UKH

Hi all,

in the past when I've gone on an expedition abroad for an extended period, there's been a doctor on the trip that has prescribed some general antibiotocs in case they were needed when in the mountains. This time there are no doctors and it was suggested that I ask my GP to prescribe something, but I'm being stonewalled by the practice - they keep saying they will call me back, but never do.

What, if anything, have you done to source antibiotics in this situation?

Cheers

In reply to hokkyokusei:

Depends where you're going. In Nepal, India, Pakistan, Bolivia and Peru I've found it easy to buy them cheaply at pharmacies in the cities. Amoxycillin, cipro, Diamox, dex, strap-on nitro are all very cheap and reliable in KTM, Leh etc.

In reply to hokkyokusei:

do a search for a doctor that holds the diploma in mountain medicine many are GPs they'll know the score and can write a private prescription.

In reply to hokkyokusei:

Try to actually speak to a Doctor without telling them in advance what you want, go armed with relevant evidence to support your wish - the BMC or Dr DH might be able to help with this (although you might also need to explain all your previous expedition experience to sway the matter). Ask to see a different doctor if you get a no. Expect to pay for this.

Alternatively antibiotics are generally available without prescription in most 'expedition countries' - there are some small but potentially serious risks with taking this route though.

In reply to hokkyokusei:

If there isn't a doctor on the trip who can deal with any allergic reactions I'd think very carefully about whether you want to risk taking medications that can (very rarely) have severe allergic reactions in a situation where the nearest medical care is far away. If you really want to carry and use these kinds of things in an expedition setting you might find one of the Far from help courses from wilderness medical training very useful. I did this before spending time in Malaysia and found it extremely beneficial. The side benefit that comes with having the knowledge to use a range of drugs safely is the doctor who runs the course helps you obtain the required drugs for use outside of the UK in an expedition setting.

In reply to hokkyokusei:

It's the same with getting vaccinations and diamox etc... It depends on your Dr. I've never had a problem, and will always ask for a two types of wide spectrum antibiotics - one to treat gastro problems and another for respiratory problems. As mentioned having evidence will help your cause. Personally I wouldn't feel comfortable getting the meds in country!

In reply to Adam_Turner:

Asking your gp can be a bit of a lottery. last year mine refused to prescribe diamox whereas my friends did (he was based in kendal though so probably had a more clued up doc for this sort of thing).
In South America I've just got them over the counter.

In reply to hokkyokusei:

If you say exactly where you are going, maybe someone will know a reliable pharmacy in country (there is a huge variety of quality of pharmacy - some can be almost completely full of counterfeit drugs) as this is often your easiest option.

The problem is that by writing you a prescription they assume some responsibility for your welfare (e.g. if you try treat HAPE with antibiotics and don't seek other help and come to harm) - so if they aren't familiar with this and don't know you they will be very cautious. Likewise if they are not a GP they won't be insured to prescribe in this way.

You could try and find if any of the Diploma in Mountain Medicine Doctors are around your area (list at http://medex.org.uk/diploma/diploma_holders.php ) - there are a fair few in Yorkshire. Otherwise it's just hit and miss with your own set of GPs.

If you're going somewhere good and need a doctor to come on the trip, I can offer a reasonable rate

In reply to hokkyokusei:

Go for an appointment to discuss the trip.

In reply to hokkyokusei:

What Damo says. I've easily bought the likes of Cipro and Amoxicillin everywhere I've travelled and at a small fraction of the cost and without the need for a prescription. I always just stop by a pharmacy at the start of the trip.

In reply to splat2million:


Won't GPs also be less inclined to do this if/when antibiotics use becomes more restricted?

In reply to hokkyokusei:

Wherever you go and whatever you do, make sure you know what Abx are relevant for what condition. No point in giving amoxicillin for gut rot, for example. Without medical knowledge, drugs are redundant.
FWIW, when I went to the Andes, in addition to high altitude meds, I took amoxicillin, ciprofloxacin, doxycycline, flucloxacillin and metronidazole.
There's no such thing as a "general antibiotic" that will be effective in all situations, and someone (doctor, expedition medic etc) will need to know where the infection is before prescribing. I have free access to the above meds (and others) through work and being WEMSi certified, but as stated, the key is knowing what to use when. Otherwise oak the meds in the world won't help.

In reply to hokkyokusei:

Hi all, thanks for all of the advice. Too many to reply to individually so I will to cover them all here:

I did make an appointment with my GP, but he said it wasn;t his area of specialism and he would consult a colleague and call me back. They didn't. I also asked the nurse that gave me my vaccinations and she said that she would follow up and she didn't several calls to the surgery have not led to the promised call back either. I think they just don't want to do it.

