- Azithromycin 200mg/5ml suspension (Wx0.3) x1x5
- Brufen 100mg/5ml syrup (Wx0.375) + Paracetamol ( Revanin) 125mg/5ml Syrup (w/2) alternately every 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
- Rhinaction nasal spray 1 spray per nostril, 6 times a day
Azithromycin :
Acute Otitis Media
<6 months: Safety and efficacy not established
≥6 months
- 30 mg/kg PO x 1 dose OR
- Alternative dosing
- 10 mg/kg PO qDay for 3 days OR
- 10 mg/kg PO x 1 dose on Day 1 followed by 5 mg/kg on Days 2-5
Community-acquired Pneumonia
- <6 months: Safety and efficacy not established
- ≥6 months: 10 mg/kg PO x 1 dose on Day 1, followed by 5 mg/kg PO on Days 2-5
Pharyngitis/Tonsillitis
- <2 years: Safety and efficacy not established
- ≥2 years: 12 mg/kg PO qDay for 5 days; not to exceed 500 mg/day
Cat Scratch Disease (Off-label)
- ≤45 kg: 10 mg/kg (not to exceed 500 mg/dose) PO as single dose; then 5 mg/kg (not to exceed 250 mg/dose) PO qDay on days 2 through 5
- >45 kg: 500 mg PO once, then 250 mg once daily for 4 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
Brufen
- Analgesic and antipyretics
- Has anti-inflammatory effect
- Suitable for Temperature( 38-38.5) C
- Not save under 6 months
- Taken After meal
- 200mg every 6-8 hours, May increase to 400mg every 6-8hours
Trade names : brufen (Taskine , Doloraz, Iburam,Remofen ,Ibugesic,Sapofen,Perofen,Rupan,Bulkaprofen,Advil liquid-gel , Profast, Nashat ,Midofen,Ibusoft).
Other concentration: 800mg and 400mg tablet 600mg tablet, 100mg/5ml syrup
Dose:
Tablets :
Syrup, suspension :
- 100mg/5ml Syrup(Wx0.375) every 6-8hours
Oral drops :
40mg/1ml
- 6-11 months : 1.25ml every 8 hours
- 12-23months : 1.8ml every 8 hours
Maximum dose : 3200 mg per day
Contraindication:
- History of hypersensitivity to aspirin or other NSAIDs
- current or recent stomach ulcer
- severe heart failure.
- severe 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
Rhinaction Hypertonic sea water spray
- Sea water
- is a natural nasal decongestant spray
- Clearing and purifying solution, combining hypertonic seawater with a complex of 3 essential oils: Ravintsara, Thyme Linalool and Field Mint.
- Enables a reduction in symptoms of congestion, rhinorrhoea (runny nose) and sneezing by eliminating viruses and bacteria from nasal passages through draining effect
- Quickly relieves blocked nose and for up to 8 hours with a regular application of 1 spray per nostril, 6 times a day.
Dose:
- 1 spray per nostril, 6 times a day.
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