- Cefuroxime 125 mg/5ml suspension(w x 0.6) x2x10
- 5 mg suppositories + Paracetamol ( Revanin) 125mg/5ml Syrup (w/2) alternately every 6 hours until fever subside
In excessive nasal secretions (Rinorrhea,sneezing),congestion :
- Lorine 5mg/5ml syrup one teaspoon (5 ml), once a day, with or without food
- Vibrocil nasal drops 1 to 2 drops 3 to 4 times a day in each nostril
Cefuroxime
Acute Bacterial Maxillary Sinusitis
- 3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively
- 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
Acute Otitis Media
- <3 months: Safety and efficacy not established
- 3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
- Alternatively: 125-250 mg PO q12hr for 10 days
Impetigo
- 3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day or 75-100mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
- Alternatively: 125-250 mg PO q12hr for 10 days
Pharyngitis/Tonsillitis
- 3 months-12 years: 20 mg/kg/day PO divided q12hr for 10 days; not to exceed 500 mg/day or 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day
- Alternatively: 125-250 mg PO q12hr for 10 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
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
Loratadine
Available forms:
- Loratan, clara, histal, Klarihist, Loreen, Lorine Lohist, Ramitin:10mg tab, 5mg/5ml syrup
- Tidilor, Claritine, Lorax :10mg tab, 1mg/1ml syrup
- Loratin, Restamine:10mg tab
- Lostamin: 5mg/5ml syrup
Indications:
- Relief of symptoms associated with allergic rhinitis, such as sneezing, nasal discharge (rhinorrhea) as well as ocular itching and burning.
- indicated for the relief of symptoms and signs of chronic urticaria and other allergic dermatologic disorders.
Dose:
- Adults and children 6 years and older who weigh more than 30kg : 1 x tablet once daily
- Adults and children over 12 years of age: 2 teaspoons (10 ml), once a day, with or without food.
- The dosage for children aged 2-12 is by weight:
- Body weight over 30 kg: 2 teaspoons (10 ml), once a day, with or without food.
- Body weight of 30 kg or less: one teaspoon (5 ml), once a day, with or without food.
Pregnancy and breast-feeding :
As a precautionary measure, it is preferable to avoid the use of Loratadine Tablets during pregnancy. Loratadine is excreted in breast milk so preferable to avoid the use in lactation
side effect:
- drowsiness
- headache
- increased appetite
- difficulty sleeping.
Vibrocil
Composition :Nasal drops, nasal spray: Dimetindeni maleas 0.25 mg, Phenylephrinum 2.5 mg
Indications Therapeutic use :
- Common colds, acute and chronic rhinitis, seasonal (hay fever) and non-seasonal allergic rhinitis, acute and
- chronic sinusitis, pre- and postoperative care, adjuvant in cases of acute otitis media.
Dosage:
Nasal drops
- Children from 1to 6 years: 1 to 2 drops 3 to 4 times a day in each nostril.
- Children over 6 years and adults: 3to 4 drops 3 to 4 times a day in each nostril.
Nasal spray
- Adult: apply 1 to 2 sprays in each nostril, 3to 4 times a day.
pregnancy and breast-feeding :
- Vibrocil should not be used as a precaution because too little experience is available
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