- Amoxicillin 500 mg capsule 1x2x10-14 or 250 mg capsule 1x3x10-14
- Revenin 500mg tablet 1x 4 up to 2 x 4 until fever subside
If there are excessive secretions and sneezing add:
- Levocetirizine 5mg tab 1×1 in the evening
If there is nasal obstruction add :
- Otrivin 0.1% spray/drop 2-3 drops in each nostrils up to 3 times daily not more than 7 days
Amoxicillin :
Dosage Forms & Strengths
1000mg, 1g, 500mg, 750mg 625mg tablets, 500mg, 250mg capsules, 375mg/5ml suspension ,250mg/5ml suspension, 125mg/5ml suspension
Trade names : Amoxil, Moxiram, Penamox, Ultramox, Moxilen, Hymox, Amoxapen, Julphamox, Ospamox, Amoxydar, Amoxibel
Therapeutic indication and dose :
Ear, Nose, & Throat Infections
Mild to moderate infections
- 500 mg PO q12hr or 250 mg PO q8hr for 10-14 days
Severe infections
- 500 mg PO q8hr for 10-14 days
Genitourinary Tract Infections
Mild to moderate infections
- 500 mg PO q12hr or 250 mg PO q8hr
Severe infections
- 500 mg PO q8hr
Skin & Skin Structure Infections
Mild to moderate infections
- 500 mg PO q12hr or 250 mg PO q8hr
Severe infections
- 500 mg PO q8hr
Lower Respiratory Tract Infections
- 500 mg PO q8hr for 10-14 days
Helicobacter Pylori
H pylori infection and active or 1-year history of duodenal ulcer
Triple therapy
- 1 g PO q12hr for 14 days with lansoprazole (30 mg) and clarithromycin (500 mg)
Dual therapy
- 1 g PO q8hr for 14 days with lansoprazole (30 mg) in patients intolerant of, or resistant to, clarithromycin
Infective Endocarditis
Prophylaxis
- 2 g PO 30-60 min before procedure
Chlamydial Infection in Pregnant Women
- First trimester: 500 mg PO q8hr for 7 days
Contraindications:
- Hypersensitivity to penicillin’s, semi-synthetic penicillin’s or cephalosporin.
- Liver problems
- Renal impairment
Pregnancy:
- Category B
Breastfeeding :
- Amoxicillin is excreted into breast milk in small quantities
- Diarrhea and fungus infection of the mucous membranes are possible in the breast-fed infant, so that breast-feeding might have to be discontinued.
Common side effects:
- Anaphylaxis
- Anemia
- AST/ALT elevation
- Mucocutaneous candidiasis
- Diarrhea
- Headache
- Nausea
- Vomiting
- Rash
- Pseudomembranous colitis
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
Levocetirizine
Available forms:
- Xyzal, Levosyn, levar, Levozal, Zolix, Cetazal :5mg tab
- Layal : 5mg tab, 2.5 mg /5ml syrup
- L-cet : 5mg tab, 0.5mg/ml syrup
- Hpi –levocetirizine : 5mg tab
- Lesonal : 5mg tab, 0.5 mg /ml syrup
Theraputic indications:
- allergic rhinitis (including persistent allergic rhinitis);
- nettle rash (urticaria).
Dose:
Adults :
- 5 milligrams (mg) or 10 mL) (2 teaspoons) once a day taken in the evening. Some patients may be given 2.5 mg or 5 mL (1 teaspoon) once a day taken in the evening.
Children 6 to 11 years of age :
- 2.5 mg or 5 mL (1 teaspoon) once a day taken in the evening. Do not take more than 2.5 mg per day.
Children 6 months to 5 years of age :
- 1.25 mg or 2.5 mL (1/2 teaspoon) once a day taken in the evening. Do not take more than 1.25 mg per day.
For oral dosage form (tablets):
- Adults and children 12 years of age and older—5 mg (1 tablet) once a day taken in the evening. Some patients may be given 2.5 mg (1/2 tablet) once a day taken in the evening. Do not take more than 5 mg per day.
- Children 6 to 11 years of age—2.5 mg (1/2 tablet) once a day taken in the evening. Do not take more than 2.5 mg per day.
Side effect:
- dry mouth,
- headache,
- tiredness
- somnolence/drowsiness.
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