I'm going to Peru, the Cordillera Blanca, I'll be going through Lima and Huarez, so perhaps I could pick something up there. Does anyone have a recommendation for a place?

I'll google for a doctor with a diploma in mountain medicine.

By general antibiotic I meant broad spectrum, something like amoxicillin, which I've had before so little danger of an allergic reaction. I've noted that there are different types for gastro and respiritory, thanks.

Again, thank you all for the advice.

In reply to splat2million:

...


Just had a look at the list and spotted someone I know from a previous trip. Will drop her a line and she what she says.

Thanks again.

In reply to hokkyokusei:

This is quite an interesting thread for a few reasons.

1. What meds to take on expeditions abroad?

2. What knowledge / training to use them?

3. Where/when to get them- UK from a doctor or abroad over the counter? (or from a dodgy website that'll sell you anything and ship it to the UK).

4. How to get a script in the UK when you are well for meds to take abroad just in case you get sick?

5. Whether or not this is anything at all to do with your NHS GP practice?

6. If it is OK to email a doctor you vaguely know asking for professional advice expecting to get it (for free)?

Thought experiment:
What would d you expect to happen if you went to your solicitor asking them for some free advice about buying house in France because you are going on holiday to France and just might want to buy a house when you get there. But they so "no- not really my area of expertise" (and anyway you doing actually need to buy a house right now so how can they possibly advise) so instead you email a solicitor you met on holiday once- who you know knows all about buying houses in France- and ask them to just tell you what you want to know....(for free).

In reply to freeheel47:

Intensive care doctor here. Hence this is not my area of expertise. The following are some observations though:

1. Depends on where you're going and how far you're likely to be from medical support and what the potential patient is like in terms of any pre-existing conditions

2. In a remote setting would happily give abx in situations I judged serious. I would not remotely give them for your average tummy bug/cold etc so that someone could get over it one day earlier etc and resume the expedition.

3. Clearly the safest way is to get them from a doctor you've spoken to and knows your history and the likely possible pathogens etc etc. Doctors are criticised all the time for over-prescribing abx and there is a looming resistance crisis pretty much worldwide. Hence many doctors will be reluctant to prescribe abx for some undefined possible future complaint to someone who is well.

4. Good question. There are relatively few infectious problems that are so acute and so serious that you couldn't get to medical help in country in most places. Admittedly it might inconvenience your expedition somewhat.

5. Depends on your GP's approach I suppose. I think many would see this as not exactly within the usual scope of NHS work.

6. Most doctors are used to this from friends etc but won't commit very much without (a) seeing the patient in an appropriate professional context and (b) it being within their area of expertise.

As a sidenote I would be very very cautious about just buying stuff and hoping for the best. Abx are one of the commonest classes of drugs that cause anaphylactic shock: this is a life threatening emergency even when it occurs in hospital, hours/days from high quality medical care it could have catastrophic consequences.

In reply to hokkyokusei:
It looks like your GP surgery is not inclined to assist with your request. This is perfectly reasonably able to do this as your are not requesting an NHS service. The NHS does not provide drug treatment when there is no preexisting condition. There are complex rules about which travel vaccinations are and are not provided as an NHS service. Perhaps it would have been better if they'd just said that upfront. Some GP surgeries might agree to assist- but as pointed out in the thread there are some difficulties in supplying prescriptions for medicines which might actually need some specialist skills in deciding to start a course and then in dealing with the possibility of adverse drug reactions or other diagnoses. If they did provide you with a script it would be a private prescription- there would be a fee for the script and the pharmacist would also charge for the drugs at a rate different from an NHS script (ironically it might be cheaper).

If your GP practice won't provide this non-NHS service:

In the UK you could visit a specialist travel clinic. There is one at the Liverpool School of Tropical Medicine, or you could ask to see a GP privately (but that could not be your own GP)- or a travel GP somewhere else. They will all charge you a fee.

You could also decide yourself which drugs you'd like and then see if you can get them through online pharmacies in the UK the would avoid the problems with counterfeit drugs- I'm not at all sure what I think of these- they mostly specialise in lifestyle drugs- Viagra, Orlistat etc but a few seem to also sell drugs for travellers diarrhoea and altitude sickness. They usually have a tick box approach to deciding whether to issue a script.

It is a little bit difficult to ask doctors, or any other professional for 'informal advice' as they then end up carrying some risks- as well as giving away their services. It is interesting that in the UK there is a general expectation that the NHS should do anything and everything.

In reply to hokkyokusei:

I have got antibugs from the travel clinic before - my local cotswolds outdoors has a nomad travel clinic in it so I just go there. They give diamox too.