100%) patients receiving ciprofloxacin.
  • Gonorrhea
    1 g azithromycin is at least as effective and well tolerated as 500 mg of ciprofloxacin in the treatment of gonococcal infections. Azithromycin is particularly useful for sailors and people constantly on the move 23.
    59 men and 49 women with gonococcal infection were enrolled in clinical study. Data of 50 patients treated with azithromycin and 51 with ciprofloxacin were evaluable for efficacy and tolerability at the end of the study. After 2 weeks clinical and microbiological cure rates were 96.0% (48 out of 50) for the patients treated with azithromycin and 92.15% (47 out of 51) for the patients treated with ciprofloxacin. Side effects were reported in 5 patients treated with azithromycin and 6 with ciprofloxacin.
Azithromycin (Zithromax) vs. Levofloxacin (Levaquin)
  • Acute bacterial exacerbations of chronic bronchitis
    Standard 5-day course of oral azithromycin was clinically and bacteriologically equivalent to a 7-day course of oral levofloxacin in the treatment of ABECB. Favorable results were demonstrated in 89% of patients receiving azithromycin and in 92% of patients receiving levofloxacin by day 4 of therapy. At day 24 favorable responses were approximately 82% and 86%, respectively. The bacterial eradication rates of respiratory pathogens were 96% for azithromycin and 85% for levofloxacin24. Both treatments are well-tolerated, with the majority of adverse events being GI in nature.
  • Community-acquired pneumonia
    A single 2 g dose of azithromycin microspheres is at least as effective as a 7-day course of levofloxacin in the treatment of mild to moderate community-acquired pneumonia25.
    The cure rates were 89.7% for azithromycin microspheres and 93.7% for levofloxacin. Bacteriologic success at test of cure in the “bacteriologic per protocol” population was 90.7% for azithromycin microspheres and 92.3% for levofloxacin. Both medications were well tolerated. The incidence of side effects was 19.9% for azithromycin and 12.3% for levofloxacin.
  • Sinusitis
    Single 2 g dose azithromycin microspheres has efficacy comparable to 10 days of levofloxacin in the treatment of acute bacterial sinusitis26.
    Clinical success rates were 94.5% with azithromycin-microspheres and 92.8% with levofloxacin. In patients with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, clinical cure rates were 97.3%, 96.3%, and 100%, respectively, for the azithromycin and 92.3%, 100%, and 90.9%, respectively, for the levofloxacin.

