Preparing for Biological and Chemical Terrorism: A Practical Guide to Antibiotics and Their Usage for Survival
Leonard G. Horowitz, D.M.D., M.A., M.P.H.
Disclaimer and Background
This information is for educational purposes only. It is intended to help in the event of biological and chemical weapons attacks on civilian populations. It is not provided in order to diagnose or treat any disease, illness, or injury of the body, mind, or spirit.
The author, publisher, and distributors of this work accept no responsibility for people using or misusing the potentially life-saving information in this text.
Individuals suffering from any disease, illness, or injury should, as Hippocrates prescribed, "learn to derive benefit from the illness." In this sense, in the context of "America's New War" on terrorism, diagnosing the root causes of contemporary threats best derives "benefit". That is, comprehend the evil bringing on such illness and distress. The macroscopic--political, social, moral, and personal forces, beside the microscopic agents, are best identified to provide appropriate treatments.
The antibiotic applications against germ warfare discussed herein are not well-established medical practices. They are best considered speculative, but reasonable, given the urgent and widespread risks of biological attack for which there is no precedent, nor adequate scientific research. Discussions herein are intended to provide self-help strategies under emergency circumstances in which professional care is unavailable, as is anticipated following large-scale exposures of unprotected populations to lethal biologicals.
It must be stressed that the unsupervised lay use of antibiotics is dangerous for several reasons: 1) antibiotics may cause potentially fatal reactions (e.g., allergy, asthma, and death); 2) antibiotics can prompt greater growth, development, and spread of resistant pathogens such as fungi and Mycoplasma prompting more severe or alternative infections; 3) antibiotic usage can make it more difficult for physicians to diagnose life-threatening infectious illnesses. Thus, self-medication is not advised under normal circumstances of medical personnel availability.
Furthermore, though certain antibiotics are customarily prescribed to kill certain strains of bacteria, germ warfare presents unique challenges. Biological weapons developers have routinely developed germ strains, such as anthrax, smallpox, influenza, Mycoplasma, Brucella, and more, that are antibiotic resistant. At the same time, vaccines and vaccine manufacturers have proven themselves to be highly untrustworthy.
Moreover, in the event of a biological attack, the initial benefits of antibiotic prophylaxis and treatment may be jeopardized by a second wave of infection of the same microbe, or secondary infections with other germs. These are expected due to subsequent disease transmission by infected insects, such as flies, fleas, and ticks, and immune compromised victims in which secondary infections are common.
Typically, bacteria are classified either "Gram-positive" or "Gram-negative" due to their structure and staining characteristics, which reflect their susceptibility to certain antibiotics. The Penicillin family of
antibiotics has been effective against Gram-positive infections. Alternatively, the Tetracyclines have been used successfully to combat Gram-negative agents. These will be discussed in more detail later.
Near the beginning of a widespread biological attack, it may be extremely difficult to determine precisely the causative agent, and thereby select the proper antibiotic. This is due to: 1) the latency, or slow growth period of the germ within exposed individuals, and 2) biological weapons specialists often mix microbes to be used in such a manner as to confuse diagnosis and delay effective treatment.
For instance, a consensus of authorities predicts inhalation anthrax is among the likeliest biological weapons to be used by terrorists. This is due to its relative ease of manufacture, durability of spores, and difficulty of delayed treatment. Anthrax is a Gram-positive rod-shaped Bacillus. To be more effective in killing large populations, authorities suggest that Gram-negative bacteria, such as Pasteurella tularensis, may accompany such attacks. This germ is likewise rod-shaped to confuse accurate diagnosis and delay time-critical treatment.
For the above reasons a "combination therapy" may be indicated and most useful in saving lives following a biological weapons attack.
Weights and Measurements
Safe and effective antibiotic dosages depend on accurate weights and measurements. For this reason, the following recommendations and basic knowledge is provided for lay civilians under emergency situations:
To accurately weigh antibiotics in an emergency, use the chart below. Begin by placing a ceramic cup on a postal scale. Weigh it. Next, add the powder you wish to weigh to the desired amount. For instance, if the cup alone weighs four ounces, and you require one ounce of powdered antibiotic (where, according to the chart, one ounce equals approximately thirty (30) grams, that is, thirty 1,000 milligram [mg.] doses), set (or tip) the scale at five ounces with the desired antibiotic.
