For Clinicians | Off-Grid Health Care: A Guide to Medical Preparation When the System Fails (aka SHTF)

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For Clinicians | Off-Grid Health Care

A Guide to Medical Preparation When the System Fails (aka SHTF)

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Your patient has already Googled “SHTF medical” at 11pm. They didn’t bring it up at the visit because they don’t think you’ll know what to say. They might be right.

They are not alone. Behind every shortage story (saline, Adderall, Ozempic, amoxicillin liquid, the two weeks of hurricane evacuations that emptied a region’s pharmacies), patients are running a quiet clinical question through their head: “What’s reasonable to have on hand,…… just in case?”
Most of us were never trained to answer it. Yet, when we hedge, the prepper internet doesn’t. It tells them to buy fish antibiotics and trust no one. Our silence on the subject isn’t helping our patients: it’s giving them only extremes to turn to for answers.

Today we’re talking about this question. The category is appropriate medical preparation, sized to the disruptions families actually face, not a doomsday-world-is-ending scenario.

The framework breaks into five modules: medication, trauma and wound care, water and sanitation, power and continuity, and household-specific layers. A sixth, capability, makes the rest work or not.

Medication: chronic supply, contingency supply

This is where preparation actually starts, and where the bulk of the work is. The hurricane Katrina chronic-disease data is dated but still the cleanest evidence we have on what happens when a region’s pharmacies go offline, settles the question of priority. Of medications dispensed to evacuees in San Antonio, 68% were for chronic disease. Cardiovascular alone was 39%. The federal stockpile supplied 9%. Retail pharmacies covered 73%¹.

What we don’t really recognize here is that the patient’s own medicine cabinet is the primary line. Federal caches and DMAT formularies are backstops, not plans.

So the first tier is the chronic supply, patient-owned. A 90+ day on-hand supply of every prescription the household can’t go without, paired with a written list any pharmacist can act on (drug, dose, prescriber, pharmacy). You might object that this isn’t preparation, it’s just well-managed primary care. Yep. That’s the point. The category isn’t separate from primary care. It’s primary care that takes evacuation, supply chain disruption, and Friday-night closures seriously. Ready.gov anchors a 3-day baseline kit². Disaster medicine literature pushes 30 to 90 days for chronic meds³. What actually holds up in a big disaster is closer to 90 days to have on hand.

The trickier prescriptions to navigate are controlled substances. Schedules III through V are workable. During a governor’s declaration, pharmacists in most states can dispense an emergency supply (typically up to 30 days) without a new prescription on file⁵. Coverage varies by state but typically includes medications like benzodiazepines, tramadol, and codeine combinations, the prescriptions most likely to surface in a sheltered population.

Schedule II is the cliff. Stimulants and most opioids. A declared disaster does not, by itself, authorize a Schedule II refill. That takes a fancy, specific DEA waiver, and the waivers are inconsistent. We don’t endorse stockpiling. We also don’t have a clean way to tell a patient on a Schedule II to save some each month, because clinically that’s the opposite of how these medications are supposed to be taken. There is a gap. They should just know ahead of time, and so should we, that navigating this one is inherently just going to be very tricky.

The second tier is the contingency supply. The prescription half: short-course antibiotics, antifungals, rescue inhalers, oral rehydration salts, basic wound care. The OTC half: acetaminophen, ibuprofen, diphenhydramine, loperamide, antacids, electrolyte tablets, meclizine, loratadine, bismuth subsalicylate. The clinical logic for the prescription half is the same one telehealth platforms already use for the same conditions, with the same prescribing patterns and the same evidence base. The only difference is timing. Same medications, same standards, prescribed before symptoms arrive instead of after.

This is the gap JaseCase is built to close: amoxicillin-clavulanate, azithromycin, ciprofloxacin, doxycycline, metronidazole, a methylprednisolone dosepak, ondansetron, triamcinolone topical, plus the OTC backbone.

Trauma: bleeding control, wound care, burns

The medication layer is what you have when the pharmacy is gone. The trauma layer is about what you do in the minutes before EMS can get there. Hemorrhage is the only category of injury where a layperson can credibly outperform “wait for the ambulance,” and that’s the core of this section.

Stop the Bleed has been around long enough that most clinicians know the program by name, but the kit itself doesn’t follow most patients home. The core list is short and CoTCCC-vetted: a CoTCCC-listed windlass tourniquet, hemostatic-impregnated gauze (kaolin-based is the canonical mechanism), a 4 to 6 inch pressure dressing, nitrile gloves, trauma shears, and a permanent marker for time-of-application⁶. Skill-retention data argue for refreshing training every 1 to 2 years⁷. The fact that a tourniquet is in the kit doesn’t mean a patient knows when to reach for one.

That set, plus a pair of vented chest seals, a space blanket for hypothermia prevention, and a casualty card, is what separates a real household IFAK from a box of band-aids. NPAs and needle decompression are training-dependent. They belong in the kit when a household member has been trained to use them, and they don’t when no one has.

Most calls to use the kit aren’t going to be trauma though. They’ll be wound care, and the Wilderness Medical Society’s 2014 austere wound care guidelines are the cleanest reference⁸. Irrigate with at least 1 liter of potable or disinfected water at pressure (a 30 to 60 mL syringe with an 18 gauge angiocath does the job). No additives in routine wounds. Close clean, low-tension wounds within 8 to 12 hours, up to 24 for the face, with adhesive closure strips or tissue adhesive. Sutures and staples belong in trained hands, not a kitchen. Pack contaminated wounds open and watch them. AAFP evidence is clear that plain white petrolatum is equivalent to triple antibiotic ointment for routine wound aftercare, with less contact dermatitis and less selection pressure on resistant flora⁹. The kit version: petrolatum, non-adherent dressings, gauze rolls, adhesive strips, tissue adhesive, sterile gloves. Teach the household what infection actually looks like: spreading erythema, streaking, purulence, fever, increasing pain.

Burns are the injury most under-prepared for, and the field guidance has changed. The American Burn Association and the 2025 Annals of Emergency Medicine literature now support 20 minutes of cool running water (not ice, not butter) within 3 hours of injury, with measurably better outcomes¹⁰. Cover with a non-adherent dressing or plastic cling wrap. Hydrogel burn dressings are a field-acceptable third option per ABA, distinct from the older silver sulfadiazine cream that’s no longer first-line. The household version of “what to do with a burn” is simpler than what most of us grew up teaching: water, time, clean cover.

Splints, briefly. One 36-inch SAM splint covers the realistic home use case. Radiolucent, reusable, immobilizes wrist, forearm, ankle, and cervical spine when folded. Add a triangular bandage and a couple of ACE wraps. 

One frame to hold through the rest of this: kits scale with capability. A household with a trained member can credibly carry a higher-tier kit. The category is appropriate medical preparation, sized to capability.

Water and sanitation

Back to fundamentals here. In austere medicine, dehydration is the leading preventable cause of death, and sanitation failures drive much of the rest. The kit answer for both is cheap and simple.

Start with safe water. Ready.gov’s anchor is 1 gallon per person per day¹¹. Treat the source with whatever you have available. Boiling for 1 minute (3 minutes above 6,500 feet) is the gold standard. Unscented household bleach (5 to 9% sodium hypochlorite) works at 8 drops per gallon of clear water or 16 drops per gallon of cloudy water, 30 minute contact time¹². For filtration, the spec that matters is “≤1 micron absolute,” which screens out Giardia and Cryptosporidium; viruses still need chemical disinfection on top.

Then rehydration. The WHO low-osmolarity oral rehydration salt formula (75 mEq sodium, 75 mmol glucose, 20 mEq potassium, 10 mEq citrate per liter) is the standard¹³. Commercial ORS packets are cheap to stock; the home recipe in a pinch is 1 liter of clean water, 6 level teaspoons of sugar, and half a teaspoon of salt. One thing worth telling patients over and over again: adult sports drinks are not pediatric ORS. The sodium is too low and the sugar is too high to treat clinical dehydration in a child, and this really matters when the household has small kids and no power.

Infection prevention is the third leg, and it’s mostly about hand hygiene and a few pieces of PPE. CDC guidance: soap and water for 20 seconds, 60% alcohol hand rub as backup, nitrile gloves (not latex), N95 respirators for smoke and infectious exposure, household bleach for surface disinfection¹⁴. Gloves don’t replace handwashing. We all know to wash our hands. This is the reminder: scrub them, and scrub them well. As basic as it gets, and as load-bearing as anything in the kit.