References
  • 1. Reveneau N, Crane DD, Fischer E, Caldwell HD. Bactericidal activity of first-choice antibiotics against gamma interferon-induced persistent infection of human epithelial cells by Chlamydia trachomatis. Antimicrob Agents Chemother. 2005 May;49(5):1787-93. PubMed
  • 2. Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis. 2002 Sep;29(9):497-502. PubMed
  • 3. Sendag( F, Terek C, Tuncay G, Ozkinay E, Guven M. Single dose oral azithromycin versus seven day doxycycline in the treatment of non-gonococcal mucopurulent endocervicitis. Aust N Z J Obstet Gynaecol. 2000 Feb;40(1):44-7. PubMed
  • 4. Parsad D, Pandhi R, Nagpal R, Negi KS. Azithromycin monthly pulse vs daily doxycycline in the treatment of acne vulgaris. J Dermatol. 2001 Jan;28(1):1-4. PubMed
  • 5. Barsic B, Maretic T, Majerus L, Strugar J. Comparison of azithromycin and doxycycline in the treatment of erythema migrans. Infection. 2000 May-Jun;28(3):153-6. PubMed
  • 6. Swanson RN, Lainez-Ventosilla A, De Salvo MC, Dunne MW, Amsden GW. Once-daily azithromycin for 3 days compared with clarithromycin for 10 days for acute exacerbation of chronic bronchitis: a multicenter, double-blind, randomized study. Treat Respir Med. 2005;4(1):31-9. PubMed
  • 7. O’Doherty B, Muller O. Abstract Randomized, multicentre study of the efficacy and tolerance of azithromycin versus clarithromycin in the treatment of adults with mild to moderate community-acquired pneumonia. Azithromycin Study Group. Eur J Clin Microbiol Infect Dis. 1998 Dec;17(12):828-33. PubMed
  • 8. Arguedas A, Loaiza C, Rodriguez F, Herrera ML, Mohs E. Comparative trial of 3 days of azithromycin versus 10 days of clarithromycin in the treatment of children with acute otitis media with effusion. J Chemother. 1997 Feb;9(1):44-50. PubMed
  • 9. O’Doherty B. Azithromycin versus penicillin V in the treatment of paediatric patients with acute streptococcal pharyngitis/tonsillitis. Paediatric Azithromycin Study Group. Eur J Clin Microbiol Infect Dis. 1996 Sep;15(9):718-24. PubMed
  • 10. Gruber F, Grubisic’-Greblo H, Kastelan M, Brajac I, Lenkovic’ M, Zamolo G. Azithromycin compared with minocycline in the treatment of acne comedonica and papulo-pustulosa. J Chemother. 1998 Dec;10(6):469-73. PubMed
  • 11. Jacobson GF, Autry AM, Kirby RS, Liverman EM, Motley RU. A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol. 2001 Jun;184(7):1352-4; discussion 1354-6. PubMed
  • 12. Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol. 2001;9(4):197-202. PubMed
  • 13. Arguedas A, Emparanza P, Schwartz RH, Soley C, Guevara S, de Caprariis PJ, Espinoza G. A randomized, multicenter, double blind, double dummy trial of single dose azithromycin versus high dose amoxicillin for treatment of uncomplicated acute otitis media. Pediatr Infect Dis J. 2005 Feb;24(2):153-61. PubMed
  • 14. Luft BJ, Dattwyler RJ, Johnson RC, Luger SW, Bosler EM, Rahn DW, Masters EJ, Grunwaldt E, Gadgil SD. Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial. Ann Intern Med. 1996 May 1;124(9):785-91. PubMed
  • 15. Dunne MW, Latiolais T, Lewis B, Pistorius B, Bottenfield G, Moore WH, Garrett A, Stewart TD, Aoki J, Spiegel C, Boettger D, Shemer A. Randomized, double-blind study of the clinical efficacy of 3 days of azithromycin compared with co-amoxiclav for the treatment of acute otitis media. J Antimicrob Chemother. 2003 Sep;52(3):469-72. Epub 2003 Jul 29. PubMed
  • 16. Henry DC, Riffer E, Sokol WN, Chaudry NI, Swanson RN. Randomized double-blind study comparing 3- and 6-day regimens of azithromycin with a 10-day amoxicillin-clavulanate regimen for treatment of acute bacterial sinusitis. Antimicrob Agents Chemother. 2003 Sep;47(9):2770-4. PubMed
  • 17. Ferwerda A, Moll HA, Hop WC, Kouwenberg JM, Tjon Pian Gi CV, Robben SG, de Groot R. Efficacy, safety and tolerability of 3 day azithromycin versus 10 day co-amoxiclav in the treatment of children with acute lower respiratory tract infections. J Antimicrob Chemother. 2001 Apr;47(4):441-6. PubMed
  • 18. Jennings MB, McCarty JM, Scheffler NM, Puopolo AD, Rothermel CD. Comparison of azithromycin and cefadroxil for the treatment of uncomplicated skin and skin structure infections. Cutis. 2003 Sep;72(3):240-4. PubMed
  • 19. Block SL, Cifaldi M, Gu Y, Paris MM. A comparison of 5 days of therapy with cefdinir or azithromycin in children with acute otitis media: a multicenter, prospective, single-blind study. Clin Ther. 2005 Jun;27(6):786-94. PubMed
  • 20. Alvarez Gutie’rrez FJ, Soto Campos G, del Castillo Otero D, Sa’nchez Go’mez J, Caldero’n Osuna E, Rodri’guez Becerra E, Castillo Go’mez J. A randomized comparative study of 3 days of azithromycin treatment and 10 days of cefuroxime treatment in exacerbations in patients with chronic obstructive pulmonary disease Med Clin (Barc). 1999 Jul 3;113(4):124-8. PubMed
  • 21. Skerk V, Schonwald S, Krhen I, Banaszak A, Begovac J, Strugar J, Strapac Z, Vrsalovic R, Vukovic J, Tomas M. Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. Int J Antimicrob Agents. 2003 May;21(5):457-62. PubMed
  • 22. Khan WA, Seas C, Dhar U, Salam MA, Bennish ML. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind, randomized, controlled trial. Ann Intern Med. 1997 May 1;126(9):697-703. PubMed
  • 23. Gruber F, Brajac I, Jonjic A, Grubisic-Greblo H, Lenkovic M, Stasic A. Comparative trial of azithromycin and ciprofloxacin in the treatment of gonorrhea. J Chemother. 1997 Aug;9(4):263-6. PubMed
  • 24. Amsden GW, Baird IM, Simon S, Treadway G. Efficacy and safety of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis. Chest. 2003 Mar;123(3):772-7. PubMed
  • 25. D’Ignazio J, Camere MA, Lewis DE, Jorgensen D, Breen JD. Novel, single-dose microsphere formulation of azithromycin versus 7-day levofloxacin therapy for treatment of mild to moderate community-acquired Pneumonia in adults. Antimicrob Agents Chemother. 2005 Oct;49(10):4035-41. PubMed
  • 26. Henry DC, Kapral D, Busman TA, Paris MM. Cefdinir versus levofloxacin in patients with acute rhinosinusitis of presumed bacterial etiology: a multicenter, randomized, double-blind study. Clin Ther. 2004 Dec;26(12):2026-33. PubMed