The same method may be used for measuring liquid doses. However, one ounce of liquid antibiotic may weigh less than once ounce on a scale. For this reason it is wise to use a graduated measuring containing, if possible, for measuring liquids.
Weights, Measures and Conversions Solid Weights and Measures 1 ounce (oz.) of solid = nearly 30 grams (Gm.) 1 pound (lb.) = 454 grams (Gm.) 1 kilogram (kg.) = 2.2 pounds (lb.) 1 gram (Gm.) = 1,000 milligrams (mg.) 1 grain (gr.) = 64.8 mg. Liquid Weights and Measures 1 ounce (oz.) of liquid = nearly 30 milliliters (ml.) 1 pint = 473 ml. (sometimes rounded up to 480 ml.) 1 teaspoon (tsp.) = 5 ml. 1 tablespoon = 15 ml. (that is, half [.5] an ounce) 1 milliliter (common droppers held upright) = approximately 20 Antibiotic Conversions 400,000 units of penicillin = 250 milligrams (mg.) Antibiotic Usage and Duration of Treatment
Under normal circumstances, antibiotics are intended to be used for approximately one to two weeks. This duration is prescribed in order to kill more slowly growing germs, such as those initially in spore forms that require incubation for disease expression.
Emergency situations may require less careful treatment durations. This is particularly true if antibiotic shortages occur as expected following a biological weapons attack. In this case, rationing may be necessary and helpful in saving more lives. The shortest duration of antibiotic coverage recommended following a biological attack is from the onset of symptoms to at least 72 hours after the person's symptoms completely disappear. Ideally, antibiotic prophylaxis (for prevention of disease) should begin as soon as a biological weapons attack is confirmed for individuals at risk of exposure. In other words, it is best to leave risky environments in advance of possible exposures. Certainly, urban populations are at greatest risk for biological and chemical weapons attacks. Common Allergic Reactions to Antibiotics
Again, under normal circumstances, individuals who are hypersensitive, or allergic, to antibiotics should avoid taking them. However, following a biological weapons attack, it may warrant the risk of allergic reaction, particularly if antihistamines (such as Benadryl) are available, rather than contracting the infectious disease which is often more life-threatening. In this case, individuals who develop symptoms of allergy, including skin rashes, should ideally be under the care of a physician or hospital staff. Careful monitoring of even seemingly benign skin rashes is advised because of more urgent conditions that may result from simple allergic reactions.
Individuals with known allergies to specific antibiotics should, obviously, try to avoid taking these antibiotics. Alternative antibiotics, in this case, should be sought and used. For example, people allergic to penicillin may be able to effectively substitute erythromycin.
As detailed below, there are several types of penicillin, all of which may cause severe allergies and fatal reactions. Penicillin G and penicillin V have been known to cause more severe reactions than ampicillin. Similarly, penicillin injections have been known to cause more severe reactions than similar doses taken orally.
Approximately ten percent of people allergic to penicillin are also allergic to the cephalosporin antibiotics. The good news is that the incidence of deadly reactions to the entire class of cephalosporin antibiotics is very low.
In some liquid penicillins, manufacturers mix the anesthetic procaine (i.e., Novocain) into their formulas. Therefore, persons allergic to this commonly used dental anesthetic should avoid taking liquid penicillin suspensions.
The antibiotics suggested below for use in case of bioterrorism or biowarfare do not contain sulfur or "sulfa" drugs to which many people are allergic.
Preventive Foresight Regarding Pharmaceutical Supplies
The likeliest source of breaking news concerning a biological or chemical attack, launched by terrorists or other foes, is the mainstream media. By the time you hear such reports, it is likely that hospital emergency rooms, and doctor's offices, will be full of ailing victims. It typically takes a day or longer for symptoms of infectious diseases to manifest. The first signs and symptoms of a covert attack include inexplicable headaches and flu-like symptoms.