Power, monitoring, documentation, communication

Four things beyond the supplies themselves. Power: durable medical equipment needs a backup plan. CPAP and BiPAP units run off a portable battery overnight; oxygen concentrators draw too much for that, and the answer is standby tanks, not bigger batteries.

The refrigerator is the harder problem.  I know you’re already thinking about insulin, because the idea of a disaster panics any diabetic patient. Insulin is stable at 59 to 86°F for up to 28 days unopened, per FDA emergency guidance⁴. Do not freeze. Use it warm before going without.


Beyond the insulin window, GLP-1 agonists run 14 to 56 days at room temperature depending on product (Ozempic 56 days at up to 30°C, Trulicity 14)¹⁵. Most injectable biologics fall in a similar window. The point a patient needs to hear in the office, before a hurricane forecast lands: check the package insert for the room-temp tolerance of their specific medication, pack a cooler with ice packs (not direct contact), and don’t freeze any of it.

Monitoring: a thermometer, a validated home blood pressure cuff, a glucometer for diabetics, and a pulse oximeter cover the household use case, with the FDA Safety Communication caveat that pulse-ox devices overestimate true saturation in darker-skinned patients¹⁶. Skip the otoscope; non-clinicians can’t reliably interpret what they see. 

Documentation: the patient’s kit should include a written med list with doses, an allergy list, photos of every pill bottle (the label itself is a functional clinical document), insurance and immunization records, an advance directive, and recent labs on a thumb drive. HIPAA doesn’t block emergency disclosure¹⁷. 

Communication: four pre-emergency setups worth pushing at a routine visit. Patient portal credentials stored somewhere accessible, the prescriber’s direct line saved, a regional telehealth fallback identified before the season, and a backup ER chosen if the usual system is overwhelmed.

Pediatric, mental health, household specifics

A generic kit doesn’t fit a specific household. Here’s a few specific populations who need specialized resources in an emergency. 

Pediatric. Weight-based dosing for acetaminophen, ibuprofen, diphenhydramine, and ondansetron printed on a card the household can read at 2am¹⁸. Pediatric ORS, not adult sports drinks. Ready-to-feed formula in any household with an infant; powder requires safe water that may not be available. Children’s medication doses can be improvised from adult bottles sometimes if truly needed, but beware your numbers: the math is the most common error in field pediatric care.

Mental health. Continuity of psychiatric medications is the under-discussed half of disaster planning. SSRIs, mood stabilizers, antipsychotics, and benzodiazepines: discontinuation syndromes and decompensation are the predictable failure modes when an evacuation runs longer than the on-hand supply. The Schedule II hardship from Module 1 lives here too; stimulants and opioids are the gap. Brief acute insomnia in a sheltered population is expected and self-resolves; eye masks and earplugs are kit items worth recommending.

Pregnancy. A pregnant patient needs an earlier evacuation trigger, a clean emergency birth kit, and prenatal vitamins added to the chronic supply per ACOG¹⁹.

Older adults on polypharmacy need indications named on the med list, not just drug names, plus spare hearing-aid batteries and glasses.

A dental emergency kit (Dentek temporary filling, clove oil, ibuprofen-acetaminophen combo) covers most field dental needs; antibiotics for systemic signs only, ER for swelling extending under the tongue or to the eye.

Capability, and the cliff

A kit you don’t know how to use is decoration. The previous five modules describe the contents of a household’s medical preparation; this one describes what makes that preparation actually work.

Capability is training. Stop the Bleed certification, a basic wound care class, comfort with the medications in the kit, a household conversation about who in the family knows what. Most of this is free or close to it. None of it gets done if we as the clinician haven’t said it out loud during a routine visit.

Which brings us to the cliff.

Patients are figuring this out themselves. They are Googling at 1am and going down Reddit rabbit holes. They are taking dosing advice from prepper forums because the clinical voices have stayed quiet. Healthcare’s collective response to “what should I reasonably have on hand?” has been to hedge or say, ‘you can’t have any prescription on hand ahead of time. That’s not responsible. You’ll be treated only after you need it”. 

The void doesn’t stay empty; somebody fills it.

The failure is at the category level. We never named the thing the patient was asking about, so we never built the framework for thinking about it. The category has a name now: appropriate medical preparation. The framework is the five modules above. The work is making sure the patients in our practices encounter our voice in this space before they encounter someone else’s.

A few of us are charting the grey area in public. We are publishing the criteria, the dosing thresholds, the kit composition, the indications, and the limits, week after week, so that what a curious patient finds when they search is a clinician’s framework rather than a forum’s. This is the work Jase exists to do. If you have patients asking the SHTF question and you want a clinically rigorous resource to point them to, we work with HCPs directly. The goal is not to sell to your patient. It’s to make sure your patient has the guidance of clinical help in this emerging area.

Sources

  1. Greenough PG, Lappi MD, Hsu EB, et al. Chronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees. American Journal of Preventive Medicine. 2007;33(3):207-210. PubMed: 17826580.
  2. Ready.gov, Build A Kit (3-day baseline). ready.gov/kit
  3. Healthcare Ready, A Review of State Emergency Prescription Protocols; supporting disaster medicine literature on 30 to 90 day chronic-medication supply.
  4. FDA, Information Regarding Insulin Storage and Switching Between Products in an Emergency.
  5. DEA Pharmacist’s Manual; Healthcare Ready, Review of State Emergency Prescription Protocols (Schedule III through V emergency dispensing coverage varies by state).
  6. American College of Surgeons / Stop the Bleed, kit composition and CoTCCC-listed contents.
  7. Goolsby C, et al., skill-retention data on Stop the Bleed training (the underlying evidence base for the 1 to 2 year refresh recommendation).
  8. Wilderness Medical Society, Basic Wound Management in the Austere Environment (2014 practice guidelines).
  9. American Academy of Family Physicians, wound care evidence: petrolatum vs. triple-antibiotic ointment.
  10. American Burn Association field guidance; Annals of Emergency Medicine (2025), Cool Running Water as a First Aid Treatment for Burn Injuries. PubMed: 40985917.
  11. Ready.gov, Build A Kit (water anchor: 1 gallon per person per day). ready.gov/water
  12. CDC, Making Water Safe in an Emergency; CDC water filtration guidance (the ≤1 micron absolute filter spec for Giardia and Cryptosporidium).
  13. World Health Organization, Oral Rehydration Salts: Production of the new ORS.
  14. CDC, Guidelines for Personal Hygiene During an Emergency; supporting CDC respiratory protection and wildfire smoke guidance for N95 use.
  15. GLP-1 manufacturer prescribing information (Novo Nordisk for Ozempic, Eli Lilly for Trulicity, current US labeling).
  16. FDA Safety Communication: Pulse Oximeter Accuracy and Limitations (2021, updated 2022).
  17. ASPR-TRACIE, HIPAA and Disclosures in Emergency Situations fact sheet.
  18. AAP pediatric dosing charts (acetaminophen and ibuprofen); Lexicomp Pediatric and Harriet Lane (diphenhydramine and ondansetron weight-based dosing).
  19. American College of Obstetricians and Gynecologists Committee Statement No. 15 (January 2025): Preparing for Disasters: Addressing Critical Obstetric and Gynecologic Needs of Patients.

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For Clinicians | Azithromycin (Z-Pack): Why It Earns a Place in Appropriate Medical Preparation

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For Clinicians | Azithromycin (Z-Pack)

Why It Earns a Place in Appropriate Medical Preparation

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Can’t you just call in a Z-Pack?“

Your patients probably ask for one all the time. They know it works, and almost everyone has taken one at some point in their life.

Today we’re talking about the Z-Pack and why it’s so helpful for appropriate medical preparation across a number of different common conditions. What it’s approved to treat. What it’s actually being used for. And where the line sits between what’s okay for a patient to keep on hand and what still needs to be seen by a doctor.

What is azithromycin, and what does it treat?

Azithromycin is a macrolide antibiotic, FDA-approved for a number of common bacterial infections.¹ Most courses run 3 to 5 days, with one-time single-dose regimens for a few specific indications.

