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Help request, expiry dates: antibiotics

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Technophobe View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Topic: Help request, expiry dates: antibiotics
    Posted: September 22 2015 at 9:41am
Do any of our learned members know how I can find out the stability of various antibiotics?  I am aware that, on the whole, they lose potency after expiry dates and a few such as tetracycline can become toxic.  I know too that refrigeration reduces the decay rate, as long as you do not freeze them.

I am however searching for much more specific info.  I want to know the laboratory findings for remaining/lost percentages, over set time periods, at specific temperatures.  Only with that can I perform exact calculations of remaining potency=doses.

The only peer reviewed stuff I can find is in Portugese.  I can plod my way through scientific papers (with a dictionary and time) until I fully understand them.  But not after google translate has muddled/befudddled them.

Help!  Please! Confused
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Jen147 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jen147 Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 10:24am
Great post Techno! I'm eager to see the responses as well.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote FluMom Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 12:57pm
The breakdown products of tetracyclines are toxic and can cause Fanconi syndrome, a potentially fatal disease affecting proximal tubular function in the nephrons of the kidney. Prescriptions of these drugs should be discarded once expired because they can cause hepatotoxicity.

Can't seem to find any other antibiotics that turn toxic.
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Jen147 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jen147 Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 1:35pm
That is good info to know. I did not know it myself. Currently have some Cipro and some Doxycycline Mono in my preps. Should I discard the Doxy?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jen147 Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 1:36pm
Tetracycline Brand names:

http://www.mayoclinic.org/drugs-supplements/tetracycline-class-oral-route-parenteral-route/description/DRG-20069585
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 4:33pm
Tetracycline was reformulated after it was believed to break down into toxic compounds, and it's fine. The case that started the debate was, and still is, hotly contested as having actually been caused by tetracycline in the first place. This is how the JAMA described it back in 1963 -  "A contested example of a rare exception is a case of renal tubular damage purportedly caused by expired tetracycline. This outcome (disputed by other scientists) was supposedly caused by a chemical transformation of the active ingredient". A great deal of hedging going on there, but if you read between the lines, they didn't believe tetracycline was responsible.
The patient in question self medicated with 4 grams (Shocked) of tetracycline over a 48 hour period for a toothache, and the pills she took had got wet accidentally over a year before, so she dried them and kept them in a cardboard box. Hard to imagine why she got sick...
As for Techno's original question, I guess it all depends on the way antibiotics are stored. Dark, cool places will make them last a lot longer than warmer conditions. As you mentioned, they don't go bad - they just begin to lose their potency.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508026/?page=1
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"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 4:34pm
"And that the belief now was more along the lines of: "Old" and degraded tetracyclines have previously been demonstrated to have direct toxic effects on the renal proximal tubule, but because of changes in manufacturing techniques this is no longer a real problem."
'Tetracyclines in Renal Insufficiency-1978'

(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1807475/pdf/bullnyacadmed00127-0087.pdf)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 4:40pm
Jen - doxycycline is considered to be the safest of that class of drugs.

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"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jen147 Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 6:22pm
Ok, thanks JD!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote hachiban08 Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 6:33pm
Doxicycline is the one that makes me the most sick to my stomach. :( Shouldn't be taking zithromax either because I have a heart issue unless that advisory is gone.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: September 22 2015 at 11:05pm
No problem, Jen. This has come up before on AFT, and it's a regular topic on many of the survivalist/prepping sites. As hard as it can be to get antibiotics sometimes, I'd hate to think of people throwing them away when they might make all the difference in a pinch. Glad to help Thumbs Up
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: September 23 2015 at 10:05am
Hmm....  Thanks everyone!  'Still not quite what I was after.

At specific temperatures )
Over set time periods     ) ,  Organic (that means containing carbon) compounds degrade, they do this at a specific rate. 
If stored dry                    )

Chemists can measure this rate accurately and the results can be plotted on a curved graph. You or I can then extrapolate from that graph, to arrive at a reasonably accurate approximation of remaining potency.

This is precise information, arrived at in lab conditions, peer reviewed and beyond my facilities (or faculties) to do.  But, it is done.  That is the stuff I am chasing.  I have found the results for trimethomprim and its sulphur drug assistant (they follow a zero order process) but after that I am stymied.

So thanks folks - please keep looking.

--------------------------------------------------------------------------------------------------------------------------------------------------------
Regarding sulphamoxazole/sulphadiazine + trimethoprim=co-trimoxazole or norodine:

Zero order process = no measurable change = They do not decay WHEN DRY!!!!!!!!  even at 140*C!  When in a solvent the decay rate is determined by the temperature and the choice of solvent.  In water at 50*C its all gone within 48 hours!

This means that the expiry date for these [co-trimoxazole] is based on the resilliance of the packaging and is affected by both the humidity of the storage and the way the packaging is handled.  The substances themselves are hydrophillic/delequescent so they commit hari-kiri if there is an invisibly small pinprick in the package.  Wrap/seal well enough and you can and keep them forever.

I will add more information when I can find it............................... but don't hold your breath!

