1. Azithromycin 500mg capsule 1x1x3
2. Voltaren 75mg tablet 1 x 2 until fever subside
3. Nasonex .05% nasal spray 2 sprays in each nostril once a day

If there are excessive secretions and sneezing   add:

• Hydroxyzine 25mg 1 tab every 8-6 hours

 If there is nasal obstruction add :

• Sterimar Isotonic sea water spray 1puff 4-6 times

Azithromycin

Dosage Forms & Strengths:

• 250mg ,500mg  capsule and tablet, 500mg vial, 200mg/5ml suspension, 300mg /7.5ml suspension

Trade names  :

Zocin, Zimax , Zomax, Azomycin, Azi_once, Zithromax, Azitam, Zithrova, Zaha, Zilacid, Azicure, Azomyne , Azox

Therapeutic indication and dose :

Community-acquired Pneumonia

• 500 mg PO x 1 dose on Day 1, followed by 250 mg PO qDay on Days 2-5

Pharyngitis or Tonsillitis

• 500 mg PO x 1 dose on Day 1, followed by 250 mg PO qDay on Days 2-5

Uncomplicated skin/skin structure

• 500 mg PO x 1 dose on Day 1, followed by 250 mg PO qDay on Days 2-5

Acute bacterial exacerbations of chronic obstructive pulmonary disease

• 500 mg PO qDay for 3 days OR
• 500 mg PO x 1 dose on Day 1, followed by 250 mg PO qDay on Days 2-5

Acute bacterial sinusitis

• 500 mg PO qDay x 3 days

Genital Ulcer Disease (Chancroid)

• 1000 mg PO x 1 dose

Nongonococcal or Gonococcal Urethritis and Cervicitis

• 1000 mg PO x 1 dose

Cat Scratch Disease (Off-label)

• >45.5 kg: 500 mg PO once, then 250 mg once daily for 4 days

Pertussis (Off-label)

• 500 mg PO once, then 250 mg once daily for 4 days

Endocarditis (Off-label)

Prophylaxis

• 500 mg PO 30-60 min before procedure

Contraindications:

• Hypersensitivity to azithromycin, erythromycin, any macrolide

Pregnancy:

• The safety of azithromycin has not been confirmed with regard to the use of the active substance during pregnancy. Therefore, Azithromycin should only be used during pregnancy if the benefit outweighs the risk

Breastfeeding :

• Azithromycin has been reported to be secreted into human breast milk
• Because it is not known whether azithromycin may have adverse effects on the breast-fed infant, nursing should be discontinued during treatment with Azithromycin. Among other things diarrhea, fungus infection of the mucous membrane is possible in the nursed infant. It is recommended to discard the milk during treatment and up until 2 days after discontinuation of treatment. Nursing may be resumed thereafter. 

Common side effects:

• Anorexia
• Dizziness, headache, paranesthesia, dysgeusia
• Visual impairment, Deafness
• Vomiting, dyspepsia
• Rash, pruritus

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 (Mometasone)

• help to relieve inflammation(swelling and irritation of the nose), sneezing, itching and a blocked up or runny nose.

Available forms:

• Nasonex, Tabunex, Sinocort: 05% nasal spray

 Indications:

• to treat the symptoms of seasonal allergic rhinitis (also called hayfever) and perennial (long lasting) rhinitis in adults and children aged 3 and older;
•  to treat nasal polyps in adults aged 18 and over

Dose:

Adult:

• recommended dose is two sprays in each nostril once a day. 
• Once symptoms are controlled, dose reduction to one spray in each nostril may be effective for maintenance.
• may  increase to  the dose; the maximum daily dose is four sprays into each nostril once a day. 

Children aged 3 to 11 years :

• the usual dose is one spray into each nostril once daily. 
• May used some days before the start of the allergy season, as this will help to prevent  allergic rhinitis symptoms from occurring. 
• Prophylaxis must be initiated up to 2-4 weeks prior to the anticipated start of the allergy season.
•  Benefit of treatment may be achieved in the first two days.
•  Maximum benefit is achieved within 1-2 weeks following initiation of treatment. Therefore, patients should continue regular use to achieve full therapeutic benefit. 

For patients who use MOMEX® at regular intervals for treatment of allergic rhinitis,:

• recommended dose is a spray into each nostril once a day. For children between the ages of 2 and 11 years the usual recommended dose is one spray in each nostril once a day.

Hydroxyzine

Available forms:

• Atarax :25mg tab, 10mg/5ml syrup
• Newrax  :10mg/5ml syrup

Therapeutic indications:

• Anxiety in adults 
• Itching (pruritus) caused by allergic reactions in adults and children.

Dose :

• In adults the maximum daily dose is 100 mg (4 tablets) per day 

Adults

For anxiety:

• The usual dose is ½ tablet at breakfast, ½ tablet at lunch and 1 tablet in the evening
• doctor may increase this to a maximum of 4 tablets taken three times a day.

For pruritis (itchiness of the skin):

• The usual dose is 1 tablet before going to bed
• doctor may increase this to 1 tablet three or four times a day

Children

• In children up to 40 kg, the maximum daily dose is 2 mg/kg/day.

For pruritis :

• The usual dose is 0.5 mg per kg of body weight twice a day
• doctor may increase this to a maximum of 1 mg per kg of body weight twice a day

The elderly

• In the elderly, the maximum daily dose is 50 mg (2 tablets) per day.
• The usual starting dose is 25 mg (1 tablet) a day

Contraindication :

• allergy to hydroxyzine hydrochloride or any of the other ingredients 
• allergy to cetirizine, other piperazine derivatives, aminophylline or ethylenediamine
• pregnancy or breastfeeding
• porphyria.(A blood disease that can cause stomach pain, vomitingand mental disturbances such as depression
• ECG (electrocardiogram) shows a heart rhythm problem called “QT interval prolongation”

Pregnancy and breastfeeding :

• Not recommended in  pregnancy or breastfeeding

Side effect:

• feeling sleepy
• dry mouth, feeling tired, headache

Sterimar Isotonic sea water spray 

• Is a natural nasal decongestant spray
• Is an isotonic filtered sea water solution, 100% natural and free from preservatives
• Restores natural moisture of the nose (air conditioning, heating, travel). To assist when ENT disorders (sinusitis, colds, hayfever, allergies, dry & stuffy noses).

Dose:

• 1puffs 2 to 6 times a day in each nostril as required or as needed.

Pregnancy and lactation:

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