A few things make it useful when access to care is delayed:

  • The course is short. The drug accumulates in tissue and has a prolonged terminal half-life, which clinically supports a short course providing antimicrobial activity beyond the dosing window.²
  • It covers the common community-acquired pathogens behind respiratory infections, skin and soft tissue infections, certain sexually transmitted infections, and traveler’s diarrhea.¹
  • It’s a real option for patients who can’t take penicillin, which is a larger group than most clinicians realize.
  • It’s oral, well-tolerated, and inexpensive.

FDA-approved indications include:¹

  • Acute bacterial sinusitis
  • Acute bacterial exacerbation of chronic bronchitis (mild to moderate)
  • Community-acquired pneumonia (mild severity, suitable for outpatient oral therapy)
  • Pharyngitis and tonsillitis as an alternative to first-line therapy in penicillin-allergic patients
  • Uncomplicated skin and skin structure infections
  • Urethritis and cervicitis due to Chlamydia trachomatis or certain gonococcal infections
  • Genital ulcer disease due to chancroid
  • Acute otitis media in pediatric patients

Guideline-supported uses outside the FDA label:

  • Traveler’s diarrhea, particularly in regions where fluoroquinolone-resistant Campylobacter is common (notably Southeast Asia).³
  • Pertussis treatment and post-exposure prophylaxis.⁴
  • MAC prophylaxis in HIV patients with CD4 <50 not on effective ART, and as part of combination treatment for disseminated MAC.⁵

Why azithromycin is in the JaseCase

We here at Jase provide, ahead of time, the medications patients need for a number of emergencies, and azithromycin is one of our favorites.

When a patient picks up a prescription at their regular pharmacy, the clinical work has already been done: the diagnosis is confirmed, the indication is documented, the dosing is verified, and the pharmacist is two steps from the prescriber if anything looks off. Contingency stocking removes all of those backstops. The protocol, the indication match, the dosing, the dispensing instructions, and the patient education all have to be locked before the bottle goes on the shelf.

Jase is in a unique position to help patients proactively. We prescribe for a select set of emergencies, before they happen, at the same clinical standard a patient would receive in the room. Azithromycin earns its place in the JaseCase against a specific set of criteria for contingency use:

Indication breadth. One molecule covers the common community-acquired infections a patient is most likely to encounter outside business hours: a sinus infection that goes brutal on day three, a respiratory infection that won’t quit, a strep-positive kid who can’t take amoxicillin, a chlamydia exposure that needs treating, traveler’s diarrhea that hits halfway through a trip. Stocking one drug that addresses several presentations is more useful in a kit than stocking five drugs each addressing one.

Fixed, short dosing. A 3 to 5 day course with no titration, no renal dose adjustment in the typical adult, no requirement for serum levels, and no repeat dosing decisions. The course we wrote ends when the package ends.

Penicillin alternative. About 10% of the U.S. population carries a documented penicillin allergy on their chart.⁶ The true IgE-mediated rate is closer to 1%, but the labeled-allergy patients still avoid penicillin-class drugs in real practice because confirming the true rate requires testing most patients haven’t had. Amoxicillin-clavulanate is the other common kit antibiotic, and for roughly one in ten patients it isn’t an option. Azithromycin is.

Familiarity that reduces error. Roughly 10.3 million prescriptions for azithromycin are written every year in the U.S., making it the 64th most-commonly prescribed medication in the country.⁷ The patient has likely taken it. The prescriber writes it from muscle memory. The protocol Jase delivers with the kit slots into a pattern both already know. Familiar drugs are safer drugs in contingency use.

Storage and stability. Tablets, room temperature, multi-year shelf life. The drug stays viable in a kit on a shelf at home or in a glovebox on the road.

This is how we treat all the drugs in our JaseCase. They’re very carefully selected.

Azithromycin at a glance

The view for the indications most likely to come up when a patient reaches for their kit. Doses are adult standard unless noted.

Don’t reach for azithromycin for:

  • Viral upper respiratory infections. Antibiotics don’t help. Symptomatic care.
  • Suspected gonorrhea. CDC now recommends ceftriaxone monotherapy; azithromycin is no longer routinely added.⁸
  • Suspected MRSA skin or soft tissue infections.
  • Anything escalating: high fever, sepsis signs, immunocompromise, hemodynamic instability, or systemic involvement.
  • Bacterial infections where a beta-lactam is first-line and the patient is not actually penicillin-allergic. Use the right tool.

Two cautions worth flagging:

  • QT prolongation. Use caution in patients with known QT prolongation, electrolyte derangements, or concurrent QT-prolonging medications.⁹
  • Macrolide resistance. Pneumococcal macrolide resistance is significant and varies by region. For pneumonia in particular, current resistance patterns matter for empiric choice.

Stewardship is the bar, not the brake

The answer is the clinical work that happens before the bottle ever ships, while the situation is still calm and considered. For contingency stocking, the prescriber isn’t going to see the patient at the moment of use, so the screening has to be stricter on the front end, not looser. We review the patients current medical conditions, medications, and any allergies they may have to determine if the case medications would be safe for them to take. Patients complete an intake and attestations, a licensed prescriber reviews them against those criteria, and the kit ships only when the fit is appropriate. The patient isn’t reaching into the cabinet on instinct. They are reaching for a medication a prescriber already cleared for them, before they ever got sick.


Each medication in the kit ships with an information sheet: basic drug information, common side effects, contraindications, and dosing for common conditions. The sheets aren’t a diagnostic tool. They are reference materials patients can use to follow the prescriber’s plan and bring accurate information into the room if they end up in front of another clinician. Our team can answer clarification questions about how the medications work. We are not the patient’s treating clinician, and the kit is not a substitute for primary care.

Contingency stocking in this category needs to clear a higher stewardship bar than routine office prescribing, not a lower one. The patient is going to be at home, at a campsite, on a cruise ship, in a hotel halfway across the world, somewhere the prescriber can’t see them. That changes the protocol design. It does not relax it.

Who makes these calls

Our team is medical doctors, physician assistants with field experience in disaster medicine and humanitarian response, and pharmacists. The clinical work happens on the front end, so the patient isn’t doing it alone at 11pm.

Kristen Carpenter, PA-C, put it this way when we mapped out the JaseCase formulary:

“When we decided which antibiotics belonged in the JaseCase, azithromycin was an easy choice. It’s a broad-spectrum antibiotic that can treat a number of different bacterial infections. It is fast acting, usually requires shorter treatment courses, compared to other antibiotics, and is a great alternative for people who are allergic to, or cannot get, penicillin, offering a necessary backup in a limited-supply scenario.“

Charting the grey area in public

Contingency stocking for predictable, common emergencies is a real clinical category, and the guidelines haven’t caught up to it yet. Our team is publishing how we make these calls, the criteria we use to add or exclude a drug, and the protocols we deliver with each kit.

If a patient keeps asking and you’d rather not take on the contingency work yourself, you can refer them to us at Jase.com. It’s a clinical handoff, not a product pitch.

Public knowledge gets better when clinicians chart the grey area in public instead of letting the internet do it. The category is going to fill in. The question is who fills it in, and with what standard.

The bottom line

Azithromycin earned its place in the JaseCase on clinical merit: indication breadth, short fixed-course dosing, a real penicillin alternative, familiarity, and shelf stability. The same screen applies to every drug we add. This is not a replacement for primary care. It is the bridge for the moments primary care isn’t there. Trusted medicine, on your patient’s shelf, before the moment they need it.

To learn more, check us out at Jase.com.

