Thursday, January 20, 2022

Are Expired Antibiotics Safe? A Survivalists Guide

The Survival Medic provides general information that does not substitute for individual medical advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

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The expiration date is not a magic number. When preppers (preparedness-minded persons) begin stockpiling, one of the first things they learn is that shelf-stable foods do not go off suddenly on the stamped date and can last for months or even years after that.

Their quality, however, may begin to decrease. A can of vegetables that’s past its date may not taste as good. A herbal supplement may be less potent. An antibiotic may not work as well.

Vegetables not tasting as fresh or supplements not being as potent may not seem like a big deal, but if the antibiotic doesn’t work well—that’s a problem. You may have just given yourself an antibiotic-resistant virus due to taking medication that was not full-strength.

So, as a prepper, should you replace expired antibiotics right away?

Antibiotics aren’t like ibuprofen – If they don’t work as they should and you’re in a survival scenario, it’s terrible news.

This article will look at long-term storage for survival – for antibiotics and other prescription drugs so that you can make your own decisions about which medicines to trust and for how long.

What Does an Expiration Date Mean Actually?

In the United States, a drug’s expiration date is like a pharmaceutical firm’s guarantee: they stand by the effectiveness of the medicine. The medication has been tested and shown to endure for up to six months if kept unopened and stored correctly.

It’s unusual for a medication to have an expiration date shorter than one year; or longer than five years. While an expired date doesn’t always imply the drug won’t last, it’s more that the time period has been tried and tested.

However, a manufacturer’s expiration date may not be the same as the expiration given by a pharmacist.

When a pharmacist gives you a subscription for medication, they will put a date on it, which is usually one year from the date of getting the drug. Most prescriptions expire in 12 months, says Ilisa Bernstein of the Food and Drug Administration.

Furthermore, once the prescription is removed from its original container and given to the patient at home, it is subjected to damaging environmental factors such as humidity and heat, so it will not last as long in its original environment.

In 1986 the U.S. government began a program to conduct its own research to determine how long drugs really last. It’s known as the Shelf Life Extension Program. And it has impacted how many people think about drug expiration dates.

expired antiboitics

The Shelf Life Extension Program

The Shelf Life Extension Program, often known as SLEP, was started in 1986 to study expired antibiotics with its primary aim to reduce federal spending.

The Government maintains stockpiles of medicines in case of emergency worth millions of dollars. Replacing those drugs every few years came at a high cost. So the Government decided to investigate whether the medicines would still be effective after their expiry dates had passed.

The SLEP study began in collaboration with the Food and Drug Administration (FDA) to test whether medicines that are kept past their expiration dates are still effective over x period of time past their expiry date.

The medications in SLEP are divided into two groups. Each group goes through two testing processes:

  1. Accelerated stability testing: A sample of antibiotics is placed for 60 days at 122 degrees Fahrenheit and 75 percent humidity. The results indicate how long the drug would probably remain good if stored properly, with the group being given a new expiration date based on this data.
  2. Room temperature testing: A sample is kept in optimal circumstances and it is retested once or twice a year to ensure that it remains fresh.

The FDA follows a policy of precaution when extending expiration dates. No medicine has ever been granted an extension longer than ten years beyond its initial expiration date.

Ongoing research1 shows that stored under optimal conditions, many drugs retain 90% of their potency for at least five years after the labeled expiration date, and sometimes longer. Even ten years after expiration, many pharmaceuticals retain a significant amount of their original potency.2

The study concludes

In our data set, 12 of 14 medications retained full potency for at least 336 months, and 8 of these for at least 480 months.3 

While the conclusions are promising, what the study was unable to control or test for was different environments. As the results were limited to a controlled environment, it can not be taken universally. This is the kicker for any survivalist wanting to store antibiotics in unregulated conditions over the long term, and unfortunately, more studies need to be made.

What is the Ideal Expiration Date?

However, while SLEP is frequently presented as evidence that your antibiotics will last, what isn’t usually pointed out is the fact that most individuals do not keep their prescription drugs in the best manner.

The bathroom medicine cabinet is one of the worst places to store antibiotics.

Prescription medicines are generally dispensed in a pharmacy-supplied pill bottle rather than factory sealed, making these bottles susceptible to humidity, which is one reason why they’re discouraged from being kept in a bathroom with a shower.

Medications taken in daily life do not mirror the testing conditions found in a lab. Consider that the medications in the program are kept in their original packaging and always exactly according to the manufacturer’s instructions, before applying SLEP findings to your stash.

storage of antiboitics
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How to Store Antibiotics at Home?

So first things first: let’s just get your antibiotics to last at least to the expiration date you’re given. To do that, store them in tight containers at room temperature (59 to 86 degrees F).