Such is the case with anthrax. The first indication of an anthrax attack, providing the strain had not been modified, is cattle becoming sick and dying. This can happen in a matter of hours. Moreover, this is an indication to begin antibiotic prophylaxis.
Under such trying circumstances, you can expect there to be tremendous demand for medical supplies and pharmaceuticals in the wake of a terrorist attack. It is, therefore, highly advisable to consider beforehand what medical supplies might be essential for your survival and the protection of your loved ones.
Obviously, people on a regimen of prescription drugs should stock, perhaps, a three months supply in a cool, dark, and dry closet or basement.
Antibiotics can be purchased in bulk from pharmacists or livestock and veterinarian supply stores.
In case you need to leave your home or workplace in an emergency, try to plan, in advance, transporting your antibiotics and other medicinal requirements with you. Maintain access to standard emergency kits, particularly during times of possible trouble. Keeping one in your car is a good idea, providing the car doesn't overheat.
Given these constraints, diabetics, on the move in an emergency, should try to keep their insulin at room temperature until they are resettled. Above 80 degrees and while freezing insulin will begin to degrade.
In general, when traveling or storing antibiotics and medications in your car, be aware of extreme temperatures. Extreme heat and cold often inactivates, like insulin, many medicines.
A Simplified Guide to Antibiotics and Their Uses Penicillins
The original penicillin-G (Pen G), along with more the common penicillin-V (Pen V), are used to fight gram-positive bacteria, such as anthrax. Pentids, the brand name for penicillin-G, come in 400 and 800mg pills. Brand names for penicillin-V include V-Cillin-K and Pen Vee K. The basic Pen G may be purchased from farm and veterinary stores for far less expense than through pharmacies, though make sure you only buy the refrigerated brand. The active ingredients in the unrefrigerated variety are far lower and potentially inadequate.
Pen G must be taken on an empty stomach. This is not as critical for Pen V. A dose of 250mg (i.e., 400,000 units), for people weighing 50 pounds or more, is taken four times daily. A rule of thumb for children weighing less than 50 pounds, the dosage should be reduced by 20% for every 10 pounds of less body weight.
These penicillins are more likely to cause allergic reactions, and fatalities, than synthetic penicillins such as ampicillin. Some of the allergic reactions are caused by procaine (Novocain) that is added in some Pen G formulas.
Brand names of this synthetic penicillin include Principen, Omnipen, Polycillin and Totacillin. These are also affective against gram-positive microbes such as anthrax.
Dosages of ampicillin are the same prescribed for penicillin. This antibiotic should be taken, ideally, on an empty stomach.
Strains of anthrax that resist penicillin may be more susceptible to destruction by ampicillin. Also, ampicillin may be more helpful than penicillin for killing a broader spectrum of infections.
These are also effective against anthrax. One gram of Cephalexin taken every six hours is recommended. Brand names for this are Keflex, Keflet and Keftab. One gram of the related Cefadroxil, brand named Duricef, should be taken every twelve hours.
Erythromycin (Macrolide family of antibiotics)
Erythromycin and its relatives provide a broader spectrum of coverage than penicillins. Brand names of Erythromycin Pediamycin, Erythrocin, Eryc, EES, Ery-Tab, PCE, Ilosone, and E-Mycin. Other related antibiotics, such as clarithromycin (Biaxin) and azithromycin (Z-pak or Zithromax) may also be effective. A liquid form of erythromycin, called Gallimycin, is available for injection. The oral dose of this injectable product is the same.
Taken on an empty stomach, this may be used to treat more difficult cases of anthrax. If upset stomach occurs, it should be consumed with a bit of food. Avoid eating citrus fruits or products, which deactivate these antibiotics during digestion. Note: Fatal heart attacks may result from taking these antibiotics in combination with Seldane (terfenadine), Hismanal, or Seldane-D.
For individuals weighing 150 pounds or more, a 500mg dose is recommended. People weighing less should reduce their dosage proportionately.