Sources

  1. FDA Zithromax (azithromycin) prescribing information. Indications and Usage; Dosage and Administration. DailyMed: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=db52b91e-79f7-4cc1-9564-f2eee8e31c45
  2. FDA Zithromax (azithromycin) prescribing information, Clinical Pharmacology section (pharmacokinetics: tissue distribution and prolonged terminal half-life). Same DailyMed reference as #1.
  3. CDC Yellow Book, Travelers’ Diarrhea chapter. Azithromycin first-line empiric treatment in Southeast Asia and other regions with fluoroquinolone-resistant Campylobacter. https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html
  4. CDC. Pertussis (Whooping Cough): Treatment and Post-Exposure Prophylaxis. https://www.cdc.gov/pertussis/hcp/clinical-care/index.html (treatment overview); https://www.cdc.gov/mmwr/pdf/rr/rr5414.pdf (MMWR RR-54/14, 2005, for dosing).
  5. NIH/CDC/IDSA. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV: Mycobacterium avium Complex. Azithromycin is the preferred agent for primary prophylaxis (CD4 <50 not on effective ART) and a preferred first agent as part of combination treatment for disseminated MAC. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/disseminated
  6. CDC. Evaluation and Diagnosis of Penicillin Allergy for Healthcare Professionals. ~10% of U.S. patients report a penicillin allergy; <1% are truly allergic. https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html. Supporting: Castells M, Khan DA, Phillips EJ. “Penicillin Allergy.” N Engl J Med 2019;381:2338-2351.
  7. ClinCalc DrugStats Database. Azithromycin: estimated 10,337,595 U.S. prescriptions (2023), ranked #64 among the most-commonly prescribed medications. https://clincalc.com/DrugStats/Drugs/Azithromycin
  8. CDC Sexually Transmitted Infections Treatment Guidelines, 2021. Gonococcal infections: ceftriaxone monotherapy (500 mg IM single dose for patients <150 kg). Azithromycin is no longer routinely added to dual therapy. Chlamydial infections: doxycycline 100 mg BID x 7 days is the recommended regimen; azithromycin 1 g single dose is listed as an alternative. https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm and https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm
  9. Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. “Azithromycin and the Risk of Cardiovascular Death.” N Engl J Med 2012;366:1881-1890. FDA Drug Safety Communication, March 2013: azithromycin QT prolongation risk. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-azithromycin-zithromax-or-zmax-and-risk-potentially-fatal-heart. Current Zithromax label includes QT prolongation in Warnings.

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For Clinicians | Natural Disaster Preparedness: The Medical Framework Most Emergency Kits Miss

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For Clinicians | Natural Disaster Preparedness

The Medical Framework Most Emergency Kits Miss

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Are families actually prepared for natural disasters?

Most aren’t. Not because they don’t care. Not for lack of being told to prepare. We prescribers haven’t done the proactive work. Families don’t know what they actually need on hand, or what to prepare for medically.

A 72-hour kit and a flashlight aren’t a medical plan. A bandage and a bottle of Tylenol aren’t a medical plan. Prescriptions and medical supplies are the part most checklists skip. We prescribers have to make sure that part is right.

This article is that framework. It pulls together the patient-facing components Jase has been building for years: the 72-hour kit, the family communication plan, and wound care. The clinical layer sits on top of all three.

Most of us had a lecture on disaster medicine. Few of us had to use it.

Pharmacy school, medical school, PA school all covered it. A slide deck, maybe a chapter on triage in a mass-casualty event. Then we moved on. Most of us didn’t think about it again until it was actively happening to a patient, or to us.

That’s the muscle we’re training now, and it has to cover more than the big ones. Two categories matter here.

Natural disasters are usually few and far between for individual families, but of epic proportions when they happen. Evacuation across state lines at 2am because of a wildfire. Pharmacies underwater for a week after a flood. An earthquake that closes the only urgent care in the county. The ER two counties away after a hurricane knocks out the closer ones. These are the ones that make the news. The families who do well didn’t assume the system would be there afterward. They got medically ready before the storm had a name.

Situational disasters are the everyday version. The disaster isn’t the weather. It’s the access gap itself. The patient who lives 90 minutes from urgent care and gets a UTI on a Friday night. The family on a cruise when a kid spikes a fever and the nearest English-speaking pharmacy is closed. The traveler whose refill won’t arrive before the flight. The toddler whose ear infection announces itself at 11pm on a Saturday in a town with no 24-hour pharmacy. These don’t make the news. They happen every week, to most of our patients. They hit the same access gap as the natural disasters. Just smaller.

The framework has to serve both. Our patients don’t have time to wait while we figure it out in the moment. The job is to think proactively. Build the framework once. Have a ready answer for what they need, before they need it.

Patients are already figuring it out on their own. Prepper internet, TikTok dosing advice, online forums, the friend-of-a-friend who knows a guy. When clinicians don’t chart this space, the internet does. The answers patients find range from reasonable to reckless.

What medication readiness actually looks like

Two layers, both clinical. The first keeps the patient’s current regimen intact. The second covers what the disaster predictably brings.

Layer 1: Chronic continuity
Every patient with a chronic medication needs at least a 90-day supply on hand. Insurance vacation overrides and mail-order fills are the standard mechanisms; coverage varies by state and insurer.

The written medication list is the second half. It is the part that gets skipped most often. Keep one page on the patient or in their go-bag. List every medication by name, dose, prescribing physician, and the pharmacy that actually fills it. With that list in hand, a pharmacist who’s never seen them before can help them so much more easily. Without it, the patient is trying to remember their own regimen under stress.

Layer 2: Acute contingency
This layer covers what the disaster predictably causes.

When water and sanitation fail, GI infections spike. When evacuation shelters fill up, skin and wound infections follow.1 UTIs don’t pause for the storm. Respiratory exacerbations get worse in smoke or mold. Pediatric ear infections happen on the same Saturday night they always do. This time, in a town where the 24-hour pharmacy just closed. These are predictable conditions with well-defined treatment paths. They don’t need a new clinical decision in the moment. They need access in the moment.

That means a prescription contingency layer. Antibiotics for the UTI, skin, respiratory, and GI infections disasters predictably cause. Anti-emetic, anti-diarrheal, and oral rehydration for when IV access isn’t on the table. The JaseCase covers this. A clinician prescribes ahead, evaluates the patient’s history, and counsels on appropriate use.

Think of it this way. Telehealth already prescribes for most of these conditions reactively. Layer 2 is the same prescribing, moved earlier in the timeline. The decision tree is short. The evidence base is solid. The medication ends up with the same patient either way. The only thing that changes is whether they have it when they need it.

What disasters predictably cause, and what to have ready

Different disasters drive different clinical needs. The pattern is consistent enough to build a reference you can carry into the room:

Disaster type Predictable medical needs
Wildfire / smoke event Respiratory exacerbations, eye irrigation, refill disruption
Flood / hurricane GI infections from contaminated water, skin and wound infections, mosquito-borne, mold-triggered respiratory
Earthquake / tornado Traumatic injuries, debris wounds, crush, contamination, local mass-casualty triage
Extended power loss Insulin and refrigerated medications, CPAP and oxygen disruption, heat illness
Extreme heat Heat exhaustion and heatstroke, dehydration, cardiac and respiratory exacerbation, medication temperature instability
Winter storm / extreme cold Hypothermia, frostbite, CO poisoning from indoor heating workarounds, refill and supply disruption

The prescription contingency layer maps cleanly onto this:

  • Skin and wound infections: amoxicillin-clavulanate, doxycycline, clindamycin
  • GI infections from contaminated water: ciprofloxacin, TMP-SMX, metronidazole
  • UTIs (which happen disaster or not): ciprofloxacin, TMP-SMX
  • Broad-spectrum for high-contamination wounds: amoxicillin-clavulanate, doxycycline

The point of the table is not to memorize coverage. It’s a quick reference for what to keep an eye out for, given the disaster type most likely in your area. A clinician in coastal Florida prepares a different list than one in tornado country or wildfire county.

 

Beyond the prescription layer: the survival-medical basics most kits get wrong

Three pieces patients consistently under-pack:

  • Water. A filter that handles both viruses and bacteria, not just bacteria. Most consumer filters miss viruses.2 Add a chlorine or boiling protocol the family has actually practiced.
  • Wound care. Most wounds heal without antibiotics. Clean with tap water and soap. Keep moist with petroleum jelly, not OTC antibiotic ointment.3 Then monitor. Prophylactic antibiotics matter for contaminated wounds, non-potable water exposure, bites, sensitive locations, and patients who are diabetic or immunocompromised.4.
  • OTC. Pain, fever, allergy, anti-emetic, anti-diarrheal, and oral rehydration. The standard kit skews toward pain and antacids. Anti-emetic and oral rehydration are the missing pieces.

The category has a name: appropriate medical preparation. It covers self-limiting, predictable, well-understood conditions. Prescribing ahead is clinically identical to prescribing at the moment.

