RX (58) :
- Cephalexin 125mg/5ml suspension (w x 0.33) x3x7-10
- Voltaren 5 mg suppositories every 12 hour
In excessive nasal secretions (Rinorrhea,sneezing),congestion :
- Histazin 5mg/5ml syrup 1-3ml daily in 1 or 2 divided doses
- Otrivin 05% spray /drop 1drops in each nostrils up to 3 times daily
Cephalexin
Uncomplicated Cystitis
- <15 years: 25-50 mg/kg/day PO divided q6-8hr for 10 days; not to exceed 4 g/day
- >15 years: 250 mg PO q6hr; dosage range, 1-4 g/day in divided doses
Genitourinary Tract Infections
- 25-50 mg/kg/day PO divided q6-8hr for 10 days; not to exceed 4 g/day
Beta-Hemolytic Streptococcal Infections
- 25-50 mg/kg/day PO divided q6-8hr for 10 days; not to exceed 4 g/day
Bone Infections
- 25-50 mg/kg/day PO divided q6-8hr for 10 days; not to exceed 4 g/day
Otitis Media
- 75-100 mg/kg/day PO divided q6hr for 10 days; not to exceed 4 g/day
Skin/Skin Structure Infections
- 25-50 mg/kg/day PO divided q6-8hr for 10 days; not to exceed 4 g/day
Respiratory Tract Infections
- 25-50 mg/kg/day PO divided q6-8hr for 10 days; not to exceed 4 g/day
Streptococcal Pharyngitis
- 25-50 mg/kg PO q12hr for 10 days; not to exceed 500 mg q12hr
Cellulitis and Mastitis
- Adolescents: 500 mg PO q6hr; dosage range, 1-4 g/day in divided dose
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
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 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