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Outdoor First Aid

Hiking Medicine: Trail Rx

Got a first-aid kit? Great. Now add these over-the-counter medicines and it'll be perfect.

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One trip down the drugstore aisles will convince you: There’s an over-the-counter tube, bottle, or canister of medication for just about any minor ailment a backpacker is likely to encounter. The trick is deciding which one you actually need to lug into the field.

Some first-aid potions are automatic choices. Triple antibiotic ointment, for example, should be in every first-aid kit, as should any medicine that addresses your specific

needs, like recurring gastric distress or athlete’s foot. But beyond the obvious, how do you make sure your health and well-being bases are covered, outside of carrying a pharmacy in your pack?

What follows is a list of likely candidates, with some suggestions about when to use, when to avoid, and which ones work best for what. Remember to look for the smallest container, and repackage when appropriate. Personally, I double-bag each separately and include the box top with the name, lot number, and expiration date. That way I don’t have to play the guessing-by-flashlight game at night. If you’re not familiar with a drug, also include the use and dosage.


Add to your kit: The NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen, naproxen, and aspirin. Available as generics or in the common brand names Advil, Motrin, Aleve, Anacin, and others.

When to use: These little pills are good for alleviating pain and inflammation from a host of common ailments likely to strike a backcountry traveler sooner or later, including sore muscles and joints, headache, toothache, fever, and sprains.

Don’t use if: You experience stomach irritation or allergic reactions (hives, rashes, asthma).

In the field: Take according to instructions at the first sign of pain or inflammation. Never mix with each other, or with alcohol. Aspirin’s only advantage is its cost. It has more side effects than the others, and it doesn’t survive dampness well. A strong vinegar smell means it’s outdated. Note that acetaminophen (Tylenol) is an effective painkiller, but does nothing for the inflammation of an overused knee joint or a twisted ankle.


Add to your kit: A tube of triple-antibiotic ointment or cream such as Neosporin, Mycitracin, or one of the many generic brands.

When to use: When a nasty fall or slip of a knife results in an open cut or scrape with redness, pain, swelling, and a honey-colored crust over broken skin, use a triple-antibiotic to prevent and treat bacterial infection.

Don’t use if: Skin is unbroken or if bleeding from broken skin is more than an “ooze.”

In the field: Gently wash crust off wound, then apply just enough cream to cover the area, twice daily. Use cream instead of ointment, which has a petrolatum base that can seal out air. If you see a tender red streak meandering from the wound toward the heart, you have a more advanced infection that needs an oral antibiotic, pronto.


Add to your kit: A small tube or spray bottle of tolnaftate (Ting), miconazole (Lotrimin spray), or clotrimazole (Mycelex cream).

When to use: Fungi love to grow where it’s warm, dark, and damp. Favorite spots are between toes inside hiking boots and under constantly wet and not terribly clean clothing. The skin is puffy red and feels hot or itchy. Symptoms are worse when the area is warm. If the skin cracks or weeps, you may also see a “secondary” bacterial infection.

Don’t use if: You’re allergic to antifungal drugs or if the symptoms haven’t improved in two to three days.

In the field: The most important part of treatment is drying the skin. If skin stays damp, the fungal infection may not heal. Once the area is dry, apply the cream, spray, or powder twice daily, and continue treatment for twice the time it takes to clear all your symptoms.


Add to your kit: A small bottle or tube of benzocaine (Americaine spray) or lidocaine (Xylocaine ointment).

When to use: Use this on the type of wounds you’d treat with the triple-antibiotic ointment. While it won’t help heal a cut or scrape, it will temporarily reduce pain.

Don’t use if: There is more than an “ooze” of bleeding.

In the field: Apply just enough to thinly cover the area, and repeat in 2 to 3 hours if needed. These are okay to use around mucous membranes such as the nose, but keep it out of eyes. Don’t put it on small children anywhere they might lick and swallow it. The ointment comes in a tube and takes up less space, but the spray can be applied without rubbing.


Add to your kit: Any of a variety of antihistamines such as diphenhydramine (Benadryl), triprolidine (Actidil), chlorpheniramine (Chlor-Trimeton), or clemastine (Tavist). Other brand names as well as generics are widely available.

When to use: Though most often used for common hay fever and other such allergies, antihistamines are especially useful to backpackers for alleviating severe itching from insect bites as well as pain and swelling from bee and hornet stings.

Don’t use if: You’re already taking a prescription antihistamine.

In the field: Since there’s a delay of 30 minutes or so before these kick in, you should take at the first sign of swelling from an insect sting. Drowsiness and dry mouth are very common with antihistamines, but symptoms vary from brand to brand. If one bothers you, try another. It’s okay to mix them with NSAISs if, say, your allergy is also giving you a crashing headache. Never mix with alcohol.


Add to your kit: A roll or small pill bottle of tablets containing bismuth subsalicylate (Pepto-Bismol and others), or loperamide (Imodium AD).

When to use: When the extra spicy freeze-dried chili that sounded good at home gives you the runs in the backcountry or if you pick up a slight stomach bug, or altitude or other factors have your stomach doing back flips, these can prevent and treat the associated diarrhea, nausea, heartburn, and indigestion. Note that loperamide, while good for diarrhea and gut cramps, does nothing for heartburn or indigestion.

Don’t use if: You’re allergic to or already taking aspirin. They’re both chemically similar, so you could overdose. If you develop a fever or bloody diarrhea get medical attention.


Add to your kit: A few witch hazel/glycerin pads (Tucks, many others) in zipperlock baggies.

When to use: Any time you’re plagued by hemorrhoid itch, poison ivy, and other weepy scratchies.

Don’t use if: The medication causes burning or increased pain.

In the field: Wipe the affected area gently with a pad every few hours as needed and allow it to air dry. Also, use to clean an area before applying triple-antibiotic or antifungal cream.


Add to your kit: Aloe vera gel in a film canister.

When to use: To soothe a mild sunburn, scald from boiling water, and mild frostbite.

Don’t use if: Any of the above are blistered or bleeding or if the aloe vera causes a rash or makes the pain worse.

In the field: Apply a thin film of gel ASAP after the injury. Repeat three to four times a day until healed.

Notes: Can be combined with topical anesthetics and/or triple-antibiotic.

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