HEALTH Combat Pill Pack - Emergency Injury Meds - Good Idea or Bad?

[1911user]

A US "combat pill pack" is a group of 3 drugs selected to be taken together after a soldier is injured.
It consists of a strong anti-biotic, an anti-inflamatory, and pain relief.
The military combat pill pack contains 400mg Moxifloxacin (anti-biotic), 15mg Meloxicam (Mobic, anti-inflammatory), and two 650mg Acetaminophen (Tylenol, pain relief).

This is intended to be taken only once soon after injury then additional specific meds would be provided at a military medical aid station. What about non-military in tough situations?

(click to expand - from Deployed Medicine website - slide from Combat Lifesaver training showing combat pill pack)

Deployed Medicine (good military medical training information - link originally shared by @ComCamGuy)

-------------------------------------
One description I found:

"The Combat Pill Pack first originated in the SOF community in the Ranger Regiment. It contains Acetaminophen for pain relief, Meloxicam (Mobic), which is an anti-inflammatory medication, and Moxifloxacin, which is a broad spectrum antibiotic. While this item is currently available with NSN 6505-01-548-5129 it is rarely used by units outside the SOF community. The distribution plan for this item is one per Soldier carried in the individual's IFAK. Directions are: if injured with an open battlefield wound and you are still able to fight, continue the mission, perform any lifesaving interventions and then take the entire contents of the pill pack. The non-sedating nature of these medications will provide a moderate level of analgesia, without interfering with the Soldier's ability to function. In addition, this medication has little effect on the blood clotting mechanism. This regimen is probably the best non-narcotic oral form of pain medication currently available to the individual Soldier. Other anti-inflammatory medications like Ibuprofen, Naprosyn, and especially Aspirin, can have a detrimental effect on the blood clotting process and should be avoided."

(Source: The Society of Army Physician Assistants)
-----------------------------------

Questions:

1) Is any testing done for possible reactions to Moxifoxacin? It'd be bad to be shot/injured and have a medicine reaction. Is that really an issue?

2) Would this be good to have for people who might be in isolated rural/wilderness situations?

3) What about using Levofloxacin instead of Moxifloxacin? Both are strong anti-biotics from the same family (and available from India and maybe vet supply).

4) I have some 15mg Meloxicam samples. Is there a good substitute that doesn't hurt blood clotting? It's not so easy to find.

-------------------------------

Please discuss why having this available is a good or bad idea.

 

[Mongo]

We have them in our battle kit
Jes sayin....

 

[subnet]

Good idea

 

[Doc1]

IMHO you need something stronger than Acetaminophen for serious trauma pain. Acetaminophen and codeine or ibuprofen and hydrocodone would be better bets.

Everyone responds differently to various analgesics, but in my case, Acetaminophen barely scratches the surface of pain. Ibuprofen works better for me. Adding an opioid to either works better still.

Best
Doc

 

[1911user]

Good idea ,though I would have to substitute something else for the sulfa, sulfa would do more harm than the wound....lol
Stupid sulfa

No sulfa drugs were listed.

 

[ShadowMan]

Its not a Sulfa drug.
Moxifloxacin belongs to a class of drugs called quinolone antibiotics. In the same family as Ciprofloxacin, more commonly known as Cipro. Whatever antibiotic you use will have to take into account individual allergies and possible reactions.

IMHO you need something stronger than Acetaminophen for serious trauma pain.

I totally agree, however I'm sure you will agree that we can't use anything that would act as a blood thinner and I'd be leery about narcotics unless really needed and again in consideration of allergies.

Drug allergies should not be that much of a concern for kits made up for your immediate family and/or "team" members.

Something I did in Desert Storm with my Marines. The idea came from all my WWII D-Day movies with battle dressings attached to their helmets. In my battalion Medical OWNED the RIGHT cargo pocket of every Marine. Inside there we taped together: one Large, one Medium and one Small Battle Dressing, a Triangular bandage and wrapped them with a 4 inch Ace Wrap and Medical Tape. That was our basic Blow-Out kit for the Kuwait ground invasion. Wish we'd had Quick Clot back then, but that was well before it was available, but something I'd absolutely include in any combat kit.

