1. Clarithromycin 500mg capsules orally 1 x 2 x 14 days
2. Voltaren 75mg tablet 1 x 2 until fever subside
3. 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:

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