These antibiotics that are effective against anthrax, tularemia, and the Bubonic plague, include: Streptomycin, Gentamycin, and Neomycin. They can all be extremely toxic. Primary organs at risk for destruction by the aminoglycosides include the kidneys and inner ears.
Each of the aminoglycosides must be injected, and cannot be taken orally. The oral dosage forms of these antibiotics are effective only against gastrointestinal (GI) tract infections of the stomach and intestines.
Gentamycin (Garacin) powder can be purchased in bulk. It cannot be absorbed when taken orally, but it can be effective against certain biologicals striking the GI tract such as botulism.
Streptomycin, taken two to four times daily, in one to four gram doses, equally spaced throughout the day. It can be used in combination with tetracycline until the person's fever breaks. Then the tetracycline can be continued alone. Otherwise, streptomycin should be used consistently for a week to ten days.
Gentamycin, is effective against tularemia and the plague. It should be injected intramuscularly or intravenously every eight hours in emergency measures of 1.7mg per kilogram body weight. As soon as symptoms of disease disappear, the dose should be reduced to 1.0mg per kilogram of body weight for the remaining 7-10 day period.
This antibiotic is available in bulk through veterinary stores. It is likely that this less expensive product may be successfully used orally to defend against the plague or tularemia germs infecting the gut.
Neomycin, when given in doses of 500mg, four times daily, may be helpful against anthrax, plague, and tularemia, though it has not been traditionally prescribed for these. Use this only if the other aminoglycoside antibiotics are unavailable.
In daily doses of 300mg per kg. of body weight (i.e., 65mg. per pound), Ciproflavoxin (Cipro) is effective against tularemia and anthrax. The daily dose should be divided into four doses taken every six hours for two weeks. Following the terrorist attacks on September 11, 2001 on the Pentagon and World Trade Center, this extremely expensive drug has been in high demand as the FDA's antibiotic of choice against anthrax. Disturbing politics regarding this selection and its manufacturer-Bayer-may be found at http://www.tetrahedron.org.
Effective against anthrax, tularemia and plague, Chloramphenicol (Chloromycetin) has a relatively high rate of lethal side effects. Thus, persons allergic to safer antibiotics should only use it, or in the event other medications are unavailable. More expensive than other antibiotics, this injectable product can also be consumed orally and absorbed effectively into the bloodstream. Ideally, taken on an empty stomach, it may be consumed with food to reduce stomach upsets.
Chloramphenicol has the same spectrum of activity as erythromycin. Thus, it should never be given with erythromycin unless under emergency conditions at the first sign of biowarfare-induced illness. It may, however, be taken with Tetracycline for a broader spectrum of effectiveness. This combination may be wise if it is unclear which biological weapon is causing illness, and if rationing is not in effect.
The injectable form of chloramphenicol tastes awful! For people weighing 200 pounds or more, 2,500mg doses recommended.
Tetracyclines (brand named Sumycin and Achromycin-V) are broad-spectrum antibiotics available from farm supply shops and veterinary stores in the form of oxytetracycline. These can be used effectively against all most strains of anthrax, plague, and tularemia.
Oxytetracycline comes in bulk powder form under the brand name Terramycin-343. It also comes in combination with livestock feed (Advance Calf Medic). This could be used in a pinch if other antibiotics were unavailable. There are 3 grams of active antibiotic in each pound of feed. A low dose could be provided by consuming almost 1.5 ounces; a high dose twice that could be measured and eaten.
Two newer classes of tetracycline are Doxycycline and Minocycline. Brand names for these tetracyclines include the Doxycyclines-Vibramycin, Vibra-tabs, Monodox and Doryx; and the Minocyclines called Minocin.
Tetracycline is typically taken four times a day, doxycyclines once per day or twice per day when taken with Minocycline. The two newer cyclines can be taken with food, not the older tetracycline. They, thus, tend to cause fewer stomach upsets. Doxycycline is typically less costly than traditional tetracycline, and Doxycycline and Minocycline provide a broader spectrum of antibiotic effectiveness than the old standard. Stains of biological weapons the may have been manufactured to resist tetracycline might be more susceptible to the newer cyclones.