Even if the pills get really hot one time (for example, you leave them in the car on a hot summer day), that could be enough to render them unusable, Prabhavathi Fernandes, Ph.D., founder and president of Cempra Pharmaceuticals, said in an email interview. “Some of them could be partially or completely destroyed. Some could be fine.”

Storing the pills below room temperature, however, might not be a bad idea. “Refrigeration will prolong the life of most drugs. But each drug will behave differently,” said Fernandes, whose company is focused on developing antibacterials. “Once opened, one must be careful, as some of the tablets may absorb moisture. Freezing could prolong life, but some drugs may be unstable to a freeze-thaw cycle. Repeated freezing can cause a drug to break down.”

Some preppers wonder whether vacuum sealing could help. Fernandes thinks it might but in most cases isn’t necessary.

If you’re thinking about storing your pills in a container other than the one the pharmacy gave you, consider that the United States Pharmacopeial Convention, which sets quality standards for medications, even has standards for packaging material. For example, manufacturers must ensure plastic doesn’t leach into the drug or vice-versa.

It should be noted that all of these storage instructions are about pills. Liquid antibiotics have their own concerns. “Most liquid drugs must be refrigerated and have a short life,” Fernandes said. “They should not be used past their expiry date. In addition to the drug, there are excipients added for flavoring, color, etc., that can also go bad.”

Essential Drugs: Practical Guidelines (2013), a guidebook for health care providers from Médecins Sans Frontières, or Doctors Without Borders, advises, “Freezing may be detrimental, particularly for solutions, leading to the precipitation of active ingredients or the shattering of ampoules.” (Doctors Without Borders is a humanitarian organization that provides medical care where it’s hard to access, such as in countries affected by conflict or natural disasters.)

What Happens When an Antibiotic Pill Goes Bad

So what’s the big deal if an antibiotic does go bad?

Well, there’s good news and bad news. The good news is toxicity usually isn’t a concern. “There are very few medications that actually break down into something that could specifically cause harm as the product ages,” said Svensson, the dean at Purdue’s College of Pharmacy. “An example would be [the antibiotic] tetracycline, whose degradation products can cause liver injury.”

The bad news is a decrease in potency is a concern—a big one. “The use of expired antibacterials does not cure an infection and also favours the emergence of resistant strains,” says Essential Drugs. In other words, you’ll still be sick—only now possibly with mutant bacteria. Even a just-from-the-factory version of that antibiotic probably won’t kill your newly resistant bugs.

You’ll also have contributed to antibiotic resistance outside yourself. If a family member catches your illness, they’ll have those antibiotic-resistance germs.

Like bad meat, a weakened antibiotic doesn’t usually smell or look any different.

Just try a different antibiotic? They’re often not swappable. Most illnesses have one or more preferred antibiotics that work better for them.

Can You Tell Whether an Antibiotic Is Bad?

Sniffing meat left on the counter does not tell you whether it’s gone bad. The same goes for antibiotics.

“The stability of the antibiotic within a tablet or capsule cannot be judged by simply looking, smelling or tasting the tablet or capsule,” Svensson said. “The same is true for a liquid antibiotic. Occasionally, a suspension will physically look different as it ages, but the potency of the antibiotic will often be reduced prior to the time the physical appearance changes.”

However, if an antibiotic does have an altered appearance, that’s a warning sign, according to Essential Drugs. For example:

In time, certain drugs undergo a deterioration leading to the development of substances much more dangerous, thus an increase in toxicity. Tetracycline is the principal example: the pale, yellow powder becomes brownish and viscous, its use therefore being dangerous even if before the expiry date.

An increase in allergen strength has been observed in certain drugs such as penicillins and cephalosporins [both antibiotics].

Suppositories, pessaries, creams and ointments that have been melted under heat should not be used. The active ingredient is no longer distributed in a homogenous manner.

How Long Specific Antibiotics Can Last

So now you’ve gotten all this bad news and a little good news, and the question remains: If you store them under ideal conditions—factory sealed and everything—how long can antibiotics last?

The answer, for most of them, is longer than their expiration date. How much longer varies quite a bit, from around one year to, in a few cases, more than 10.

A 2006 report published in the Journal of Pharmaceutical Sciences summarized SLEP’s findings from the previous 20 years. Below are the antibiotics included in the report.

You’ll notice that there’s quite a variation in extension times. Experts we spoke with cautioned that each antibiotic is different. If one lasts 10 years, that doesn’t mean they all will, by any stretch. If an antibiotic you’re curious about isn’t included in this list, you can’t make any assumptions. There’s even variability from lot to lot. One lot may last five years; another lot of the same medication may not.

One note: You may wonder what “powder” refers to in this list. That’s a powdered form of the drug, which pharmacists use to make injectable solutions.

