- Clarithromycin 500mg capsules orally 1 x 2 x 14 days
- Voltaren 75mg tablet 1 x 2 until fever subside
- Rhinase 50mcg/dose nasal spray 2 sprays in each nostril once a day
If there are excessive secretions and sneezing add:
- Histazin 25mg 1tab at night
If there is nasal obstruction add :
- Free breath 7.1mg/1ml spray1puffs 4-6 times daily
Clarithromycin :
Dosage Forms & Strengths:
- 250mg tablet, 500mg tablet, 500 mg vial, 125mg/5ml suspension, 250 mg/5ml suspension.
Trade names :
Klacid , Claritop, Klarimid , Claridar , Joclar , Klarilide, Eracid, Macromax, Klaribac , Clamycin, Claranta Claritt, Klrimed, Klamed, Clarix
Therapeutic indication and dose :
Acute Exacerbation of Chronic Bronchitis
- 250-500 mg PO q12hr for 7-14 days
- Extended release: 1000 mg PO once daily for 7 days
Acute Maxillary Sinusitis
- 500 mg PO q12hr for 14 days
- Extended release: 1000 mg PO once daily for 14 days
Mycobacterial Infection
- 500 mg PO q12hr for 7-14 days
Peptic Ulcer Disease
Indicated for H pylori eradication when treating patients with active or history of peptic ulcer disease
- 500 mg PO q8-12hr for 10-14 days
Administer as part of 2- or 3-drug combination regimen with bismuth subsalicylate, amoxicillin, H2 receptor antagonist, or proton pump inhibitor
Pharyngitis, Tonsillitis
- 250 mg PO q12hr for 10 days
Community-Acquired Pneumonia
- 250 mg PO q12hr for 7-14 days
- Extended release: 1000 mg PO once daily for 7 days
Skin/Skin Structure Infection
- 250 mg PO q12hr for 7-14 days
Pertussis (Off-label)
Used off-label for treatment of pertussis or for postexposure prophylaxis
- 500 mg PO twice daily for 7 days
Endocarditis (Off-label)
Used off-label for bacterial endocarditis prophylaxis
- 500 mg PO 30-60 minutes before procedure
Contraindications:
- Hypersensitivity to the active substance clarithromycin, to other macrolides
- Electrolyte disturbances (hypokalaemia or hypomagnesaemia, due to the risk of prolongation of the QT interval).
- Severe hepatic failure in combination with renal impairment.
- Clarithromycin should not be used concomitantly with statins (lovastatin or simvastatin), due to the increased risk of myopathy, including rhabdomyolysis
Pregnancy:
- The safety of clarithromycin for use during pregnancy has not been established. .
- Some observational studies evaluating exposure to clarithromycin during the first and second trimester have reported an increased risk of miscarriage compared to no antibiotic use or other antibiotic use during the same period.
- Therefore, use during pregnancy is not advised without carefully weighing the benefits against risks.
Breastfeeding :
- The safety of clarithromycin for use during breast feeding of infants has not been established.
Clarithromycin is excreted into human breast milk in small amounts
Common side effects:
- Abdominal pain
- Diarrhea
- Nausea
- Vomiting and taste perversion
Diclofenac sodium
- Mainly analgesic
- Has anti-inflammatory effect
- Suitable for temperature >39
- Contraindicated in < 1year age
- After meal
Trade names of diclofenac : (Diclogesic,Votrex,Infla-ban,Voltaren,Tratul,RofenacDiclofen,Olfen,Optifen,Almiral, Clofen, Diclosal, Divido,Diclomax, Nalgofen, Difen,)
Other concentrations: 12.5 mg, 50, 100 suppositories, 25, 50, 100 tablet, 100 capsules, 75 mg/3ml mg injection
Dose :
Tablet:
- 75 mg to 150 mg daily in two or three divided doses.
Suppositories :
Adults: 75-150mg daily, in divided doses every 12 hour
children:
- 1-3 years or <15 kg: 12.5 mg suppositories every 12 hour
- 3-12years or >15kg : 25mg suppositories every 12 hour
IM Injection 75mg/3ml
Adults : 25 to 75 mg depending on the severity pain.
The maximum daily dose is :150 mg.
Contraindication:
- History of hypersensitivity to diclofenac sodium
- Asthma
- Hypertension
- current or recent stomach ulcer
- severe heart failure.or evere liver disease
Pregnancy : not usually recommended in pregnancy
Corticosteroids nasal spray (Fluticasone)
Available forms:
- Flixonase, Rhinase, Dalman, Avamys, Aierxem: 50mcg/dose
Indications:
corticosteroid indicated for the management of thenasal symptoms of perennial nonallergic rhinitis in adult and pediatric patients
aged 4 years and older.
Dose:
For intranasal use only. Recommended starting dosages:
- Adults: 2 sprays per nostril once daily (200 mcg per day).