 

[Henry Bowman]

Sounds like a good idea to me. If you need something stronger for pain you can add it.

A fat Joint would do the trick with out the complications of some sort of opioid ( for later use if the Acetaminophen did not do the trick)

 

[hiwall]

Use caution with antibiotics unless you have taken that exact one before.
Many people have reactions to antibiotics.
Amoxicillin put me in the hospital for 4 days once.

 

[naegling62]

Good idea ,though I would have to substitute something else for the sulfa, sulfa would do more harm than the wound....lol
Stupid sulfa

Yeah, I've had 3 relatives nearly die from Sulfa drug reactions.

 

[naegling62]

Use caution with antibiotics unless you have taken that exact one before.
Many people have reactions to antibiotics.
Amoxicillin put me in the hospital for 4 days once.

I can actually die from penicillin. 1st dose was ok, 2nd dose? Throat swelled up and fingers almost couldn't bend them. That was scary.

 

[ShadowMan]

Something to consider about pain medication....PAIN IS SELF LIMITING!! If it hurts to do that - DON'T DO THAT!! IF you give someone a big pain killer (like Morphine and other Opiates) you've just made a walking wounded patient, a litter case! THINK ABOUT THAT. It takes at least two to four able bodied people to move one litter case from the field of battle.

In a crisis combat situation, especially in small unit tactics, your PRIMARY medical goal, besides saving lives, is: To Keep As Many Guns - Online - As Long As Possible! Walking wounded can still fight. Again...think about it.

 

[Ogre]

Acetaminophen barely scratches the surface of pain. Ibuprofen works better for me.

Me too. but unfortunately opioids are worse than the pain. Ibuprofen works best on me. No matter what you have in your kit, you should check first to see if you have any adverse reactions. When you need it is not the time to find out.

 

[subnet]

No sulfa drugs were listed.

Yeah for some reason I misread that one big time..smh

 

[1911user]

Yeah for some reason I misread that one big time..smh

That which might kill you is worth being concerned about. No worries.

I have some Bactrim (mix of 2 sulfa drugs) but hadn't considered it for part of a pill pack.
I also have some 500mg Levofloxacin that might serve as an alternate for the anti-biotic.
The military used Moxifloxacin, so that must still be a good choice?

How to safely establish a drug isn't going to react badly seems like a challenge.

 

[subnet]

That which might kill you is worth being concerned about. No worries.

I do have some Bactrim (mix of 2 sulfa drugs) but hadn't considered it for part of a pill pack. Mil used Moxifloxacin, so that must be a good choice?

How to safely establish a drug isn't going to react badly seems like a challenge.

Cipro is readily available, so that would be a good sub, for the list anyhow.
I would need to do some research and figure out which available options would be best for wounds that I could add.

 

[Oscar Wilde]

Yeah, I've had 3 relatives nearly die from Sulfa drug reactions.

Bactrim.
Don't know if I was dying but the thought was there ... looked and felt
as if I'd been massaged with a blow torch.

O.W.

 

[Swampdweller]

Something to consider about pain medication....PAIN IS SELF LIMITING!! If it hurts to do that - DON'T DO THAT!! IF you give someone a big pain killer (like Morphine and other Opiates) you've just made a walking wounded patient, a litter case! THINK ABOUT THAT. It takes at least two to four able bodied people to move one litter case from the field of battle.

In a crisis combat situation, especially in small unit tactics, your PRIMARY medical goal, besides saving lives, is: To Keep As Many Guns - Online - As Long As Possible! Walking wounded can still fight. Again...think about it.

I agree that pain has limits. Having passed kidney stones of various sizes more than three dozen times, I have explored the limits of pain.