Published: March 31, 2008
Last updated: January 09, 2010

Enhanced by Zemanta
Posted in Acne, Antibiotics, Bites-animal, Bronchitis, Chlamydia, COPD, Dental antibiotics, Gonorrhea, Herpes, Medical archives, Pneumonia, Prescription Medications, Skin infection, STD, Stockpiling medical supplies | Tagged , , , , , | 4 Comments

Protected: Tooth Extraction – Part 1 – Maxillary Anesthesia

This content is password protected. To view it please enter your password below:

Posted in Contributors, Dental, Dental - MPO, Dental anesthesia, Equipment, Lidocaine, Medical archives, Medical Professionals Only, Tooth extraction, W Hampton - Tooth Doctor | Tagged , , , , | Enter your password to view comments.

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
Enhanced by Zemanta
Posted in Education, Medical archives, Medications, Question of the Week, Stockpiling medical supplies | 18 Comments

The Dreaded Question . . .

Let’s tackle the BIG Q in the realm of dentistry without dentists:  the dreaded extraction. The patient puts up with the pain until it overcomes the dread of getting a tooth pulled, and the operator dreads the thought of the first effort to take a tooth out.  This is the ultimate question and ultimate challenge that will face the local health care “go to” person, no matter who that may be in a TEOTWAWKI situation.   

As with any problem in daily practice for any of us, no matter what flavor of degree, the first task when we are presented with a patient is to use our head and hands to take a good history and perform an examination to reach a diagnosis.  Let’s think about several possible scenarios: 

  1. Someone has fallen, hit his mouth and snapped off a couple of teeth.  Nerves are exposed, edges are jagged, and the patient cannot eat due to the pain.  
  2. The patient is in acute pain, to the point that he cannot think straight.  The patient is hyper and can barely sit still long enough for you to figure which tooth is causing the trouble.  
  3. A knock on the door leads to a person with an eye swollen shut and a face that looks like it holds a lemon under the cheek, or worse . . .
  4. That swelling is below the jaw, the patient is running a high fever, lymph nodes are swollen,  and the patient looks sick as a dog. 
Example of post-operative swelling following t...

Image via Wikipedia

 

Other than the first scenario where the dental causation is obvious, the operator will have to come to the conclusion that a tooth or teeth are the source of the pathology. In an end-of-the-world situation, there will be very limited options for treatment. There will be emery boards and nail files for smoothing sharp edges, there may be some temporary filling material for filling and soothing cavities. But beyond that … teeth are going to need to be removed. Once we have made the decision that the patient in front of us has a tooth that needs to be removed, someone needs to make it happen, and if there is no dentist around, then it just might fall to you. 

Let me say at this point that extractions range from super-easy (finger or gauze pad easy), to hammer and chisel, one-bit-at-a-time ordeals. I have had in my office extractions range in time from less than 30 seconds to more than 1 ½ hours. Just yesterday I had a tooth break off at the bone line in a patient with rock hard bone, who due to the patient and his distress, was sent to an oral surgeon for sedation for final removal. That is after 35 years of practice amounting to thousands of teeth.

Teeth vary significantly in anatomy. In today’s world, even with a lifetime of studying dental anatomy (or perhaps because of it) I will not attempt to remove a tooth that I do not have an x-ray of.  Some teeth have tiny thin roots, extra roots, roots with L- shape, S-shape, as well as corkscrew bends. Some bone is soft and pliable; some is rock-hard and unbendable.  Lips, cheeks, and the tongue often want to get in the way.

And lastly, let me add that blood is opaque. You cannot see through it. In my office I have a trained assistant constantly suctioning the field to allow me to see what I am doing. Even with all the advantages of a modern facility and equipment, successfully removing a tooth intact is quite an accomplishment. 

Medieval dentist removing tooth

Image via Wikipedia

 

My point is that taking teeth out is as much an art as it is a science. You can read and study science from a book. Artistry comes from experience and often serving a preceptorship at the feet of a master. It is not to say that every dentist did not start somewhere. My suggestion for the layman to begin the process of training to perform emergency extractions is to find a dentist that is willing to teach as he is extracting teeth. Most communities have a free indigent dental clinic that would be a good place to begin.  True hands-on experiences in extractions are problematic in any first world country, due to the minor problem of the need for a degree and a license, as well as liability insurance.  One of the best places to learn is in a dental mission to a third world country. There is always a need for helpers in these types of settings and volunteers are always welcome.   

