Can you still buy Cipro in Coz w/o seeing a dr there?

[Blue Sparkle]

Bratface,
I wasn't trying to be mean; I was just responding because you advised her to see her doctor at home, and in her OP she stated that she had seen her doctor and he or she had given her a prescription for 6 Cipro pills. That gave me the idea that checking with her doctor was probably not going to net her any more. Apparently 6 was the limit for what her doctor was going to give her "just in case."

I got a "just in case" Cipro prescription from my dr here but he only gave me 6 (legal limit, I guess).

Why not ask your doctor for a prescription and get it filled before you go. .... Check with your own doctor first.

 

[judydivescoz]

Do they still sell Viagra OTC?

They sure do!!

 

[morecowbells]

I agree with the other posts about the overkill and unnecessary treatment of travelers diarrhea and use of antibiotics. In addition to the risk of a torn tendon, sun sensitivity is also a risk associated with Cipro. When traveling to Cozumel I have successfully treated mild stomach upset with Pepto and prophylactic probiotic therapy. However, I must confess that when visiting Roatan this year I did bring along a treatment course of Cipro as a 'stand by' measure. In the middle of the night I work up incredibly thirsty from the Dramamine taken earlier in the day. In a semi-stupor I chugged down a full glass of tap water-unaware of what I had done until I realized how foul tasting it was. I tried to counter that with some Pepto. Sure enough the next day the fever, chills, diarrhea and the worst stomach craps I have ever experienced completely sidelined me. I started the Cipro immediately. I was flying out the following morning and could not imagine being stuck in my seat during the flight. I felt much better after about 12 hours of taking the Cipro and know I made the right decision. I must say that after years of traveling to the islands that is the only time I have ever actually taken the Cipro.

The decision to initiate antibiotics is not one I take lightly. I would never consider it as prophylaxis either. If you wish to bring it with you to Mexico I would get it filled at your local pharmacy and use it only as a last resort.

 

[Bubbletrubble]

For the most part, I follow the recommendations as stated on the Centers for Disease Control listing for travelers' diarrhea (TD). Most cases of TD are caused by enterotoxigenic E. coli (ETEC), which is usually tractable to antibiotic treatment. Fluoroquinolones such as ciprofloxacin are commonly prescribed for this application. It's also worth noting that most uncomplicated cases of ETEC are self-limiting.

For a Cozumel trip, I think it's reasonable to carry ciprofloxacin, loperamide (Imodium), and bismuth subsalicylate (Pepto-Bismol). It's also reasonable to take the preventative probiotic approach.

FYI, any medication will have side effects. When a medication is known to have "serious" side effects, it's important to consider how frequently it occurs in the type of patient in which it will be administered. Special considerations should be made for young/old/very sick/immunocompromised patients and those allergic to one or more ingredients of the med. One should also take into consideration: dosage, route of administration, method of breakdown/elimination (kidney/liver function), interactions with other meds, etc.

Often times, people shy away from certain meds because of the scary side effects printed on the side of the box or pharmacy print-out. Sometimes I think that these warnings should also indicate "percent chance" of the various side effects reported. At least then, people might appreciate how rare, for instance, tendon rupture occurs in patients taking ciprofloxacin.

That being said, it's plain to see that, due to over-prescription of antibiotics in the past few decades, more antibiotic-resistant strains of bacteria are out in the wild. That shouldn't be too much of a surprise. However, there are some infectious conditions, ranging from mild to very severe, in which antibiotic treatment is appropriate.

Someone mentioned a preference for Septra. [-]There's nothing wrong with trimethoprim-sulfamethoxazole. Generally, it has good activity against ETEC.[/-] Trimethoprim-sulfamethoxazole was traditionally one of the first line agents prescribed for TD, but in recent years a significant percentage of ETEC cases have shown resistance to it. Moreover, patients with sulfa allergies should avoid it.

 

[Mossman]

Someone mentioned a preference for Septra. There's nothing wrong with trimethoprim-sulfamethoxazole. Generally, it has good activity against ETEC. However, patients with sulfa allergies should avoid it.

Actually, the CDC site you quoted disagrees: Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high level of resistance to these agents.