 

[hiwall]

Ciprofloxacin is a very strong antibiotic and very useful. It also has side effects, one of which is you should reduce walking (especially uphill) while taking the drug.

 

[1911user]

Tendon damage is a known risk with the floxacin family of antibiotics.
I'm not sure how much risk just 1 pill would have though.

 

[Oscar Wilde]

There's a lesson to be had here boys 'n girls.

We can't afford an injury so do things smart, calculated, thought out.
Ya get one chance to do stuff right.
In the past we sometimes took chances and won, now, we can't afford not to.

Ease of tendon tearing is a real risk with anything from the floxacin family of antibiotics.

Was taking Gabapentin for ... a while.
Fell and caught myself but tore my triceps tendons from my left elbow and injured my right.
I'm thinkin the fall should no doubt have produced injury but to such an extent?
Don't know as to the Gabapentin's involvement but I stop taking it.

O.W.

 

[ShadowMan]

1911user, IF...you're taking them for a while, yes there is the possiblity of that kind of reaction. However, that's not an expected result of just one initial dose. I think the reasoning behind this "Combat Pac"idea is to givean initial dose of medications to SLOW DOWN the rist of infection, pain, etc. until more definitive secondary treatment is available.

I think that is a GREAT IDEA. Have not seen, nor heard of this kind of use before of preloading meds in trauma situations, but then I've been out of the loop since my retirement from the navy and medicine in '98.....so I'm pretty OLD SCHOOL in my knowledge and training. However, I have been in actual combat and do have some first hand experience in this area....just using older techniques and experience.

 

[von Koehler]

CBD oil is a better pain relief as it has much fewer adverse side effects and is not addictive.

I like to add aspirin because besides being a painkiller it is also an anti inflammatory, and helps reduce swelling.

 

[night driver]

All of the civilian-accessible, homemade Drive-On packs I have been exposed to were built to keep you trucking through MINOR injuries, and none of them were designed to have an effect on open injuries.
they consisted of 2 ibuprofen/Motrin (400 mg tot), 2 Tylenol 500 mg tabs, 1 gm total,1 true pseudoephedrine (Pseudofed), and one 80 mg caffeine dose (See 5-hour bottle).

it buys you about 5 hours of drive-ON if you add some calories.

it's designed for the rather youthful of us'ns

 

[1911user]

1911user, IF...you're taking them for a while, yes there is the possiblity of that kind of reaction. However, that's not an expected result of just one initial dose. I think the reasoning behind this "Combat Pac"idea is to givean initial dose of medications to SLOW DOWN the rist of infection, pain, etc. until more definitive secondary treatment is available.

I think that is a GREAT IDEA. Have not seen, nor heard of this kind of use before of preloading meds in trauma situations, but then I've been out of the loop since my retirement from the navy and medicine in '98.....so I'm pretty OLD SCHOOL in my knowledge and training. However, I have been in actual combat and do have some first hand experience in this area....just using older techniques and experience.

My understanding is the pill pack idea was developed during the Vietnam war era by SF types. I'm not sure how widespread its use was though. There seems less interest with fast access to military medical aid. In a bad situation, we may not have quick access to med care like that. That's why I started the thread.

 

[school marm]

The doc teaching an off-grid medicine course I took a couple of years ago recommended this same combat pill pack combination for our IFAKs. He addressed the concern about tendon and ligament rupture at the time. The risk is with longer-term use, not a single dose. And if you're in a situation where you need to take the combat pill pack, the risk of serious infection is greater than the potential problem posed by a single dose of moxie.

All Day Chemist normally carries meloxicam. It's not very expensive. Moxifloxacin, on the other hand, is $3 per pill, minimum 25 pills. But you only need one per pill pack. After you get back to a doctor, then you get started on the appropriate antibiotic for the injury.

Moxifloxacin--A Pre-Emptive Strike Against Bacteria in a Dicey Situation

 

[ShadowMan]

I like to add aspirin because besides being a painkiller it is also an anti inflammatory, and helps reduce swelling.