Charting this grey area in public

Jase’s team includes board-certified family medicine physicians. Our physician assistants have field experience in disaster medicine and humanitarian response. The clinical work happens on the front end. The patient isn’t doing it alone at 11pm in a town where urgent care just closed.

Public knowledge gets better when we chart the grey area in public. Otherwise, the internet does it for us. If you don’t have bandwidth to build a medical readiness plan in the room, you can refer patients to us at Jase.com. We’ll keep sharing frameworks and decision criteria here as we go.

We link three patient-facing guides below. They cover the 72-hour kit, the family communication plan, and wound care. The JaseCase covers the prescription contingency layer for families who want to go further. FirstAid sits alongside it for wounds and injuries. Bunker in a Box handles the longer haul. None of this replaces primary care. It exists for the times primary care isn’t reachable.

Sources

  1. Centers for Disease Control and Prevention. “Vibrio Illnesses After Hurricane Katrina, Multiple States, August–September 2005.” MMWR Morb Mortal Wkly Rep. 2005;54(37):928-931. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5437a5.htm
  2. Centers for Disease Control and Prevention. “About Water Treatment Options When Hiking, Camping, or Traveling.” Drinking Water Prevention guidance, 2025. https://www.cdc.gov/drinking-water/prevention/water-treatment-hiking-camping-traveling.html
  3. Smack DP, Harrington AC, Dunn C, et al. “Infection and Allergy Incidence in Ambulatory Surgery Patients Using White Petrolatum vs Bacitracin Ointment: A Randomized Controlled Trial.” JAMA. 1996;276(12):972-977. https://jamanetwork.com/journals/jama/article-abstract/408314
  4. Stevens DL, Bisno AL, Chambers HF, et al. “Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America.” Clin Infect Dis. 2014;59(2):e10-e52. https://academic.oup.com/cid/article/59/2/e10/2895845
  5. Centers for Disease Control and Prevention. “What to Do After a Hurricane or Flood: Mosquitoes.” https://www.cdc.gov/mosquitoes/response/index.html
  6. Centers for Disease Control and Prevention. “Use of Carbon Monoxide Alarms to Prevent Poisonings During a Power Outage, North Carolina, December 2002.” MMWR Morb Mortal Wkly Rep. 2004;53(09):189-192. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5309a1.htm

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For Clinicians | World Cup 2026 Pre-Travel Counseling

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For Clinicians | World Cup 2026 Pre-Travel Counseling

Three Host Countries, Three Measles Outbreaks

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

By the time a patient is in your exam room asking about MMR before a Mexico City group stage match, or whether the dengue notice applies to their cruise out of Galveston, they’ve already done the easy googling the answer online. The basic question doesn’t require a visit with you.

What lands on your schedule now is the second-layer question. The one they couldn’t find a good answer to online.

Most of us were having a different conversation with travelers five years ago. Pre-travel counseling mostly isn’t reaching a provider at all. Patients are searching, asking AI, scrolling forums, and going. The ones who do bring it to you are bringing the residual question, the one the internet didn’t resolve cleanly. Often it’s a very specific recommendation they want: do I actually need this booster, what should be in the kit, etc. This article is meant to be the clinician-side reference for the summer 2026 version of that conversation.

What’s actually on the CDC board for summer 2026?

The World Cup is the biggest thing happening this summer around the world. Measles is active in all three World Cup host countries. The US has confirmed 1,952 cases as of late May, already approaching the full-year 2025 total of 2,288 with the entire summer ahead.¹ Canada lost its measles elimination status in November 2025 after twelve months of sustained transmission and has reported 907 new cases since the start of 2026.² Mexico’s Jalisco state, home of World Cup host city Guadalajara, has logged 5,282 confirmed cases through mid-April in the country’s worst outbreak in decades.³ Guadalajara isn’t a measles statistic, it’s a place your patients are booking flights to.

The CDC has issued a Level 1 Global Dengue notice covering more than 100 countries, which is an unusually broad advisory.⁴ Locally acquired dengue is also showing up in southern US cities, with multiple confirmed cases in Los Angeles County over the past two transmission seasons.⁵

A novel hantavirus cluster on the MV Hondius expedition ship in the South Atlantic killed three passengers in May, identified as Andes virus.⁶ The WHO assessed the global risk as low. More on the cruise question below.

And the World Cup itself is the largest funnel event in the history of international travel: 48 teams, 16 host cities across the US, Mexico, and Canada, and FIFA’s projected engagement figure of nearly 6 billion people.⁷ You’re thinking: most of them will be watching from a couch. True. But millions will not.

Quick reference: summer 2026 by destination

A pull-up-in-the-room reference for the most common itineraries your patients are flying.

World Cup host countries (US, Canada, Mexico). Active measles transmission in all three. Verify MMR status, especially for adults born after 1957 with uncertain documentation. Patients vaccinated between 1963 and 1968 may have received the inactivated vaccine and should be revaccinated. Check the CDC measles notice before departure.

Caribbean, Latin America, and the southern US. Dengue is elevated in 2026 across Cuba, Brazil, Colombia, Mexico, and locally in southern California and along the Gulf. Counsel EPA-registered repellent (DEET or picaridin), permethrin on clothing, and air-conditioned or screened sleeping. Tell patients to seek care if a fever spikes within two weeks of return.

Cruise ships. The cruise ship hantavirus story is everywhere this month, and it deserves a one-line answer: your patient’s Caribbean cruise out of Miami is statistically not where this is happening. The MV Hondius cluster was on an Antarctic expedition vessel, geographically remote, and WHO has assessed the global risk as low. The actual cruise ship risk is much more mundane….and much more likely. Norovirus is the leading cause of cruise ship outbreaks, and a separate norovirus event affected hundreds of passengers on a Caribbean cruise this same month. The other reliable ways to lose a cruise day: respiratory virus, traveler’s diarrhea, motion sickness. Counsel aggressive handwashing (alcohol gel works against respiratory viruses but soap and water is what handles norovirus), pack a small kit, and report symptoms early so the cruise medical staff can manage them in the cabin instead of letting them derail the trip.

The 20-minute checklist

Four steps, and it fits inside a short visit.

 

  1. MMR verification. For adults born after 1957, confirm two documented doses or evidence of immunity. Adults born before 1957 are generally considered immune. Patients vaccinated between 1963 and 1968 may have received the inactivated vaccine and should be revaccinated. (Your MA can pull these records in five minutes. It doesn’t need to be your time.)
  2. CDC notices for the specific destination. Send patients to the CDC Travelers’ Health page for their destination. The notices update frequently. The page is at wwwnc.cdc.gov/travel/notices.
  3. Medical prep, not just medications. The kit conversation is broader than prescriptions. The prescription backbone is one piece. The rest is the simple stuff that keeps a small problem from becoming the thing they remember about the trip. A reasonable kit, paperback-sized, fits in a carry-on:
  • Gauze and adhesive bandages in two sizes
  • Antibiotic ointment (Neosporin or equivalent)
  • Blister care: moleskin and hydrocolloid patches
  • Oral rehydration salts or electrolyte packets
  • A digital thermometer
  • OTC motion sickness medication
  • A short course of clinically appropriate prescription medications for predictable conditions like UTI, traveler’s diarrhea, common respiratory infections, and yeast infections. This is what Jase handles, prescribed and packaged ahead of the trip.

The kit exists so your patient doesn’t end up standing in a foreign pharmacy at 9pm with a phone translator trying to figure out which Spanish word means antiseptic.

4. What’s available at a foreign pharmacy, and what isn’t. Pharmacy availability varies more than patients expect. Some countries dispense antibiotics over the counter. Others require a domestic prescription that a US script won’t satisfy. Brand names you trust at home may carry different active ingredients abroad, or different doses. View our recent article on Prescription Medication Abroad.

The OTC trap when you’re abroad

This sounds boring and obvious, but is the highest-leverage thing a clinician can teach a traveling patient.

 

Over-the-counter in another country does not mean equivalent to over-the-counter at home. Acetaminophen is sold as paracetamol in most of the world; dosing is usually the same, but the name swap leads to accidental double-dosing when patients also take a combination cold medication that contains the same active ingredient. Ibuprofen is available widely, but the dose per tablet varies. Antihistamines sold under familiar US brand names abroad sometimes contain different active ingredients, including older sedating compounds that can interact with travel sedatives or alcohol. Counterfeit medication is a real concern in some regions and includes products with the wrong dose, the wrong drug, or no active ingredient at all.

