Editor gets to try out own treatment regimen in field after writing this initial report
The 5th Estate
06/09/2012
UPDATE:
Just my luck, after writing this initial report on tropical staph, I get to try out my modified treatment regimen in the field on myself., with improvisations dictated by location and idiocy on my part.
On a recent trip to Central Java, I had a few spare hours to stomp around in the jungle, trying to familiarize myself with the poisonous flora, fauna, insects and reptiles. But this isn't where I got into trouble.
Back in the village, I was looking closely at the local cultivation practices and bent over one bush, stabbing myself in the chest with the pointy stick holding the plant up. Having an attack of stupidity once again, I blew it off and continued the journey.
Six hours later, I felt a sharp pain in the right side of my chest and upon examination found myself looking at a full-blown staph infection, at the site where I was stabbed by the bamboo stick. It was on the right pectoral muscle, already hard and I could now feel it spreading into the glands under the right arm. I was in deep shit.
Luckily, I was already on amoxycillin for a tooth infection, so I could be fairly sure this was a strain of the deadly
MRSA, tropical methicillin-resistant staph.
My first choice for an antibiotic was
Keflex, which I had like an idiot, left in Jakarta. I did have some
erythromycin, which I took 1000 mg's of orally in an attempt to slow it down while I tried to get my hands on some vancomycin, a known MRSA killer. Out here, the odds were against me.
The nearest hospital that could infuse me with vanco was at least 80 kilometers away, and I had to deal with it now. It had suddenly and unexpectedly become a full-blown medical emergency.
Incredibly, at the nearest apotik (pharmacy) I did manage to find some vanco, which I had to mix myself for supposed infusion of at least 15 ml. Due to the properties of vancomycin, it must be infused slowly in an IV as it can damage the veins. Oral use only kills the bacteria in the gastrointestinal tract and is not absorbed into the bloodstream, it just hangs out in the colon killing everything there and causing explosive diarrhea. There was no way I was going to inject 15 ml directly into the site, in addition to making me look like half of Dolly Parton there was no data on intra-muscular injection. It just was not done, for one reason the incredible pain it causes, so there was no data. I had to guess.
NEVER DO THIS UNLESS IT IS THE ONLY OPTION AVAILABLE.
I didn't have the option of infusion, and with the infection spreading rapidly by the
minute I decided to inject the vanco directly into the site.
DO NOT ATTEMPT TO DO THIS UNLESS YOU ARE IN DANGER OF DYING AND NO PROFESSIONAL MEDICAL ASSISTANCE IS AVAILABLE.
Vancymycin is never injected directly into the muscle, however there was no choice.
After mixing the vanco (dried, in a 10 ml bottle) and using a disposable 3 ml 23GX1/14" (0.60X32 mm) syringe, and bathing the site in surgical Betadine I injected .08 cc/ml directly into the boil, taking care not to go all the way through it and further infecting the surrounding area or possibly even getting it into a vein, which would probably be fatal.
The medical professionals were right, and the pain was, well... exquisite. The banana I had put between my teeth was completely bitten in two. It stayed on for about an hour, and then dissipated.
The apotik also had two tubes of expired Bactoderm (Mupirocin) topical, exactly what was needed to slow the spread and prevent further exposure to both myself and those around me. Expired or not, it was the only option for a topical, so it was put to use.
This staph, like most, is
HIGHLY CONTAGIOUS. All medical equipment used to treat it should be put in the bonfire, along with clothes, utensils or anything else that has come into contact with the infected area. Separate toilet facilities - whatever they are - should be used to prevent the spread of the infection. Person-to-person contact should be avoided, especially in the field.
Become a compulsive hand-washer. It sounds flaky, but it will save you from contaminating yourself and others. Even when using shit water to wash with it is better than nothing, try to get your hands on some alcohol pads and go over your hands well afterwards, air-drying them. This works well and will give you additional peace of mind. Alcohol pads should always be carried in the field, as well as a 10 oz. bottle of 100% chlorine to purify wash and drinking water with. Betadine can also be substituted if necessary. A 10 oz. bottle of pure rubbing alcohol would be a very big edge. Plastic bottles are light and the weight is negligible. As always,
better to have and not need than need and not have.
I then dosed myself with 960 mg of Primadex (Trimethoprim Sulfamethoxazole).
Six hours after the first vanco injection and not having any overt allergic or other reactions, I again injected .08 cc/ml vancomycin, this time well under the boil, in an attempt to quarantine the infection at the site.
Every 4 hours I alternated 480 mg Primadex and 500 mg erythromycin.
Two days later, there was a marked reduction in the swelling and redness, and now had to be lanced. This was accomplished with a surgical scalpel after being super-heated over a flame and sterilized. The pain, again, was biblical. Following the lancing of the boil and subsequent draining, the infection expired.
Oral antibiotic treatment was continued with the Primadex, 480 mg every four hours for five days, along with the Bactoderm, keeping the wound covered at all times to avoid the spread of the infection and allow the wound to drain freely. The wound should never be left in the open air or allowed to scab over. It must drain and heal from the inside out.
A week later, the infection was completely subsided and still healing. Necrosis had already begin to set in when I began emergency treatment, it was that close.
This form of treatment should
NEVER be attempted unless you are in a dire emergency, and no other professional medical assistance is available. You should
NEVER guess at the dosage of any medicine, however when presented with a life-threatening situation in the field it may be your only chance for survival. Use your head, don't panic.