As a rule of thumb, four 250mg doses of tetracycline are prescribed daily, that is, one dose every six hours for your typical 100-pound person. For persons weighing less than 100 pound, reduce this dose accordingly. For instance, if a 100-pound person receives 1,000mg per day, then a 50-pound person would receive 500mg per day, or four 125mg doses q. 6 hours. The Doxycycline dosage is typically 200mg the first day, and 100mg doses following for up to ten days. The oxytetracycline (Terramycin) dose is the same as standard tetracycline. Another alternative tetracycline, called demeclocycline (Declomycin), may be substituted for standard tetracycline employing the same dose schedule as well.
Preserving and Administering Your Antibiotics
Most antibiotics and drugs can be preserved by refrigeration, so long as they are kept dry. If traveling through extreme temperatures, antibiotics should be encased in Styrofoam containers, at best, and efforts should be made to avoid heat or freezing cold.
Warning: No drug should be consumed beyond its expiration date, especially Tetracycline antibiotics. Severe reactions may result from this expired antibiotic. However, when faced with a life-or-death situation, as might be presented with biological warfare or bioterrorism, such chances might have to be taken.
Antibiotics are typically administered orally or by injection. However, if the patient is comatose, the oral route may be circumvented rectally by using a plastic oral syringe available in most drugstores. This should be inserted as deeply into the rectum as possible. Use of a few drops of water, then larger amounts of cocoa butter, for dissolving the antibiotic. Cocoa butter is available in most drugstores in sticks that are melted in a jar placed in hot water. The butter is commonly used for suppositories and will hold the antibiotic for absorption better than water. Water may run out of the rectum and thereby precious antibiotic may be lost. So if water is all you have, use as little as possible to dissolve and inject the measured amount of powdered antibiotic.
Antibiotic tablets can be crushed and powdered by placing them between two napkins on a hard surface and pounding them with another flat hard object or instrument.
The absorption of active antibiotic is less, given the rectal route of administration. For this reason, the dosages should be increased to compensate.
Maintaining Healthy Gut Flora and Immunity
Three primary factors determine the outcome of a biological attack on any one individual: 1) the quantity of germs to which the person has been exposed, 2) the "pathogenicity" or power of the germs to cause disease, which depends on the unique strain, and 3) the "host resistance." This depends on the vitality of the individual's immune system.
Obviously, in the event of a biological or chemical attack, the first two factors are largely, if not entirely, beyond the control of individuals. It is upon this liability that terrorists act. But people can make a profound difference affecting the third factor-human immunity-by making a few simple choices. The first is, maintaining a healthy gut flora.
According to scientific literature, the bacteria in the large and small intestine help digest foods, support nutrient assimilation from foods, are critical in preventing infectious diseases for a number of reasons. For instance, Lactobacilli, commonly found in healthy guts, helps prevent infections from eating foods contaminated with biologicals such as Botulism. A healthy gut micro flora also helps with the elimination of harmful cholesterol, toxic chemicals, and cancer-causing compounds, both natural and man-made. More than 90% of human immunity is, in fact, tied to lymphatic activity around the gut. Consequently, a healthy immune system is largely dependant on the intestinal flora.
Ideally, soil-based microbes, typically found on organically grown foods, should be consumed for boosting natural immunity against infectious diseases, including anthrax and other potential biological weapons. Far more effective than eating yogurt that contains Lactobacilli, there are several products available in good health food stores that supply a full pro-biotic spectrum of soil-based microbes that many alternative health professionals have been prescribing with very favorable results. One such product is called GI Flora Pro (http://www.healingcelebrations.com; 1-888-508-4787), which sells for about $29 for a 30-day supply. A five-step protocol for boosting natural immunity to help fight biological attacks is available from a non-profit publishing company, Tetrahedron, LL-800-336-9266). Their information includes how to: 1) detoxify your body, 2) deacidify your body, 3) boost natural immunity, 4) oxygenate the blood and other body tissues, and 5) bioelectrically manage infectious diseases and recoveries. The material is presented in a 225 page hardcover book titled, Healing Celebrations: Miraculous Recoveries Through Ancient Scriptures, Natural Medicine and Modern Science. The book sells for $22.85, and the advice may be life saving.