 

The rule we counsel: bring what you already use, in the dose you already use. Foreign pharmacies are useful for things you didn’t anticipate, not for things you could have packed.

When the call comes from abroad

Your patient is on day four of a Caribbean cruise with a UTI that started in Cozumel. Or she’s in Florence with a sinus infection she’s been ignoring since Rome. Or he’s on a two-month sabbatical and the antifungal he meant to refill before he left got missed. The portal message comes in. The voicemail comes in. The text from the family member who has your cell. The expectation is that you’ll fix it from your desk.

You can’t.

As Kristen put it to me when we were drafting this together: “I can’t send a script to Europe.”

That’s the first wall. There is no mechanism for routing US prescriptions to foreign pharmacies. And even within the US, looking up an out-of-state pharmacy in eScript takes a while. It’s doable; just a pain that takes up precious time between patients.

The second wall is bigger: anticipating everything that could come up across a two-week trip. The sinus infection that builds on the flight. The GI bug that hits day three. The skin issue from the cruise pool. The allergic reaction to something at a night market. Half a dozen potential prescriptions across as many therapeutic categories, for conditions that may or may not actually present. That work is complex, isn’t part of your fast clinical workflow, and takes hours, not minutes, per patient. Unless you’ve got a really standardized protocol covering all the categories, it’s just easier to refer. It can be done. It probably just doesn’t feel worth your time.

The known versus the unknown is the real divide here. Writing one or two prophylactic scripts for a patient with a recurring issue you already know about (the UTI history, the predictable cold sore) is something most providers can do confidently. The indication is clear, the duration is short, the patient self-identifies. Anticipating everything that might come up on a trip is hard. It should be hard, because it’s very complex.

Appropriate medical preparation

This is the category Jase is building, and pre-travel readiness is one of its clearest applications. Appropriate medical preparation means a short list of well-defined, common, predictable conditions handled clinically before the patient is sick, by people who know what they’re doing, so the patient has what they need before they need it.

It is in no way a replacement for primary care. Complex diagnoses, chronic conditions, ongoing provider relationships belong in your exam room. We work in the contingency space: the UTI on day four of the trip, the traveler’s diarrhea on day six, the strep that announces itself the night before a flight home. The conditions where the clinical decision is predictable and the only failing variable is access.

This is a call to prepare appropriately, not exhaustively.

Who’s doing this work

Jase is a family company of medical doctors, physician assistants, and pharmacists, five years in, with the credentials breadth (board-certified family medicine, disaster medicine, multi-state pharmacy) to make the clinical work defensible.

Charting the grey area in public

Pre-travel counseling is a capacity problem in most primary care practices. The visit is short, the destinations are varied, the CDC board changes faster than most providers can track. If your patients are asking and you don’t have the time to walk them through it, you can refer them to us at Jase.com. We handle the prescription work, the kit, and the patient education ahead of the trip, and we send them back to you with documentation.

We’re going to keep publishing the framework as we use it. The clinical decision trees, the destination-specific notes, the cases where the call is harder than it looks. Public knowledge gets better when clinicians chart the grey area in public instead of letting the internet do it.

The bottom line

Summer travel is supposed to be exciting. It is not supposed to be anxious.

A verified MMR, a short conversation about the destination’s CDC notice, and a small kit on the shelf will handle the vast majority of what makes a trip go sideways. Most of it is fixable in advance, and the fixing happens in your office or ours, not in a foreign emergency room at 11pm.

If your patient is heading to a host city this summer, send them out the door prepared. If you’d rather refer them, send them to us. Either way, the goal is the same: a trip they remember for the right reasons.

Sources

  1. CDC, “Measles Cases and Outbreaks,” data as of May 21, 2026: 1,952 confirmed cases in the US year to date. cdc.gov/measles/data-research
  2. Gavi VaccinesWork and PAHO: Canada lost measles elimination status November 10, 2025, after sustained transmission. CIDRAP reporting on 907 cases since January 2026.
  3. ABC News, US News, Mexico News Daily reporting on the Jalisco outbreak: 5,282 confirmed cases through April 10, 2026, in Mexico’s worst outbreak in decades.
  4. CDC Travel Health Notices, Global Dengue Level 1: wwwnc.cdc.gov/travel/notices/level1/dengue-global
  5. Los Angeles County Department of Public Health; CDC Emerging Infectious Diseases, May 2026, on autochthonous dengue transmission in southern California.
  6. WHO Disease Outbreak News, May 2026; CDC HAN 00528: MV Hondius hantavirus cluster, Andes virus, 7 cases including 3 deaths.
  7. FIFA and TheWorldData on the 2026 World Cup: 48 teams, 16 host cities across the US, Mexico, and Canada; FIFA’s projected engagement figure of approximately 6 billion.

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For Clinicians | Can You Get Prescription Medication Abroad?

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For Clinicians | Can You Get Prescription Medication Abroad?

What Your Patients Assume, What’s Actually True, and What to Do Before They Leave

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

“I can just buy antibiotics in Mexico if I get sick. I’ll be fine.“
“My friend just borrowed fluconazole from a friend she met on her cruise ship. If I get a yeast infection on my cruise next week I’m sure I can do the same.”

Your patients are telling you this. The travel forums tell the other version: the traveler who spent an afternoon in Florence hunting for a pharmacy willing to fill anything, the person who went to three pharmacies in two French cities before finding the right drug under a name they didn’t recognize, the patient who discovered mid-trip that the medication they take daily doesn’t exist under the brand name they know in the country they’re in.

This article isn’t a pre-travel checklist. You probably don’t have those visits……and when you do, the patient is asking for one specific thing (a vaccine, malaria prophylaxis, a scopolamine patch) and isn’t going to sit through a twenty-minute review of generic drug names across seven countries. 

What this actually is: what your patients are walking into once they leave, what you can’t fix from your desk when they call you from there, and where genuinely-prepared looks different from theoretically-prepared.

The foreign pharmacy experience is harder than patients expect

Before we get to prescriptions, there’s a more basic problem: patients often can’t identify what they’re looking for once they arrive.

Drug names change by country. Acetaminophen (Tylenol) is sold as paracetamol in the UK and across much of the world. A patient who walks into a British pharmacy asking for Tylenol may be told it doesn’t exist there, while paracetamol is stacked behind the counter. Imodium for travelers’ diarrhea is kept behind the counter in Switzerland and requires asking. Aspirin is sold only in pharmacies in many European countries, not in grocery stores or convenience shops. NyQuil doesn’t exist in most of the world. The ingredient combinations are different and the brand isn’t sold.

This is before your patient gets to anything prescription-strength.

This is simple: US prescriptions do not transfer abroad. A pharmacist in Italy, Japan, France, or Canada cannot legally fill what your US-licensed colleague wrote. Prescribing authority is local. There is no international equivalency. Beyond that, the picture breaks down by medication type.

Controlled substances carry the highest stakes. Stimulants used to treat ADHD (including Adderall) are illegal in Japan and restricted in a long list of other countries. Benzodiazepines, opioids, and some sedatives including zolpidem require advance documentation in many destinations: certificates from health authorities obtained before departure, sometimes weeks in advance. Consequences range from confiscation to denial of entry. A 2024 survey found 27% of Americans have had medications confiscated during international travel.² The INCB website (incb.org/travellers) is the right resource by destination. This is not something patients can sort out at the airport last-minute.

Chronic and maintenance medications (antihypertensives, thyroid medications, psychiatric medications, diabetes management) generally cannot be refilled abroad without a local physician visit and a new local prescription. For a two-week trip this is usually manageable with planning. For a six-week trip, a month-long cruise, or an open-ended stay, it requires explicit attention before departure: your patient needs more than they think they need, and they need it before they leave.

Acute medications (antibiotics, antivirals, UTI treatment, GI medications) are the tier where appropriate medical preparation does the most work, because these conditions are predictable. A patient who has had three UTIs is going to have a fourth. A patient going to Mexico has roughly one-in-three odds of needing GI treatment. The question isn’t whether these conditions will come up. It’s whether your patient has what they need, or is wasting an entire day in agony trying to find a doctor who speaks English.

The drug naming problem compounds all three tiers. Even when a pharmacist is willing to help, your patient has to know the generic name of what they’re asking for, in the local formulation. Most don’t.