   Extension Time (Mos.)
AntibioticDosage FormNo. Lots TestedMeanRange
Amoxicillin sodiumTablets212322–23
AmpicillinCapsules54922–64
Ampicillin sodiumInjection-solution85729–87
Cefazolin sodiumPowder108263–110
Ceftriaxone sodiumPowder46044­–69
Cefoperazone sodiumPowder44625–57
Cefoxitin sodiumPowder102424–55
CephalexinCapsules65728–135
Cephaprin sodiumPowder137450–114
Chloroquine HClInjection-solution46427–98
CiprofloxacinSuspension73225–40
CiprofloxacinTablets2425512–142
Clindamycin phosphateInjection-solution314418–77
Doxycycline hyclateCapsules135037–66
Doxycycline hyclatePowder312714–52
Doxycycline hyclateTablets1692715–91
Erythromycine lactobinatePowder46038–83
Neomycin and polymyxin B sulfates and bacitracin zincOphthalmic ointment52812–40
Penicillin GPowder154922–95
Penicillin G benzathineSuspension47061–84
Penicillin G procainePowder77067–72
Primaquine phosphateTablets125541–80
Spectinomycin HClSuspension88355–109
Sulfacetamide sodiumOphthalmic ointment43935–44
Sulfadiazine silverCream375728–204
Sulfadozine and pyrimethamineTablets86734–93
SulfisoxazoleTablets45645–68
Tetracycline HClCapsules115017–133

In a study unrelated to SLEP from the Institute of Pharmacy at the University of Tartu in Estonia, researchers tested antibiotic tablets and capsules they found that were at least 10 years expired.

All of the antibiotics, which were manufactured in various countries, passed their test: they contained a level of active ingredients that was acceptable by U.S. Pharmacopeial Convention standards.

The medications had been stored at the department of pharmacy at the University of Tartu in a closed cupboard at room temperature (about 68 degrees). “Some of the packages of the plastic vials of the expired formulations were opened and closed again, but none of the tablets or capsules tested was during the storage years directly exposed to the environment,” the study says. “The formulations in blister packages were not opened.”

The study doesn’t appear to have been published in any peer-reviewed, English-language scientific journal. The antibiotics, tested during the second half of 2011, were as follows:

Antibiotic TypeBrandDosage FormExpiration Date
AmoxicillinUpsamoxCapsule, 500 mg12/01
AmoxicillinUpsamoxCapsule, 250 mg7/01
AmoxicillinMoxilenCapsule, 250 mg6/97
AmpicillinPentrexylCapsule, 500 mg12/99
AmpicillinApo-AmpiCapsule, 250 mg12/00
DoxycyclineApo-DoxyCapsule, 100 mg5/95
DoxycyclineDoxy-M-ratiopharm, 100 mgTablet12/31/94
DoxycyclineDoxycyclinum, 100 mgCapsule2/1/99

The researchers caution that they “in no way promote the use of expired medications,” especially since this was a laboratory study, not one done in people to confirm whether the drugs in fact remained effective. But they also say, “neither was it completely out of the study to give any hint on the therapeutic value of these expired medications. Further studies are essential to verify the clinical efficacy of the expired antibiotics.”

What It All Means for You

After considering all this information, it’s clear that it’s most prudent to replace stored antibiotics before they expire. Taking expired antibiotics, especially if they haven’t been consistently stored optimally, poses risks that could be life threatening.

But what if you’re in a survival situation already and all you can get are expired antibiotics? This becomes a judgment call. You can hope your body is able to fight off the illness without antibiotics or that the disease is actually viral (in which case antibiotics wouldn’t work anyway), or you can chance taking the drug. Either way, there are potential risks.

“It is evident that a drug does not become unfit for consumption the day after its expiry date,” Essential Drugs acknowledges. For medications in general, if they’ve been stored optimally and “modification of aspects or solubility have not been detected,” Essential Drugs advises:

It is often preferable to use the expired drug than to leave a gravely ill patient without treatment.

Expiry dates for drugs that require very precise dosage should be strictly respected due to a risk of under-dosage. This is the case for cardiotonic and antiepileptic drugs, and for drugs that risk becoming toxic, such as cyclines.

Often for survival scenarios, there are no easy, black-and-white answers, even for highly trained health care providers. The best plan, as with many things, is excellent preparation.

If you choose to store antibiotics, store them constantly as directed, and replace them before you have to worry about the expiration date. That way, if you do get into a survival situation, you’ll know you have a little wiggle room to work with.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040264/
  2. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1377417
  3. https://www.npr.org/templates/story/story.php?storyId=127908554
  4. https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/expiration-date-extensions-certain-lots-doxycycline-hyclate-capsules
  5. https://www.astho.org/Programs/Preparedness/Public-Health-Emergency-Law/Emergency-Use-Authorization-Toolkit/Federal-Shelf-Life-Extension-Program-Fact-Sheet/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159373/

Photo credit: Pixabay

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