- Adolescents and children aged 4 years and older: 1 spray per nostril oncedaily (100 mcg per day).
Promethazine
Available forms:
- Histazin : 5mg/5ml syrup, 25mg tab
- Promet: 25mg tab
- Promethazine: 50mg/2ml for iv,im injection
Therapeutic indications
- As symptomatic treatment for allergic conditions of the upper respiratory tract and skin including allergic rhinitis, urticaria and anaphylactic reactions to drugs and foreign proteins.
- As an antiemetic.
- For short term use in treatment of insomnia in adults.
- For short term use as a paediatric sedative.
The usual doses are:
25mg tablet:
- Adults and Children>10 years : Start with 1 tablet (25 mg) taken at night. This maybe increased to a maximum of 1 tablet (25 mg) twice a dayif necessary.
- Children 5-10 years: A single tablet (25 mg) given at night. DO NOT give more than 25 mg per day.
50mg/2ml for iv,im injection
- Adult : 25 mg; may be repeated in 2 hours when necessary; switch to PO as soon as possible
- Pediatrics≥2 years: 12.5-25 mg IM at bedtime
5mg/5ml syrup:
- 2-5 years: 5-15 mg(1-3ml) daily in 1 or 2 divided doses
- >5-10 years : 10-25(2-5ml) mg daily in 1 or 2 divided doses
Contraindications
- should not be used in patients in coma or suffering from CNS depression of any cause.
- should not be given to patients with a known hypersensitivity to any of the excipients.
- contraindicated for use in children less than two years of age because of the potential for fatal respiratory depression..
pregnancy and lactation
- should not be used in pregnancy unless the physician considers it essential.
- The use is not recommended in the 2 weeks prior to delivery in view of the risk of irritability and excitement in the neonate.
- Available evidence suggests that the amount excreted in milk is insignificant. However, there are risks of neonatal irritability and excitement.
Side effects
- drowsiness, dizziness, restlessness, headaches, nightmares, tiredness, and disorientation. blurred vision, dry mouth and urinary retention
Free breath 7.1mg/1ml nasal spray
- Metered dose nasal spray
- sea water natural nasal decongestant spray
- Physiological solution for rinsing the nose
- Makes the breathing easier
- Free Breath Metered Dose Nasal Spray moisturizes the nose and improves comfort during flight. Using this product daily can help restore and optimize this self-cleaning system.
- Helps to stimulate the body’s natural shield
- Natural way to relieve congestion
- Does not contain any medication, just salt and water
Dose:
- 1puffs 4-6 times daily
Pregnancy and lactation:
- Save
In Emergency room:
- Give antipyretic:
- Perflgan 1g/100ml intravenous injection :
Dose:
Pediatrics:
- <10kg : 0 .75ml/kg
- >10kg , <50kg : 1.5ml/kg
- >50kg : 100ml Slowly over 15 minute
Adult:
- 100ml Slowly over 15 minute
OR
- Diclofenac sodium injection 75 mg/3ml intramuscular injection :
Dose:
Pediatrics:
- > 1year : 1ml/20kg every 12 hour .
Adult:
- 25 to 75 mg(1-3ml) depending on the severity pain.
- If the pain still severe, you may decide to give a second injection after 6 hours.
- Give Antibiotic:
- Lincomycin 600mg/2ml
Dose:
Pediatrics:
- IV: 10-20 mg/kg/day divided q8-12hr
- IM: 10 mg/kg q12-24hr
Adult:
- IM: 600 mg q12-24hr
- IV: 600-1000 mg q8-12hr; not to exceed 8 g/day
OR
- Ceftriaxone injection
Dose:
Pediatrics:
- 50 mg/kg IM in single dose; not to exceed 1 g
Adult:
- 50 mg/kg IM once
- Persistent or treatment failures: 50 mg/kg IV/IM for 3 days
- Give Antihistamine In sneezing and rhinorrhea :
- Allerfin 10mg/ml IM injection :
Dose:
- 1-5 year : 25-5mg (½ ml )
- 6-12 year: 5-10mg (1ml )
- Adult : 10-20 mg (1-2 ml )
Acute sinusitis
Presentation :
- Purulent nasal discharge
- Nasal congestion or obstruction
- Facial congestion or fullness
- Facial pain or pressure
- Decreased sense of smell
- Fever
- Headache
- Ear pain
- fullness; halitosis; dental pain; cough; fatigue
Examination:
- Purulent nasal secretions
- Purulent posterior pharyngeal secretions
- Mucosal erythema
- Tenderness overlying sinuses
Lines of management :
- Antipyretics
- Antibiotics
- Symptomatic treatment:
- In nasal obstruction : use nasal decongestant
- In excessive secretions and sneezing : use antihistamine
- If not respond : Intranasal Corticosteroids :
- Helpful in reducing mucosal swelling of inflamed tissue and facilitating sinus drainage because of an anti-inflammatory effect