Rx
Notes
In emergency
Disease annotations
Rx
- Cefuroxime 125 mg/5ml suspension(w x 0.6) x2x10
- Revanin 125mg/5ml Syrup (w/2) Every 4 – 6 hours until fever subside
In excessive nasal secretions (Rinorrhea,sneezing),congestion :
- Histazin 5mg/5ml syrup 1-3ml daily in 1 or 2 divided doses
- Decozal 0.05% spray /drop 1drops in each nostrils up to 3 times daily
Notes
Cefuroxime
Acute Bacterial Maxillary Sinusitis
- 3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively
- 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
Acute Otitis Media
- <3 months: Safety and efficacy not established
- 3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
- Alternatively: 125-250 mg PO q12hr for 10 days
Impetigo
- 3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day or 75-100mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
- Alternatively: 125-250 mg PO q12hr for 10 days
Pharyngitis/Tonsillitis
- 3 months-12 years: 20 mg/kg/day PO divided q12hr for 10 days; not to exceed 500 mg/day or 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
- Alternatively: 125-250 mg PO q12hr for 10 days
Paractamol
- Analgesic and antipyretics
- Not anti-inflammatory effect
- Suitable for Temperature between (37.5C – 38.5C)
- Safe under 6 months
Trade names : ( Revanin ,Adol,Panda,Dolocet ,Feverol, panadol )
Concentrations: 500 mg tablet, ,1g tablet ,125 mg/5 ml syrup, 250 mg/5 ml syrup, 125 mg suppositories, 250 mg suppositories,1g/100ml solution for infusion
Dose :
Tablet, capsule :
- 500mg tabs 1-2 tabs /cap every 6 hours
Syrup, suspension :
- < 5year : 125mg/5ml susp (w/2) Every 4 – 6 hours
- 5-12 year : 250mg/5ml susp (w/4) Every 4 – 6 hours
Suppositories :
- <1Y : 125 mg supp Every 8 hours (1 supp x 3 )
- >1Y : 250mg supp Every 8 hours ( 1supp x 3 )
Iv solution 1g/100ml :
- <10kg : 0 .75ml/kg
- >10kg , <50kg : 1.5ml/kg
- >50kg : 100ml Slowly over 15 minute
Maximum dose : 4g daily
Pregnancy and lactation : Paracetamol is the first choice of painkiller in pregnancy and breastfeeding
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
Otrivine
Otrivine Nasal Spray contains the active ingredient xylometazoline hydrochloride which helps to open up and clear the nasal passages by reducing the excessive nasal secretions and returning the swollen blood vessels to their normal size.
Used in :
- nasal congestion (blocked nose, including colds)
- allergic rhinitis
- sinusitis.
- Not used>5 days Cause rebound congestion
Pregnancy : not recommended
Available forms:
- Otrivin 0.1% spray/drop , .05% spray /drop
- Decozal 0.1% spray/drop , .05% spray /drop
- Xylomet 0.1% spray
Dose:
Adult
- 0.1% Nasal drop 2-3 drops in each nostrils up to 3 times daily
Child>6y
- 0.05% Nasal drop 2-3 drops in each nostrils up to 3 times daily
Child 6months-6y
- 0.05% Nasal drop 1drops in each nostrils up to 3 times daily
In emergency
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 )
Disease annotations
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