Short notes on ped. Drugs 1) Abs :

1- penicillins :

a) neutral penicillins : mainly for gm+ve , but not anti-staph

--penicillin G : R/ penicillin G vial (1 million unit )

50,000-100,000 unit/kg/d IV/IM divided in 4 doses

Rarely used nowadays

--penicillin V : R/ ospen susp/ tab rarely used nowadays

--benzathine penicillin : R/ durapen-s / retarpen / pencitard LA vial

b) broad spectrum penicillins :

--ampicillin ( 50-100 mg/kg/d ) : R/ ampicillin 250/500/1gm vial -- 250 susp

May cause some diarrhea ( most doctors prefer amoxicillin )

--amoxicillin (50-100 mg/kg/d) : R/ amoxil- Emox 250/500/1gm vial 250 susp

--ampicillin sulbactam (50-150mg/kg/d) : R/ unictam-unasyn-sulbin 375/750/1000/1500 vial Measure dose according to ampicillin dose which is 250/500/750/1000

Susp form is not very effective

--amoxicillin clavulinic : ( 50-100 mg/kg/d )

R/ hibiotic-N 230/460 susp ( amoxicillin dose is 200-400) R/ emoxclav augmentic - curam 156/312 susp ( amox. Dose is 125/250

R/ deltaclav 228/457 susp ( not very good )

--amoxicillin flucluxacillin : ( 50-100 mg/kg/d ) R/ flummox 500/1gm vial 250 susp

2- cephalosporins :

a) 1st G : mainly for gm+ve ( 50-100 mg/kg/d )

R/ velosef 250/500 vial

R/ duricef 250/500 susp ( the only susp form with 500 mg dose )

R/ ibidroxilbiodroxil 250 susp

b) 2nd G : broad spectrum but expensive ( 50-100 mg/kg/d )

R/ zinnat 750 vial

R/ bacticlor 250 susp

c) 3rd G : mainly for gm-ve ( 50 mg/kg/d)

R/ cefotax 250/500/1gm vial ( every 12 hrs )

R/ ceftriaxone 500/1gm vial ( every 24 hrs )

R/ suprax 100 susp ( 10mg/kg/d single daily dose) very expensive

3- macrolides : mainly for gm +ve and some gm-ve

a) erythromycin : (50mg/kg/d) : R/ erythrocin 200 susp ( every 8 hrs )

b) clarithromycin : ( 15mg/kg/d ) R/ klacid 250 susp (20 LE ) ( every 12 hrs )

c) azithromycin : (10mg/kg/d) R/ zithrokan-zisrocin-zithromax 100/200 susp (every 24 hrs )

1/2

**most commonly used :

R/ amoxil susp/vial R/ unictam vial R/ hibiotic susp R/ flummox vial

R/ velosef vial R/ duricef susp R/ cefotax ceftriaxone vial

R/ zithrokan zisrocin susp

** some additional notes :

--all Abs in susp form are 250mg except Duricef 250 and 500 susp

--all Abs in ped are given 50-100mg/kg/d except

Ampicillin sulbactam 100-150 mg/kg/d

3rd G cephalosporins 50 only/kg/d

Clarithromycin 15 mg/kg/d

Azithromycin 10mg/kg/d

--all Abs are in ped. The daily dose is devided twice daily except Erythromycin 3-4 times

Azithromycin single daily dose

Ceftriaxone vial single daily dose

**how to measure dose :

-- Each AB is named according to dose in the whole vial and the dose in 5cm of susp

e.g. flummox 500 vial the whole vial contains 500 mg

amoxil 250 susp each 5cm contains 250 mg

except penicillin combinations as previous.

-- the dose is measured according to wt of the pt

e.g. 50mg/kg/d : if pt is 10 kg so the dose is 50*10= 500mg/d

e.g. amoxil 250 susp for apt 10 kg

1- 50*10=500 i.e. 500 mg / day

2- amoxil 250 means 5cm = 250 mg

3- I need 500 mg / d so I need 10 cm / d

4- if the dose is devided as here so I will give the child 5cm each 12 hrs

And so on..

For easy measuring : most Abs are 50 mg/kg/d so

5 kg needs : 250 mg/kg/d

10 kg needs : 500

15 kg needs : 750

20 kg needs : 1000

12 500-600 18 800-1000The wt in kg = age in yrs * 2 + 8

e.g. 3 yrs child is 3*2 = 6 , 6+8=14 kg

5 yrs is 5*2=10 , 10+8 = 18 kg

Birth 3-3.5 kg

3 mo 4.5-5 kg

6mo 6-7 kg

8mo 8kh

10mo 9-9.5kg

1yr 10-11kg

2yrs 12kg

3yrs 14kg

4yrs 16kg

5yrs 18kg

6yrs 20kg

2) