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    More than a decade ago, I was the first physician to advocate for the storing of antibiotics marketed for tropical fish and pet birds as a potential tool for the medic in long-term survival settings. Although I never recommended them for use in situations where there is a functioning medical infrastructure, I believe, despite criticism, that having a supply of these on hand will save lives, otherwise lost from bacterial infections, in a prolonged off-grid disaster scenario.

    Accumulating over-the-counter drugs for the medic’s storage may be a simple enterprise, but not prescription medicines. Even with a sympathetic physician, the ability to obtain the quantity needed to be an effective caregiver for a survival community is limited, at best. Antibiotics are one example of life-saving medications that would be in short supply off the grid.

    The inability to have antibiotics at hand may cost some poorly prepared individuals their lives in a survival situation. There will be a much larger incidence of infection when people have to fend for themselves and are injured as a result. Any strenuous activities performed that aren’t routine in normal times can lead to injuries that break the skin. These wounds will, very likely, be dirty. Within a relatively short time, they might begin to show signs of infection in the form of redness, heat, and swelling.

    Treatment of such infections at an early stage improves the chance they will heal quickly and completely. However, many rugged individualists are likely to “tough it out” until their condition worsens and the infection spreads to their blood. If the medic has ready access to antibiotics, the problem can be nipped in the bud before a tragic outcome occurs.

    Some solutions for medical issues off the grid without medical help, like fish antibiotics, may save lives

    The following is contrary to standard medical practice; it’s a strategy that is appropriate only when help is not on the way. If there are modern medical resources available to you, seek them out.

    Antibiotic Options

    Small quantities of antibiotics can be obtained by anyone willing to tell their doctor that they are going out of the country and would like to avoid “Travelers’ Diarrhea” or other infections common at their destination. Likewise, asking for medications that must be taken early in an infection, like oseltamivir (Tamiflu) for influenza, is a reasonable strategy; after all, not everyone can get in to see their doctor right away, and the antiviral Tamiflu is most effective in the first 48 hours after symptoms begin.

    (Note: Tamiflu is an anti-viral and only works against influenza (and not COVID-19. Antibiotics have no effect against viruses at all.)

    This approach is fine for one or two courses of therapy, but a long-term alternative is required for the survival caregiver to have enough antibiotics to protect a family or survival group. In the aftermath of a disaster, some deaths may be unavoidable, but bacterial-related deaths are unacceptable. This concern led us to what we believe is a viable option: aquarium and avian antibiotics.

    For many years, we have kept tropical fish in aquaria and tilapia in ponds. We also have parrots as pets. After years of using aquatic medicines on fish and avian medicines on birds, we decided to evaluate these drugs for their potential use off the grid. They seemed to be good candidates: All were widely available, available in different varieties, and didn’t require a medical license or prescription.

    A close inspection of a number of these products found exactly one ingredient: the drug itself, identical to those obtained by prescription at the local pharmacy. A bottle labeled aquatic amoxicillin, for example, had as its sole ingredient amoxicillin, which is an antibiotic commonly used in humans. Unless they’re listed on the bottle, there are no additional chemicals to makes your scales shinier or your feathers more colorful.

    Any reasonable person might be skeptical about considering the use of aquarium antibiotics for humans, even in disaster settings. Those things are for fish, aren’t they? Yet, a number of them only come in dosages that correspond to pediatric or adult human dosages.

    The question became: Why should a one-inch guppy require the same dosage of, say, amoxicillin as a 180-pound adult human? We were told that it was due to the dilution of the drug in water. However, at the time, there were few instructions that tell you how much to put in a ½ gallon fishbowl as opposed to a 200-gallon aquarium (they have them now, however).

    Finally, the “acid test” was to look at the pills or capsules themselves. The aquatic or avian drug had to be identical to that found in bottles of the corresponding human medicine. For example, when (in 2010) we opened a bottle of FISH-MOX FORTE 500 mg distributed by Thomas Labs and a bottle of Human Amoxicillin 500mg (DAVA pharmaceuticals), we found:

    human amoxicillin by DAVA pharmaceuticals

    Human Amoxicillin:         Red and Pink Capsule, with the letters and numbers WC 731 on it.

    Fish amoxicillin (the brand is now defunct)

    FISH-MOX FORTE: Red and Pink Capsule with the letters and numbers WC 731 on it.

    There are still a number of examples today, including:

    fish versions of different antibiotics
    Appearance of same antibiotics made by human pharmaceutical companies

    Logically, then, it makes sense to believe that they are essentially identical, manufactured in the same way that human antibiotics are. Further, it is our opinion that they are probably from the same batches; some go to human pharmacies and some go to veterinary pharmacies or bottling companies. Over the years, readers in the human and veterinary pharmacy fields have confirmed this.