Top countries Americans visit, quick reference

For when a patient mentions their destination.

Mexico: Most visited by Americans, most misunderstood. Antibiotics are technically prescription-only; enforcement is inconsistent. Large chains (Farmacia Guadalajara, Farmacia del Ahorro) are more compliant. Many pharmacies have attached consultorios where a physician sees patients for a small fee and writes a local prescription. Quality is generally safe at major chains; counterfeit risk at unverified sources. Controlled substances: hard stop. Travelers’ diarrhea risk is high. This is the condition to address specifically when Mexico comes up.

Canada: US prescriptions do not transfer. A Canadian physician must re-authorize before any pharmacy can fill. Walk-in clinics are accessible but not free, not automatic, and not fast on a Saturday night when your patient is sick.

European Union: EU prescriptions transfer within the EU; US prescriptions do not. Pharmacists have broader advisory roles than in the US but cannot prescribe. Drug names and formulations differ enough that patients need generic names, not just brands.

United Kingdom: US prescriptions not valid. Emergency supply at pharmacist discretion exists but is not plannable. Paracetamol, not Tylenol. Generic names matter here more than patients expect.

Japan: US prescriptions not honored. Standard antibiotics permissible up to one month. Over two months requires a Yunyu Kakunin-sho, an importation certificate that takes at least two weeks to obtain. Japan bans several medications that are routine in the US: stimulants for ADHD (Adderall, Ritalin), pseudoephedrine (standard Sudafed), and most common decongestant combinations. Japan requires a destination-specific conversation, not a general one.

Caribbean (Dominican Republic, Jamaica): Prescription requirements mirror Latin American standards. Antibiotic access varies by location. Controlled substances require documentation. Quality control at informal pharmacies is inconsistent.

Southeast Asia: Significant variation by country and by pharmacy. Some OTC antibiotic access exists in parts of the region, quality control is uneven, and your patient cannot know in advance what the rules are where they’re going.

A note on cruise ships

Cruises deserve specific mention. Millions of Americans take them annually, they touch multiple countries and pharmacies in a single trip, and the onboard setup creates a particular kind of false security: patients assume the ship has them covered. It doesn’t. Not for anything short of a genuine medical emergency.

The gift shop medicine shelf. Every ship has one. Basic OTC only: Tylenol, ibuprofen, seasickness pills, anti-diarrhea tablets, cold and flu products. One brand per category. Priced at three times or more what the same product costs on land. It is a gift shop with an OTC aisle.

The onboard medical center. Every ship has one of these, staffed by licensed physicians and nurses and equipped for genuine emergencies. It carries some prescription medications, including antibiotics and epinephrine. For a life-threatening situation, it is there. For the UTI on day four, the sinus infection that’s been building since embarkation, or the travelers’ diarrhea that started in Cozumel, it may technically be able to help, but a physician visit runs $100-200 before any medication is added, everything is charged to the room key and paid upfront with insurance reimbursement to follow, and the medical center is not stocked to refill an existing prescription or treat conditions that are merely miserable. Your patient with a UTI history going on a 14-day Caribbean cruise is not covered by the medical center existing.

In port. Pharmacies are accessible in most cruise ports and a reasonable option for OTC needs. The specific guidance to pass along: avoid pharmacies positioned to catch foot traffic off the gangway. Counterfeit and substandard medications are a documented risk in tourist-facing shops near cruise terminals. Direct patients to pharmacies used by locals, ideally ones co-located with a grocery store or supermarket rather than advertising to cruise passengers. The same drug will often be cheaper there too.

The bottom line for your cruise patients: the ship handles major emergencies. It is not a substitute for appropriate medical preparation.

When the call comes from abroad

Your patient is on day four of a Caribbean cruise with a UTI that started in Cozumel. Or she’s in Florence with a sinus infection she’s been ignoring since Rome. Or he’s on a two-month sabbatical and the antifungal he meant to refill before he left got missed. The portal message comes in. The voicemail comes in. The text from the family member who has your cell. The expectation is that you’ll fix it from your desk.

You can’t.

As Kristen put it to me when we were drafting this together: “I can’t send a script to Europe.”

That’s the first wall. There is no mechanism for routing US prescriptions to foreign pharmacies. And even within the US, looking up an out-of-state pharmacy in eScript takes a while. It’s doable; just a pain that takes up precious time between patients.

The second wall is bigger: anticipating everything that could come up across a two-week trip. The sinus infection that builds on the flight. The GI bug that hits day three. The skin issue from the cruise pool. The allergic reaction to something at a night market. Half a dozen potential prescriptions across as many therapeutic categories, for conditions that may or may not actually present. That work is complex, isn’t part of your fast clinical workflow, and takes hours, not minutes, per patient. Unless you’ve got a really standardized protocol covering all the categories, it’s just easier to refer. It can be done. It probably just doesn’t feel worth your time.

The known versus the unknown is the real divide here. Writing one or two prophylactic scripts for a patient with a recurring issue you already know about (the UTI history, the predictable cold sore) is something most providers can do confidently. The indication is clear, the duration is short, the patient self-identifies. Anticipating everything that might come up on a trip is hard. It should be hard, because it’s very complex.

What you actually do before they leave

For the visits that do happen:

  • Vaccines. The thing providers do at a travel-flavored visit. Hepatitis A and B for Mexico, Latin America, Southeast Asia. Typhoid for those plus South Asia. Updated Tdap and seasonal flu. Yellow fever where required. Standard childhood vaccines current.
  • Destination-specific controlled substance check, if they ask. The patient flying to Japan with a stimulant prescription needs to know about the Yunyu Kakunin-sho before they leave. The patient traveling with a benzodiazepine needs to know certain destinations require documentation. If they ask, INCB is your reference. If they don’t ask, this falls to them.
  • Standard chronic medication supply for the length of the trip plus a buffer. Most patients know to request this. The 90-day mail-order route handles most of it.

The other items that show up in pre-travel articles (clinical letters for customs, written prescription copies, country-by-country generic name briefings) are realistically on the patient, not on you. Patients who want these can request them. They are not standard practice, and there is no expectation that you build them into a fifteen-minute slot.

Where a kit does what a prescription pad can’t

The gap here isn’t one of provider effort. It’s one of category.

A prescription handles one condition. Even if you wrote three prophylactic scripts before the trip, you’d still be one acute presentation away from the call you can’t take. And the patient would still be the one finding pharmacies willing to fill US scripts overseas, in a language they probably don’t read.

A kit is structurally different. It’s a defined formulary built for the conditions that show up most often when patients are away from home: GI infection, UTI, sinus infection, skin issues, common allergic reactions. The clinical work happens on the front end. The patient leaves with the medications, the dosing guidance, and the criteria for use, in English, in one box on their nightstand or in their suitcase.

There’s a quieter benefit that surfaces in patient feedback: the OTC layer is bundled in. Patients don’t have to figure out that paracetamol is what they’re looking for, or that NyQuil isn’t sold in most of the world, or that the dosing instructions on the box they found are in a language they have to Google-translate carefully to use safely. They have what they need, labeled in English, with usage guidance from the team that prescribed it.

This is in no way a replacement for the primary care relationship your patient has with you at home. Complex diagnoses, chronic conditions, ongoing management belong in your exam room. Jase works in a narrow, defined category: predictable, self-limiting conditions where the evidence is strong and the treatment path is clear. The category has a name now, and it’s worth using: appropriate medical preparation.

You can refer patients to Jase.com. We’ll keep sharing our clinical frameworks and decision criteria here as we go. Public knowledge in this space gets better when clinicians chart the grey area together, instead of leaving patients to figure it out on the internet.

The bottom line

A 2024 survey found that 27% of Americans have had medications confiscated during international travel. Most of your patients haven’t thought about this once. They’ll think about it when they’re standing at a foreign counter, sick, several time zones from anyone who knows their chart, asking for a drug by the wrong name.

You’re not going to add a twenty-minute international medication review to every visit. Nobody is. But the next time a patient mentions an upcoming trip, one question is worth asking: do you have anything on hand for the conditions that might show up while you’re there?

For most patients, the answer is no. Most people don’t think about medical preparation until they’ve been sick in a foreign city and spent a miserable day learning the hard way. Then they swear they’ll never leave home unprepared again. You can get them there before it comes to that.

