- Amoxicillin 125mg/5ml suspension (w*0.27) x 3×10-14 OR Amoxicillin 250mg/5ml suspension (wx0.13) x 3×10-14
- 5 mg suppositories + Paracetamol ( Revanin) 125mg/5ml Syrup (w/2) alternately every 6 hours until fever subside
In excessive nasal secretions (Rinorrhea,sneezing),congestion :
- Allerfin 2.5mg/5ml syrup 5 ml every 4-6 hours
- Apisal 9mg/ml drop 1drop 4-6 times daily
Amoxicillin :
Ear, Nose, & Throat Infections
Mild to moderate infections
- >3 months and <40 kg: 20 mg/kg/day PO divided q8hr
Severe infections
- >3 months and <40 kg: 40 mg/kg/day PO divided q8hr
Acute Otitis Media
- ≥2 months and children: 80-90 mg/kg/day PO in divided doses q12hr
- Age <2 years or severe symptoms (any age): Standard 10-day course
- >2 years with mild or moderate AOM: 5-7-day course
Lower Respiratory Tract Infections
Mild, moderate, or severe infections
>3 months and <40 kg: 40 mg/kg/day PO divided q8hr
Pneumonia, community-acquired (Off-label)
≥3 months:
Immediate release
Empiric treatment: 90 mg/kg/day PO divided q12 hr for 10 days; not to exceed 4,000 mg/day
Group A Streptococcus: 50-75 mg/kg/day PO divided q12hr for 10 days; not to exceed 4,000 mg/day
H. influenza: 75-100 mg/kg/day PO divided q8hr for 10 days; not to exceed 4,000 mg/day
Infective Endocarditis (Off-label)
Prophylaxis
- 50 mg/kg PO 30-60 min before procedure
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
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
Chlorpheniramine
Available forms:
- Allerfin: 4mg tab, 10mg/ml ampule, 2.5mg/5ml syrup
- Anallerge: 4mg tab 2mg/5ml syrup
- Chlorohistol: 4mg tab
Therapeutic indications:
- symptomatic control of all allergic conditions responsive to antihistamines, including hay fever, vasomotor rhinitis, urticaria, angioneurotic oedema, food allergy, drug and serum reactions, insect bites.
- Also indicated for the symptomatic relief of itch associated with chickenpox.
Method of administration:
- Adults: 4 mg (1 tablet or 10 ml) every 4-6 hours. Not more than six doses (24 mg) a day if under 65 years of age, or more than a total of three doses (12 mg) a day if over 65 years.
- Children aged 6-11 years: 2 mg (5 ml) every 4-6 hours. Not more than a total of six doses (12 mg) a day.
- Children aged 2-5 years: 1 mg (2.5 ml liquid medicine) every 4-6 hours. Not more than a total of six doses (6 mg) a day.
- Children 1 year-23 months: 1 mg (2.5 ml liquid medicine) twice daily, preferably morning and evening
Contraindications
- contra-indicated in patients who are hypersensitive to antihistamines or to any of the tablet ingredients.
Pregnancy
- There are no adequate data from the use of chlorphenamine maleate in pregnant women. The potential risk for humans is unknown. Use during the third trimester may result in reactions in the newborn or premature neonates. Not to be used during pregnancy unless considered essentially by a physician.
Lactation
- Chlorphenamine maleate and other antihistamine may inhibit lactation and may be secreted in breast milk. Not to be used during lactation unless considered essential by a physician
Side effects :
- Sedation
- drowsiness, dizziness, blurred vision and psychomotor impairment
- Nausea, dry mouth
- Disturbance in attention
Apisal 9mg/ml drop, 7.4mg/ml spray
- Nasal decongestant
- is a safe drug-free physiological saline solution
- can be used as often as needed, to cleanse and moisturize nasal passages and help in removing incrustations, bacteria, viruses, allergens or irritants entrapped in the nasal mucosa.
- Nasal Dryness & Congestion
- relieves nasal congestion by thinning mucus and moisturizes membranes
Dose in adult and pediatrics:
- 1puffs /drop 4-6 times daily
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