Fluoroquinolone resistance is becoming more problematic as well:

"The most common agent was ETEC, with 270 samples isolated from 291 travelers to Mexico/Guatemala (grouped together as "Latin America") and 98 of 143 travelers to India. . . . From all the regions combined, the proportion of ETEC-resistant strains was 24% to levofloxacin, 20% to ciprofloxacin, 18% to azithromycin, 17% to rifaximin, and 5% to ceftriaxone. Resistance was much higher--around 50% each--to the older, less-used agents ampicillin, nalidixic acid, and T/S." -- Internal Medicine News, 4/1/10
Drug resistance looms in traveler's diarrhea | Internal Medicine News | Find Articles at BNET

 

[DandyDon]

It sounds like the people who take the antibiotics as preventatives, or when ill but just until they feel better, are creating more and more resistant strains - or would antibiotics being added to livestock feed be part of the problem too? I would love to see a wide ban on the livestock feed additive, but antibiotics do encourage better production so such a ban would increase human food costs - not a popular idea in a world lacking in population controls.

I have wondered how much ETEC may be found in Cenotes and the aquifers with some sewage being allowed to percolate down thru the soluble bedrock on the island and peninsula? Cozumel's sewage facility is on the northwest corner of the island isn't it, but there are areas not served by the system. I think the landfill is in the southern area and it must allow some liquid losses to the aquifer but one would hope that E.coli would not be a common problem there?

I've read that the island tap water comes from a desalination plant on the south end, far enough from the dump I hope, but not from the aquifer? So how is ETEC making its way into some food supplies? Handling errors like we incur in the states? Mmmm. be sure you've had the Hep-A vaccine, eh - for home or abroad.

 

[Bubbletrubble]

Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high level of resistance to these agents.

@Mossman: I stand corrected. My comments were made using old data. Thanks for the correction.

 

[Darol]

Quote:
Originally Posted by ggunn
Do they still sell Viagra OTC?

My home bud got some on our first trip there. Of course he paid the tourist price, not the locals price. I think it was cheaper in Texas. Online is cheapest if you find a reputable source. I have been quite pleased with one company and they have a dynamite price:

Don, I'm not "Old Enough" or "Need" it, and it seems you're an expert.
My friend says "why go to the Fair, and just ride the Farris Wheel, when
you can ride everything in the park....

Is that the case....?

 

[WOODMAN]

Actually, the CDC site you quoted disagrees: Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high level of resistance to these agents.

Fluoroquinolone resistance is becoming more problematic as well:

"The most common agent was ETEC, with 270 samples isolated from 291 travelers to Mexico/Guatemala (grouped together as "Latin America") and 98 of 143 travelers to India. . . . From all the regions combined, the proportion of ETEC-resistant strains was 24% to levofloxacin, 20% to ciprofloxacin, 18% to azithromycin, 17% to rifaximin, and 5% to ceftriaxone. Resistance was much higher--around 50% each--to the older, less-used agents ampicillin, nalidixic acid, and T/S."

I was afraid of this. We are losing effectiveness on every one of our antibiotics, and resistance is mushrooming up on all of these drugs which we have depended on for so long. Even Vancomycin, (the atomic bomb of antibiotics) is running into resistance problems, and this is the one we reserved for use when nothing else would work. I fear that this problem is going to rise up and bite all of us in the rump one of these days, and this is becoming a major headache for doctors everywhere. Where will it end? Stay vigilant, my friends. Woody

 

[cxg31s]

Goodness, what an interesting and informative thread I started! I really appreciate the advice and comments from everyone, with a special thanks to Christi for definitively answering my original question. I'm not going to get into my medical background or any other specifics regarding my situation, but I'd like to assure the medical professionals who expressed concern that I know more about prescription drugs than the average patient and do not take their use lightly. The Cipro my dr prescribed for me is strictly a "last resort" based on past experience in Cozumel. I also know the difference between "traveler's diarrhea" and a bacterial intestinal infection and would not take Cipro for the former.

I was just curious if I do get violently ill like I have in the past in Cozumel what my options were. Now I know I will need to go see Dr P to get Rx drugs, which is fine as I've had to see him before. I'm sure he'll be glad to see me again! LOL