Hydrophillic = loves water, delequescent = picks up water from the air - like those dry out your closet granules, or the silica beads in disposable nappies.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Hazelpad Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2015 at 1:11pm
Probably big pharma don't like making this information available. All individual products are tested under optimal conditions for efficiency. They put their dates on and it is illegal to be given medicines that have expired. That is where their responsibility ends.    The only places that use out of date antibiotics are developing countries so you have to look there for the study information.

Article below shows the comparative bacteriostatic potentials of 31 expired and seven corresponding unexpired oral paediatric. The abstract is given but at end of post is link to full article which has more info.

On a personal note we use antibiotics on our culture plates and hate to say it but with ampicillin and neomycin, even when stored in fridge, it does begin to lose its ability to suppress growth as it ages, even freezing doesn't prolong it. Also one of the problems of giving out if date medications is that the reduced potency can lead to the growth of a recurrent infection with a resistant bacteria ( I.e. those bacteria you don't kill come back stronger and more apt to be resistant).

If it were me and I was in a complete survival emergency situation where I had to use out of date antibiotics, I would probably using combined treatment of 2 broad spectrum. What one doesnt kill the other can mop up. Drug interaction info makes it easier to understand the good and bad combinations you can get. For example giving doxycycline with amoxicillin would cancel each other out, neutralise each other.

Also not all broad spectrum antibiotics are equal and some are more useful. For example take co-amoxiclav ( Augmentin). This is your basic amoxicillin with the addition of clavulanic acid, this extra ingredient restores efficacy against amoxicillin-resistant bacteria that produce β-lactamase. So using the correct antibiotic for the correct infection type is so important.

Anyway here is the abstract of the article I have linked to. Perhaps though someone with more pharmacology background can help more.


Evaluation of bacteriostatic potency of expired oral paediatric antibiotics and implications on infant health.


Abstract


INTRODUCTION:
In spite of significant risks, as well as non-clinical importance due to loss of potency, stiff penalties against administration of expired medications are still not appropriately enforced by health policy makers in many developing countries, possibly because of little evidence to support that expired medications are hazardous. The purpose of this study therefore, was to investigate the effect of expiration dates on in vitro bacteriostatic potentials of oral paediatric antibiotics.

METHODS:
Comparative bacteriostatic potentials of 31 expired and seven corresponding unexpired oral paediatric antibiotics were determined on infantile diarrhoeagenic bacteria, using a modification of agar well-diffusion method.

RESULTS:
Verall total percentage in vitro resistance rates against expired and unexpired paediatric antibiotics respectively were - E. coli (≤100% vs. ≤15.9%), Klebsiella pneumoniae (≤100% vs. ≤31.3%), Proteus mirabilis (≤91.7% vs. ≤41.7%) and Staphylococcus aureus (≤100% vs. ≤18.2%). Resistance rates of 45.5-55.8% (sulfamethoxazole + trimethoprim 5), 39.5-63.6% (amoxycillin 6), 46.5-54.5% (cotrimoxazole 7), 37.5-63.6% (ampicillin + cloxacillin 18), and higher resistance rates of ≥75.0-100% were exhibited towards remaining expired antibiotics. Higher total resistance and multiple antibiotic resistance (MAR) rates were also recorded against expired antibiotics (45.2-93.5%) compared to unexpired antibiotics (28.6-57.2%), except for few strains of E. coli and Proteus mirabilis. Furthermore, unexpired paediatric antibiotics exhibited wider zones of inhibition towards the test diarrhoeagenic bacteria (≥25.0 mm diameter).

CONCLUSION:
This study provided preliminary microbiological results on the appreciable reduction in in vitro bacteriostatic potentials, as well as higher resistance and multiple antibiotic resistance rates among expired oral paediatric antibiotics on infantile diarrhoeagenic bacteria. Apart from less-efficacy, administration of expired antibiotics can lead to increased antibiotic resistance and clinical treatment failure, as well as adverse drug reactions.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427466/

http://www.ncbi.nlm.nih.gov/pubmed/25977741
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: October 12 2015 at 4:22pm
Thank you, Hazlepad!  

I am a great believer in polytherapy even under optimal circumstances.  Its what keeps HIV, TB and leprosy under control, against all the odds and I believe that the same trick would work on most (if not all) infections.  My personal approach is don't treat till you have to, then use a chemical sledgehammer and for a LONG time - or it may come back stronger than ever.  You confirm my personal theories.

In addition to all that, you gave me a possible new window for more research.  The only place, up till now, I could find any info was from Brazilian and African research.  The Brazilian was in Spanish (I think.  It could have been Portugeese or even Klingon for all I could tell.) and my background knowledge is not good enough to allow me to accurately dissect Google translate.  You do confirm, however, that this was the right direction for further surfing,  I was loosing heart a bit and I was approaching it from a chemist's viewpoint as opposed to a microbiologist's which was also limiting my result-finding.  Duh!  Wacko  (Forehead slap!)

Thanks again!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote newbie1 Quote  Post ReplyReply Direct Link To This Post Posted: October 19 2015 at 6:41am
here's a good article...
http://www.redorbit.com/news/health/771253/study_highlights_debate_over_drug_expiration_dates/

jackpot...!
http://www.usamma.amedd.army.mil/dod_slep.cfm
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