The thing with Aspirin is that it's also a mild BLOOD THINNER....probably not a good idea with bleeding wounds and injuries. That's the primary reason for the Tylenol instead of Aspirin. Everything is a bit of a compromise, choose wisely.

 

[1911user]

IMHO you need something stronger than Acetaminophen for serious trauma pain. Acetaminophen and codeine or ibuprofen and hydrocodone would be better bets.

Everyone responds differently to various analgesics, but in my case, Acetaminophen barely scratches the surface of pain. Ibuprofen works better for me. Adding an opioid to either works better still.

Best
Doc

I think the unit medic would have stronger drugs if needed.

A prime consideration is not affecting blood clotting ability. A person with wounds needs to keep the bleeding stopped. I've read that ibuprofin hurts clotting ability where tylenol doesn't.

Another consideration was allowing the wounded to maybe keep moving or fighting, yet still give some infection and pain help.

 

[Profit of Doom]

The doc teaching an off-grid medicine course I took a couple of years ago recommended this same combat pill pack combination for our IFAKs. He addressed the concern about tendon and ligament rupture at the time. The risk is with longer-term use, not a single dose. And if you're in a situation where you need to take the combat pill pack, the risk of serious infection is greater than the potential problem posed by a single dose of moxie.

All Day Chemist normally carries meloxicam. It's not very expensive. Moxifloxacin, on the other hand, is $3 per pill, minimum 25 pills. But you only need one per pill pack. After you get back to a doctor, then you get started on the appropriate antibiotic for the injury.

Moxifloxacin--A Pre-Emptive Strike Against Bacteria in a Dicey Situation

It should be taken at least four hours before or eight hours after consuming antacids that contain magnesium or aluminum or iron or zinc supplements (either alone or as part of a vitamin supplement).
Notice the warning about zinc.

 

[1911user]

The doc teaching an off-grid medicine course I took a couple of years ago recommended this same combat pill pack combination for our IFAKs. He addressed the concern about tendon and ligament rupture at the time. The risk is with longer-term use, not a single dose. And if you're in a situation where you need to take the combat pill pack, the risk of serious infection is greater than the potential problem posed by a single dose of moxie.

All Day Chemist normally carries meloxicam. It's not very expensive. Moxifloxacin, on the other hand, is $3 per pill, minimum 25 pills. But you only need one per pill pack. After you get back to a doctor, then you get started on the appropriate antibiotic for the injury.

Moxifloxacin--A Pre-Emptive Strike Against Bacteria in a Dicey Situation

That link is a good article at a good site (I will be spending more time there).
I'm posting the article here since it does belong and isn't too long.
For antibiotic considerations, this chart is worth a look: Antibiotic Chart To Guide Acquisition


Moxifloxacin--A Pre-emptive Strike Against Bacterial Infections in a Dicey Situation


Disclaimer. I am not a licensed health practitioner. This is just another post on items you might wish to have available if needed so that a physician can treat you and your family as best as possible. No medication, including those available over the counter, should be taken without consulting a physician. Information shared here is for educational and entertainment purposes only. It is not medical advice nor a substitute for licensed medical care. A qualified, licensed physician or other medical provider should be consulted before beginning any herbal or conventional treatment.

Moxifloxacin, brand name Avelox, is likely the last oral antibiotic to be covered here at Prep School Daily. Moxie, as it's often called, is a fourth-generation fluoroquinolone antibiotic that inhibits DNA replication and repair.[1] It’s quite possible you’ve never heard of it. Do you want it in your medical kit? Possibly. That’s because if there were ever a one-size-fits-all antibiotic, moxifloxacin would be it.[2]

For the past decade or so, moxifloxacin has been the antibiotic of choice troops carry in their combat pill packs—medications that they immediately take or are given after injury on the battlefield.[3] This is because of experience gained in the course of treating combat casualties: the sooner a person is administered a broad-spectrum antibiotic after an injury, the less likely that person is to develop an infection, and the less likely that person is to need prolonged antibiotic treatment and then experience the possible complications of that antibiotic therapy.[4] Sounds good, doesn’t it? It’s like a pre-emptive strike against the bacteria.

