- Levofloxacin 500mg capsules orally 1x1x10-14 or 750mg 1x1x5
- Advil cold and sinus 1- 2 caplets every 4 to 6 hours
- Avamys 50mcg/dose nasal spray 2 spray in each nostril once a day
If there are excessive secretions and sneezing add:
- Histazin 25mg tab 1tab at night
Levofloxacin
Dosage Forms & Strengths
- 250mg tablet ,500mg tablet, 750mg tablet , 500mg/100ml, 250mg/50ml, 5mg/ml for iv infusion
Trade names :
- Tavanic , Avoxin, Joswe avoxin , Levotop, Avicare, levanix, Levaquin, Zynolev, Loxacin, Matador, Uniflox, Evomax, joxevo, Tavaquin, Lefort, levoflox, Levonic, Talerin, Ravivo, Nevotic, Loxamox .
Therapeutic indication and dose :
Community-Acquired Pneumonia
- 500 mg PO/IV once daily for 7-14 days or 750 mg PO/IV once daily for 5 days
Nosocomial Pneumonia
- 750 mg PO/IV once daily for 7-14 days
Acute Bacterial Sinusitis
- 500 mg PO/IV once daily for 10-14 days or 750 mg PO/IV once daily for 5 days
Acute Bacterial Exacerbation of Chronic Bronchitis
- 500 mg PO/IV once daily for ≥7 days
Skin/Skin Structure Infections
- Uncomplicated: 500 mg PO/IV once daily for 7-10 days
- Complicated: 750 mg PO/IV once daily for 7-14 days
Chronic Bacterial Prostatitis
- 500 mg PO/IV once daily for 28 days
Complicated Urinary Tract Infections & Acute Pyelonephritis
- 250 mg PO/IV once daily for 10 days or 750 mg PO/IV once daily for 5 days
Uncomplicated Urinary Tract Infections
- 250 mg PO/IV once daily for 3 days
Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for uncomplicated urinary tract infections
- 500 mg PO/IV once daily for 10-14 days
Acne Vulgaris (Off-label)
- 100 mg PO q8hr for 4 weeks
Epididymitis (Off-label)
- 500 mg PO qDay for 10 days
Contraindications
- Hypersensitive to levofloxacin or other quinolones
- Patients with epilepsy
- History of tendon disorders related to fluoroquinolone administration
- In children or growing adolescents
- During pregnancy
- In breast-feeding women
Side effect:
- Headache, Dizziness
- Vomiting, Nausea, Diarrhea
- Insomnia
Advil-Cold&Sinus Capsule
Ingredients: Ibuprofen – Pseudoephedrine
Product Description:
- Advanced formula for cold & sinus relief
Indications:
- Fast, temporary relief of the symptoms of colds including sore throat pain, sinus pain, nasal congestion, headache, fever, body aches and pains.
Dose:
Adults under 65 years and children over 12:
- 1 or 2 caplets every 4 to 6 hours as needed.
- not more six caplets in 24 hours
- not given to children under 12.
- not used longer than 3 days for a fever or 5 days for pain or cold symptoms.
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
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