1. Cefuroxime 250mg  tablet orally  1 x 2 x 10
2. Voltaren 25 mg tablet + Paracetamol ( Revenin)500mg tablets  alternately every 6 hours until fever subside
3. Gurgle with salt and water solution (don’t swallow it ) 3 times daily
4. Soft food and warm drinks

Cefuroxime

Dosage Forms & Strengths:

• 125 mg, 250mg, 500mg tablet, 125mg /5ml suspension, 250 mg/5ml suspension , 750mg 1500mg 250mg vial for iv injection

Trade names  :

• Zinnat , U-cef ,Cefovex, Ceftal ,Zamur, Oraxim Daroxime, Medo-axitine,Cefutil, Zinoximor, Cefurex , Cefuzime, Furocef ,Maxil , Vaxcel cefuroxime, Xorim , Xorimax , Zilisten, Zinacef, Zinoxime

Therapeutic indication and dose :

Pharyngitis/Tonsillitis

• 250 mg PO q12hr for 10 days

Acute Bacterial Maxillary Sinusitis

• 250 mg PO q12hr for 10 days

Acute Bacterial Exacerbations of Chronic Bronchitis

• 250-500 mg PO q12hr for 10 days
• 500-750 mg IV q8hr; switch to oral therapy as soon as clinically possible

Secondary Bacterial Infections of Acute Bronchitis

• 250-500 mg PO q12hr for 5-10 days

Uncomplicated Pneumonia

• 750 mg IV/IM q8hr

Uncomplicated Skin/Skin Structure Infections

• 250-500 mg PO q12hr for 10 days
• 750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Uncomplicated Urinary Tract Infections

• 125-250 mg PO q12hr for 7-10 days
• 750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Gonorrhea

• Uncomplicated: 1 g PO once or 1.5 g IM once at 2 different sites with 1 g probenecid PO
• Disseminated: 750 mg IV/IM q8hr

Severe or Complicated Infections

• 1.5 g IV/IM q8hr; may be administered q6hr in life-threatening situations 

Contraindications

• Hypersensitivity to cephalosporin antibiotics. 
• History of severe hypersensitivity to any other type of betalactam antibacterial agent (penicillins, monobactams and carbapenems). 

Pregnancy

• Cefuroxime axetil should be prescribed to pregnant women only if the benefit outweighs the risk. 
• Category B

Breastfeeding

• Cefuroxime is excreted in human milk in small quantities. A risk of diarrhea and fungus infection of the mucous membranes cannot be excluded. 
• Breastfeeding might have to be discontinued due to these effects, Cefuroxime should only be used during breastfeeding after benefit/risk assessment by the physician in charge. 

Side effect:

• Candida overgrowth
• System disorders
• Eosinophilia
• Headache, dizziness
• Diarrhea, nausea, abdominal pain

Transient increases of hepatic enzyme levels

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, Rofenac Diclofen, 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