Time is of the essence in dealing with staph of any kind, usually precluding tests for allergic reactions. If you believe you have time, one simple test is to swab the inside of the arm with the medicine you intend to use, waiting at least an hour for any sign of allergy.
These are primitive, cave-man approaches to field medicine, however I believe that it could possibly be life-saving in emergency situations, and we believe here at
The 5th Estate that you are entitled to any measures that may one day save your life or the lives of those you are with.
Good luck, be safe, happy travels and let us know of any experiences you may have to share with other concerned readers.
Improvise, Adapt, Overcome.
Dr. Bob
Staph lives on the skin of humans, and may appear at any time, usually as a result of an injury to the epidermis but will also penetrate hair follicles to take hold and spread. If left untreated an infection may result in amputation or death and tropical environments it can spread with terrifying speed, sometimes overwhelming the body's defenses within hours.
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Staphylococcus aureus |
My worst experience was in Thailand, where a mere mosquito bite almost caused the amputation of a finger and was proceeding to engulf my arm before it was finally brought under control with high-powered antibiotics.
The bump was ridiculously small, on the second joint of my right index finger. I ignored it and went about my business until the pain forced me to seek medical attention a scant few hours later. The doctor took one look at the necrotic flesh surrounding the bite and immediately ordered my hospitalization with a Keflex IV. This failed to stem the spread of the flesh eating bacteria and now my entire arm was threatened. It took 48 hours and a massive, sustained dose of
Ceclor to finally stop it. The scar is still there today as a reminder of my stupidity in ignoring it in the first place.
Individuals with
compromised immune systems (diabetes especially) are more susceptible to infection.
Tropical staph, like all staph is incredibly infectious. It may be spread by water, clothes or simple skin contact. The resulting boils are almost unbearably painful, so when contracted there should be no doubt as to what you are dealing with.
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Immediate treatment required or an insect bite like this.... |
Strict sanitation procedures should be utilized when treating patients, and ideally, they should be isolated. All clothing worn during the active phase of infection - which is to say during the entire time of treatment and healing of the skin lesions - should be burned as washing may allow the bacteria to survive. Treatment outside of the hospital is extremely difficult. A 25% solution of chlorine and water should be used to wipe down all surfaces that the patient has come into contact with. If possible, caregivers should be dosed with a prophylaxis antibiotic. I have seen staph infect otherwise healthy people simply by using the same bathtub as the patient, even after attempts to disinfect the tub.
If the patient is in the field and medical assistance is impossible to obtain amputation/cauterization should always be considered a possibility.
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Treatments
This on treatments from Medicine World.org:
Scientists at the University of Illinois at Chicago and Israel's Weizman Institute of Science have observed that two antibiotics working together might be more effective in fighting pathogenic bacteria than either drug on its own.
 |
....left untreated could turn into this within a matter of hours |
Individually, lankacidin and lankamycin, two antibiotics produced naturally by the microbe streptomyces, are marginally effective in warding off pathogens, says Alexander Mankin, professor and associate director of the UIC Center for Pharmaceutical Biotechnology and lead investigator of the portion of the study conducted at UIC.
Mankin's team observed that when used together, the two antibiotics are much more successful in inhibiting growth of dangerous pathogens such as MRSA, or methicillin-resistant Staphylococcus aureus, and possibly others.
MRSA is a staph infection that is resistant to certain antibiotics. As per a 2007 government report, more than 90,000 Americans get potentially deadly infections each year.
The research results are reported in the Jan. 11 online edition of the
Proceedings of the National Academy of Sciences of the USA.
Lankacidin and lankamycin act upon the ribosomes, the protein-synthesizing factories of the cell. A newly-made protein exits the ribosome through a tunnel through the ribosome body. Some antibiotics stave off an infection by preventing the ribosome from assembling proteins, while others bind in the tunnel and block the protein's passage.
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Keflex should be carried in the field, it is tolerated well in most people and is effective against staph.
Prevention is obviously the best course of action when it comes to dealing with this killer in any environment. Injuries should be disinfected immediately and flushed with
Betadine or an equivalent, and if possible an antibiotic ointment like
Polysporin applied and the dressing should ideally be changed at least 4 times a day, and the old dressings, gloves and any applicators burned or buried, deep. This will prevent others from contracting it or having it take hold in another area on yourself.
Unless you are sure you will be getting professional medical attention within a few hours, once the antibiotics take hold and the site begins to soften from being rock-hard it will have to be lanced. It is exquisitely painful, but must be done in order to promote healing and open the wound to drainage. Be sure to sterilize your instrument - a small blade for example - over an open flame for at least a minute. Remove any soot from the blade with Betadine, find something to bite on, and let 'er rip. The wound also will need to be manipulated - squeezed - until it bleeds well and all he pus is removed. It may have to be repeated and hurts like hell, but it must be done.
As will all self-treatments treatments, be prepared with personal dosage information for all drugs BEFORE you depart. It will most likely be inaccessible in the field and will save your life in an emergency, especially with staph where quick action on your part may save limbs, and lives.
Dr. Bob
Dr. Bob is a broken down old U.S. Marine with extensive experience operating in both jungle and arctic environments. The treatments in this article have been tried and tested by Dr. Bob, however all medicine dosages should be checked on the Net or in the Physicians Desk Reference for applicable body weight, allergic reactions, renal and liver disease and any adverse symptoms that may arise. Whenever possible, always double check with a doctor before dosing or treating yourself.