Moxifloxacin is produced in 400-mg tablets. They are taken only once per day, making them ideal for dicey situations. Another huge advantage is that moxie doesn’t have the numerous drug interactions or sensitivities that occur with many other antibiotics, especially its close relative ciprofloxacin.[5] Moxie is a very broad-spectrum antibiotic effective against both Gram-positive and Gram-negative bacteria that cause infections of the upper and lower respiratory tracts, gastrointestinal tracts, abdomen, and more, with excellent tissue penetration.[6] It eliminates Streptococcus, Haemophilus, Chlamydia, Staphylococcus aureus (including MRSA), Klebsiella, and numerous other bacteria, with very little antibiotic resistance to date. It sounds like a dream.

Now before you get all excited, thinking you can just get this one antibiotic to take care of everything you might possibly encounter in TEOTWAWKI, think again. Moxifloxacin used to run about a dollar per pill from overseas pharmacies, pre-COVID. And that’s the least of the concerns here. Moxie, like other fluoroquinolones, can have some very nasty side effects, including spontaneous tendon rupture[7] and acute, even fatal liver injury.[8] These pills aren’t Skittles.

So why might you want some, and why does the military include them in the combat pill packs for soldiers? Well, first, obviously, is because they work well to prevent infection and further complications. Secondly, and this is really important to keep in mind, is that using moxifloxacin is like taking a shotgun approach to killing the bacteria. It is used just once, until the injured patient can get more appropriate, targeted care, that is to say, until the most ideally suited antibiotic can be administered. Instead of carrying a few doses of several different antibiotics to treat a wide array of bacteria, the soldier carries a single dose of moxie.

And that’s what we do as well. Our IFAKs and personal first-aid kits that we carry when we’re far away from medical facilities and our supplies contain just a single moxifloxacin tablet to be taken only if injured and there is the potential for infection, and only under a physician’s advice.

So if you’ve decided moxie would be a good addition to your stores, how do you go about getting it? As always, the best bet is to go through your personal physician. If he recognizes the dicey situation our country is in, he may be willing and able to help, especially because you only need a couple of tablets at most. Unfortunately, there are no fish or veterinary equivalents available. Overseas pharmacies are the only other option.

Though there are intravenous options, moxifloxacin is best administered orally, with lots of water (not just when taking the pill, but throughout the day and night as well), with or without food. It should be taken at least four hours before or eight hours after consuming antacids that contain magnesium or aluminum or iron or zinc supplements (either alone or as part of a vitamin supplement).

Caution. Avoid sun exposure while using moxifloxacin.[9]
Contraindications. Not for use in patients with myasthenia gravis or patients with a history of tendon issues.

 

[Groucho]

Sounds like a good idea to me. If you need something stronger for pain you can add it.

A fat Joint would do the trick with out the complications of some sort of opioid ( for later use if the Acetaminophen did not do the trick)

 

[Walrus Whisperer]

Some can't take gabapentin. I become the straw man on the wizard of oz.

 

[Knighttemplar]

Paco Kelly has an article called Survival a state of mind that lists OTC's for when you need to keep going when lost or injured. I have now included most in my kit.

 

[1911user]

Paco Kelly has an article called Survival a state of mind that lists OTC's for when you need to keep going when lost or injured. I have now included most in my kit.

In case others are interested. Link to the Paco Kelly article: Survival - A State of Mind
The survival kit discussion starts about half way into the article.

 

[night driver]

In case others are interested. Link to the Paco Kelly article: Survival - A State of Mind
The survival kit discussion starts about half way into the article.

WELL worth the reading time!!

 

[bobfall2005]

Good time know.