    This is not to imply that all antibiotic medications met the criteria. Many cat, dog, and livestock antibiotics contain additives that might cause ill effects on a human being. Look only for those veterinary drugs that have the antibiotic as the sole ingredient.

    There has been significant controversy regarding these medicines as some have chosen to use them in normal times against our recommendations, which only apply to long-term survival scenarios. As a result, the original distributor of these drugs, Thomas Labs, eventually stopped production in response to political pressure.  For now, other brands with names like FISH-AID and others have, at the time of this writing, filled the void by offering a number of veterinary equivalents online. Expect volatility in terms of availability as a number of these drugs are placed under increasing government control in the future. 

    VETERINARY “EQUIVALENTS”

    Having antibiotics in quantity will help the medic save lives in survival scenarios

    Here is a list of antibiotics that are commercially available in aquatic or avian form as of the writing of this article:

    AMOXICILLIN,  (Amoxicillin 250 mg and 500 mg)

    AMPICILLIN 500 MG

    PENICILLIN 250 mg and 500 mg

    CEPHALEXIN 250 mg and 500 mg

    METRONIDAZOLE 250 mg and 500 mg

    CIPROFLOXACIN 250 mg and 500 mg

    CLINDAMYCIN 150 mg

    AZITHROMYCIN 250 mg

    LEVOFLOXACIN 500 mg

    SULFAMETHOXAZOLE/TRIMETHOPRIM 400 mg/80 mg and 800 mg/160 mg

    DOXYCYCLINE 100 mg

    MINOCYCLINE 50 mg and 100 mg

    FLUCONAZOLE (anti-fungal) 100 mg

    Most of the above come in lots of 30 to 100 tablets which can be bought in multiples. This makes them eligible for the survival medic to stockpile for prolonged disaster events. As recently as December 2020, we were able to purchase several without a prescription.

    Of course, anyone could be allergic to one or another of these antibiotics, but it would be a very rare individual who would be allergic to all of them. It should be noted that there’s a 10% cross-reactivity between Penicillin drugs and cephalexin (Keflex). If you are allergic to penicillin, you could also be allergic to Keflex. For those who can’t take penicillin, there are suitable safe alternatives. Any of the antibiotics below should not cause a reaction in a patient allergic to Penicillin-family drugs:

    • Doxycycline
    • Metronidazole
    • Tetracycline
    • Ciprofloxacin
    • Clindamycin
    • Sulfamethoxazole/Trimethoprim
    • Levofloxacin
    • Minocycline

    This one additional fact: We have personally used some (not all) of these antibiotics as veterinary equivalents on our own persons without any ill effects. Whenever we have used them, their effects have been indistinguishable from human antibiotics.

    Having said this, we recommend against self-treatment in any circumstance that does not involve the complete long-term loss of access to modern medical care. This is a strategy to save lives in a post-calamity scenario only.

    Finding Out More

    Although you might think that any antibiotic will work to cure any disease, specific antibiotics are used at specific doses for specific illnesses. The exact dosage of each and every medication in existence for each and every disease is well beyond the scope of this article. It’s important, however, to have as much information as possible about medications that you plan to store.

    This information is available in a number of drug reference manuals (with images) in both print and digital form. Online sources such as drugs.com or rxlist.com are other useful sources, but we recommend a hard copy for your medical library in case a disaster affects the internet.

    Your manual should list medications that require prescriptions as well as those that do not. Under each medicine, you will find the “indications”, which are the medical conditions that the drug is used for. Also listed will be the dosages, risks, side effects, and even how the medicine works in the body. It’s okay to obtain a book that isn’t the latest edition, as information about common drugs doesn’t often change a great deal from one year to the next. Try to obtain a recent copy, though, as occasional changes do occur.

    For those skeptical of our opinion on this topic, we ask you to imagine this circumstance: A disaster has occurred that has knocked you off the grid and sent you on the road. Your family is performing activities of daily survival like chopping wood for fuel, something they’ve never done before. Your son or daughter cuts themselves and, in a day or so, the wound becomes red, hot, and swollen. There may be the beginnings of a fever. You only have a bottle of “fish” amoxicillin. Would you use it? We’ll let you decide.

    Joe Alton MD

    Dr. Alton

    Dr. Alton’s opinions are his own and not meant as medical advice. They do not take the place of evaluation and treatment by qualified medical providers wherever a functioning medical infrastructure exists.

    Learn more about antibiotics, infectious diseases, and more than 100 other topics in off-grid settings in the 2017 Book Excellence Award 1st place winner in medicine, The Survival Medicine Handbook’s 3rd edition.

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