Sources

    1. CDC Yellow Book: Travelers’ Diarrhea. https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html
    2. Kiplinger / SingleCare: International Travel with Medications — Know Before You Go. https://www.kiplinger.com/personal-finance/travel/international-travel-with-medications-know-before-you-go
    3. CDC Yellow Book: Traveling with Prohibited or Restricted Medications. https://www.cdc.gov/yellow-book/hcp/travelers-with-additional-considerations/traveling-with-prohibited-or-restricted-medications.html
    4. CDC: Traveling Abroad with Medicine. https://wwwnc.cdc.gov/travel/page/travel-abroad-with-medicine

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For Clinicians | When Patients Hear “No”: OTC Antibiotics, the Law, and the Grey Market We Weren’t Trained to Navigate.

couple looking at computer asking questions

Over-the-Counter Antibiotics: What the Law Actually Says and Where Patients Go When We Say No

A peer-to-peer look at the grey market your “no” is competing with, and the prescribing landscape we weren’t trained for

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Most prescribers can give a clean “no” to the contingency antibiotics question in their sleep. The patient asks about keeping a course on hand. You walk through the resistance picture and the documented harms of self-treating viral illness with leftover prescriptions. The clinical answer is sound. 

However, your firm “no” doesn’t end the patient’s access to antibiotics from other sources. It moves the conversation somewhere you can’t see. Your patient opens their phone and types “buy antibiotics over the counter” into Google. Or “fish amoxicillin.” Or “antibiotics without prescription USA.” Now they’re really entering a murky, unsafe place in their search. 

I’ve stood at the pharmacy counter and had patients ask almost every day what aisle the OTC antibiotics are on. And those traveling from outside the US are always always shocked that we have nothing (aside from creams and ointments) available OTC for them to purchase without a prescription.

Are Antibiotics Available Over the Counter in the US?

No.

Every systemic antibiotic in the US is federally prescription-only under Section 503(b) of the Food, Drug, and Cosmetic Act¹. Every oral. Every injectable. Every IV. There is no OTC pathway, and there hasn’t been one in decades.

The only meaningful exceptions are topical: bacitracin, neomycin, and polymyxin (the triple-antibiotic ointment trio), available without a script for surface use. None of them treat the conditions patients are searching for when they type “buy antibiotics online.” We all know nobody is stockpiling Neosporin for a UTI at sea.

So the legal answer is clear: no antibiotics over the counter. The harder question is whether the clean legal answer is actually the answer your patient is satisfied by.

We Weren’t Trained For The System We’re Practicing In

This is the part most CE courses haven’t caught up to.

Pharmacy school, medical school, and PA school all taught us to prescribe inside a closed system. One patient. One prescriber. One chart. One local pharmacy that had a relationship to all of the above and a pharmacist who would call when something looked off.

That system isn’t the system anymore. Your patient today has access to:

  • Direct-to-consumer telehealth platforms (Hims, Hers, Sesame Care, Push Health, GoodRx, Cost Plus, and a long list of others) that prescribe after a laughably thin intake with no synchronous visit and no real clinical review behind the script
  • Mail-order chains and Amazon Pharmacy shipping from warehouses outside your local network and outside your visibility
  • Foreign mail-order pharmacies advertising “no prescription needed” and shipping product from manufacturing chains the FDA has never inspected
  • Cross-border purchasing in Mexico and elsewhere, where many antibiotics are functionally OTC
  • Pet stores stocking aquarium amoxicillin, doxycycline, and cephalexin on the same shelf as goldfish food
  • Friends, family, and online communities passing along leftover prescriptions, often paired with TikTok dosing advice from creators whose credentials don’t exist

None of these channels talk to each other. None of them talk to you. Your patient is the only person holding the full picture, and most patients are not pharmacists.

Antibiotics are over-prescribed and we all know it. Sometimes the script is clinically indicated. Sometimes it’s the fastest way to end a visit with a patient convinced they have a sinus infection. Patients have noticed. When the same clinic that gave a friend a Z-Pak for a cold turns around and tells them no for a real concern, the “no” lands as arbitrary.

We were trained to be the gatekeepers of a system that no longer has gates. Patients have noticed before we have. The job now is harder than the one we trained for: guiding patients to appropriate access, especially for antibiotics, in a landscape where access is everywhere and quality is uneven.

Where Patients Actually Go When We Say No

Fish antibiotics are the version of the story we’ve all heard. The newer version is worse. Here’s the shape of the grey market today:

  • Online “telehealth” prescribers running rubber-stamp intakes and writing whatever the patient asked for, with no real clinical relationship behind the script. Some are licensed in one state and prescribing into fifty. Some are pharmacy-owned and incentivized to write.
  • Foreign mail-order pharmacies shipping product the FDA has flagged as counterfeit or mislabeled at non-trivial rates. The FDA runs BeSafeRx² as a standing consumer warning because the volume of unlicensed online pharmacies grew large enough to require one.
  • Cross-border purchases, primarily in Mexico, where many antibiotics are sold without a prescription. The product is often legitimate. The clinical guidance attached to it is essentially nonexistent.
  • Aquarium and livestock antibiotics, which are not manufactured to USP standards, not tested for human dissolution profiles, and may contain dyes or fillers cleared only for fish.
  • Leftover-prescription swapping between friends, family, and online communities, often guided by content from creators whose credentials don’t exist.

(You’re saying, ok, but my patients can spot the obvious scams. Some can. The packaging and designs on the dangerous channels are convincing enough that some can’t.)

What unites all of these is what they lack: a real clinical relationship, written guidance, a recall pathway, recourse if the batch is bad. Speed is what the patient sees first. The cost shows up later, if at all.

What Appropriate Medical Preparation Actually Looks Like

There is a legal, clinically sound version of what these patients are looking for. We call it appropriate medical preparation, and it has four pieces:

  • A US-licensed clinician running a real clinical evaluation behind every script
  • Pharmaceutical-grade medications, manufactured to USP standards
  • A US-licensed pharmacy as the dispensing point of record
  • Written clinical guidance, in the patient’s hands, for when and how to use what was prescribed

Same medications your patients were already searching for. Held to the standards of care you practice.

In no way a replacement for primary care. Complex diagnoses, chronic conditions, and ongoing provider relationships belong in the exam room with you. Appropriate medical preparation works in a narrow space: well-defined, common, low-acuity conditions where the evidence is strong and the patient’s actual problem is access, not diagnosis.

Who’s Doing This Work

Jase.com is a family team of medical doctors, physician assistants, and pharmacists who have been working in appropriate preparation space for over five years. The clinical team includes board-certified family medicine providers, an extreme-medicine and disaster medicine specialist, and a Director of Pharmacy licensed across twenty states. The clinical work happens on the front end, so the patient isn’t doing it alone at 11pm.

Charting the Grey Area in Public

This is the contingency category we’re building, and we’re building it carefully. There are plenty of online resources in this space that aren’t reputable or safe, and most weren’t built by clinicians at all.

If you have patients asking about contingency access and you don’t feel confident prescribing in this space yourself, you can refer them to us at Jase.com. Going forward, we’ll be sharing how we make these clinical decisions, the criteria we use, the frameworks we’re building, and where we’re still figuring things out, so providers have something concrete to point to and more confidence in what to do when a patient asks.

Public knowledge gets better when clinicians chart the grey area in public instead of letting the internet do it. Real resources for providers, real guidance for patients, less grey area going forward. That’s what we’re here to help build.

The Bottom Line

Patients are already making decisions about contingency antibiotics. They are doing it with or without us. The only real question is whether those decisions get made with a real prescriber attached and a US pharmacy on the other end, or alone in a search bar at 11pm.

Public health framing has historically started at “don’t.” Patients have been hearing “don’t” without an alternative long enough that the grey market filled the silence. Clinicians shouldn’t have to choose between giving a defensible “no” and watching their patient land somewhere worse.

Sources

  1. 21 U.S.C. § 353(b), Federal Food, Drug, and Cosmetic Act, Section 503(b) — Prescription drug requirements for federally regulated drugs.
  2. U.S. Food and Drug Administration, BeSafeRx: Your Source for Online Pharmacy Information. FDA consumer protection program for identifying licensed online pharmacies.

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