 

[1911user]

I ended up duplicating the military pill packs with no substitutions.
400mg of Moxifloxacin (from ADC), 15mg of Meloxicam (doctor samples), and 2 extra strength, plain Tylenol per pill pack.

One unknown is how long after no help, and there is a penetrating injury, that it would make sense to take another pill pack or selected pills from a 2nd pill pack. 12 hours? 16 hours? 24 hours? My hunch is the best timing depends on the injury, but the injured may not have that level of medical training.

 

[ComCamGuy]

The Mobic is the anti-inflamitory pain relief in conjunction with tylenol

Battlefield Analgesia in Tactical Combat Casualty Care
Ian S Wedmore 1, Frank K Butler Jr 2
Affiliations expand

• PMID: 28601204
• DOI: 10.1016/j.wem.2017.04.001

Abstract
At the start of the Afghanistan conflict, battlefield analgesia for US military casualties was achieved primarily through the use of intramuscular (IM) morphine. This is a suboptimal choice, since IM morphine is slow-acting, leading to delays in effective pain relief and the risk of overdose and death when dosing is repeated in order to hasten the onset of analgesia. Advances in battlefield analgesia, pioneered initially by Tactical Combat Casualty Care (TCCC), and the Army's 75th Ranger Regiment, have now been incorporated into the Triple-Option Analgesia approach. This novel strategy has gained wide acceptance in the US military. It calls for battlefield analgesia to be achieved using 1 or more of 3 options depending on the casualty's status: 1) the meloxicam and acetaminophen in the combat wound medication pack (CWMP) for casualties with relatively minor pain that are still able to function effectively as combatants if their sensorium is not altered by analgesic medications; 2) oral transmucosal fentanyl citrate (OTFC) for casualties who have moderate to severe pain, but who are not in hemorrhagic shock or respiratory distress, and are not at significant risk for developing either condition; or 3) ketamine for casualties who have moderate to severe pain, but who are in hemorrhagic shock or respiratory distress or are at significant risk for developing either condition. Ketamine may also be used to increase analgesic effect for casualties who have previously been given opioid medication. The present paper outlines the evolution and evidence base for battlefield analgesia as currently recommended by TCCC. It is not intended to be a comprehensive review of all prehospital analgesic options.
Keywords: OTFC; TCCC; Triple-Option Analgesia; acetaminophen; fentanyl; ketamine; meloxicam; pain.

A Triple-Option Analgesia Plan for Tactical Combat Casualty Care: TCCC Guidelines Change 13-04 - PubMed

Although the majority of potentially preventable fatalities among U.S. combat forces serving in Afghanistan and Iraq have died from hemorrhagic shock, the majority of U.S. medics carry morphine autoinjectors for prehospital battlefield analgesia. Morphine given intramuscularly has a delayed...

pubmed.ncbi.nlm.nih.gov

https://www.naemt.org/docs/default-source/education-documents/tccc/tccc-mp/instructor-guides/4-tfc-2e-monitoring-and-triple-option-analgesia-ig.pdf?sfvrsn=420c892_2

 

[SmithJ]

Be careful of the moxifloxacin. One of the posts above says it “inhibits DNA replication and repair”.

That must mean it’s actually the mark of the beast and y’all gon go to hell for discussing it.

But, your cell phone reception will improve. Or, will it get worse?

Dammit, where’s my notes…

 

[Anti-Liberal]

Be careful of the moxifloxacin. One of the posts above says it “inhibits DNA replication and repair”.

That must mean it’s actually the mark of the beast and y’all gon go to hell for discussing it.

But, your cell phone reception will improve. Or, will it get worse?

Dammit, where’s my notes…

Sounds an awful lot like rondo, hmmm......never mind.

 

[SmithJ]

Sounds an awful lot like rondo, hmmm......never mind.

It’s a joke son, a commentary on the state of the board these days.

it went right over your head, as someone was famous for saying