Since this is an open forum, I am not going to go into what I can teach about the how-to’s of extractions.  In today’s world, dentists need to handle these issues. Only when a non-dentist is the person of last resort is there any justification for taking the steps to remove a tooth. There is too high a risk of promoting dentistry without a license.

(I am going to leave that to the Medical Pro side of this site.  Please keep checking in as I post several articles of how to handle each type of tooth:  upper anterior (front) 6, upper bicuspids, and upper molars, lower incisors, lower cuspids and bicuspids, lower molars. In addition I will have a piece on what to do if there is a problem.)

Copyright © 2011 WH2THDR 

Enhanced by Zemanta
Posted in Dental, Medical archives, Teeth, Tooth extraction, Toothache, W Hampton - Tooth Doctor | Tagged , , , , , | Leave a comment

Thoughts on Disasters

The following post is contributed by Dan,  a wilderness guide, who has led teams of doctors and nurses on medical diaster response trips throughout the world. 

What does a person who has “been there, done that” have to say?

* * * 

Many of us ponder, even fantasize over what our world here in the USA would be like if we had a wide-scale disaster, whether it be natural or man-made.  We plan, we prepare, but we still don’t really understand the impact.  Even when a large-scale disruption like Katrina occurs, because of our nation’s affluence and infrastructure, we overcome much of the physical hardship. This is not to minimize the true pain and suffering individuals encounter, but to point out it’s all relative.

For example, I was part of a disaster relief team in a heavily damaged location in Mississippi, arriving four days after Katrina hit. The local Lowes had tractor trailers lined up unloading supplies. I’ve never seen so many chainsaws piled so high. There were backhoes and heavy equipment of every description on every street with dump trucks…you get my point. In Haiti, six days after the earthquake, you could still smell the decaying bodies. I only saw two backhoes the entire 18 days I was in Port-au-Prince. 

My point is, if you want to experience the end of life as we know it, volunteer to work in a disaster in a third world.  But don’t just show up, join a legitimate disaster relief organization, get some training on what to expect once you are “in country.”  Here is some advice:

1.  Join a credible organization that has specific goals that meet your world view. You might not appreciate the evening Bible study if you join a Christian relief organization even though I’m sure they would enjoy your company. By the way, we had two representatives from a NGO (non-governmental) stay with us in Haiti. Their mission: to evaluate all relief organizations, both governmental and private.  The Christian relief organizations were much more effective, their words-not mine!

2.  Research what type of medical care you will be providing in a disaster. In Haiti, we had three brilliant ER Doc’s who were not happy because they were doing clinic work. They felt under-utilized.  When we moved into the hospital setting, our ER Docs were happy but our family practice Doc felt uncomfortable with the steady stream of trauma patients.

3.  Get disaster training!!  I cannot over emphasis how important this subject is.  I’m sure most of the readers of this article are very well trained in medical issues, but here are some things to consider:

  1. Do you know the indigenous signs for landmines?
  2. Do you know how to prepare safe drinking water? How much water?
  3. What local foods in this 3rd world country can I eat without getting sick?
  4. What do you mean I have to squat over this hole in the ground to relieve myself!!  Oh – no, I forgot the toilet paper!
  5. No shower for two weeks?!?!?!!!
  6. There’s nothing like a 14 year old boy with an AK-47 searching through your backpack at a road block.
  7. What should be in my bug out bag?
  8. Team security – rally points – escape/evasion
  9. Be mindful of “when helping hurts!”  If you’re not familiar with this term, find out! 

Advanced, real life training will help you determine if disaster relief is your cup of tea.  Probably a good 80% of the people we train for disasters, never go on deployment. To be honest, some just cannot arrange time off on short notice, but a good percentage just don’t like the hardship a disaster will bring. It’s really hard, hot, exhausting, and at times scary work, yet very rewarding. 

Now to tie this all back to Armageddon Medicine.  Experience is the best teacher.  I’m convinced we in the USA do not really know hardship and therefore it is difficult to prepare for it. Working with disaster relief is one concrete way to prepare.  Yes, we can stockpile food, water, guns, ammo, and medicine, but by working in disaster relief teams, you can prepare while serving your fellow man and most importantly, God!

Copyright © 2011 Dan, Wilderness Guide, Disaster Relief

Enhanced by Zemanta
Posted in Contributors, Dan - Disaster Relief, Disaster Relief, Equipment, Medical archives, Preparation, Public health, Volunteering | Tagged , , , , , , , | 7 Comments