Biological Weapons The following chart presents the biological weapons most likely to be used during a terrorist attack, and details concerning its diagnosis and treatment: First Symptoms and Treatment Staining
Headache, fever, coughing, confusion, rash, joint and
joint and muscle pain. Tx: Tetracyclines, Pen G, ampicillin and erythromycin.
Weakness, blurred vision, difficulty in speaking
and swallowing, dry mouth, nausea, vomiting, spreaking weakness, Tx: Horse antitoxin
Fever, headache, abdominal distress, inability to
sit or stand, swollen glands particularly in the
Watery diarrhea, vomiting, abdominal cramping,
Intense aching in head, muscles and joints, and
destructive rash. Tx: none but symptom managmt.
headache, fever, malaise, cough, rash, and
Staphylococcus causes headache, nausea, fever
Tetracycline, Doxycycline or broad spectrum antibiotics.
Fever and headache, meningeal irritation,
swollen parotid glands like mumps, skin rash with some, seizures, brain dysfunction. Tx: palliative
Severe headache, high fever, skin rashes with
vesicular and pustular stages of lesions. Death
by secondary infections. Tx: palliative.
Fever, malaise, headache, liver swelling, ulcerating skin lesions, possible lung involvement
with coughing. Tx: Streptomycin, Tetracycline and chloramphenicol.
Chemical Weapons The following chart presents the chemical weapons most likely to be used during a terrorist attack, and details concerning diagnosis and self aid:
Tightness in chest. Difficulty breathing. Runny nose. Eyepain and blurred vision. Nausea, seating, salivation, elevated pulse, heartburn, vomiting, giddiness, muscle spasms, involuntary urination, paralysis and respiratory arrest. Tx: Wash off immediately and completely. Inject 2mg atropine into thigh, followed by
(oxime). If symptoms persist, give atropine again-two more 2mg doses at 15 minute intervals. Apply emergency first aid, including CPR for artificial respiration for approximately 2 hours if breathing stops. Atropine can cause serious side effects and must not be used unless there is certainty that nerve gas has caused the poisoning.
Eye and skin irritant causes blistering of skin and lung damage. High risk of developing pneumonia. Symptoms delayed for up to 48 hours. Can be fatal. Tx: Wash off contamination
immediately and completely with water. Later washes will cause worse pain. Use mydriatics, antibiotics, and local anesthetics to reduce pain. Treat blisters palliatively as burns.
Eye and skin irritant. Tearing with breathing difficulty. Nausea and
Incapacitating Blossom headache common. Tx: Codeine for
cough and plenty of warmth, oxygen and bed rest.
Severe eye irritant. Causes coughing, tearing, flu-like symptoms, nausea, and breathing problems. Tx: Wash
eyes thoroughly with warm soap and water. Breath lots of fresh air. Bed rest.
Skin flushes. Heart pounds irregularly with hastened pulse. Hallucination,
giddiness and maniacal behavior. Tx: Restrain victim. Quiet bedrest.
Clean Water and Adequate Hydration Having a pure water source following a biological or chemical weapons attack is critical for two main reasons: 1) Victims frequently become dehydrated, and 2) Purified, or distilled, water is needed for detoxification of blood, liver, and kidneys. Following a biological or even chemical weapons attack, water supplies may be contaminated.
University Hospitals/Ireland Cancer Center Sickle Cell Inpatient Treatment Guidelines Supportive Care Sickle Cell Guidelines • If patient is hypovolemic on admission, hydrate with Normal Saline @ 300 - 500 • If patient is euvolemic on admission or becomes euvolemic after hydration, hydrate with D5W1/2NS at 75-125 ml/hr continuously. Laboratory/Radiology All patient
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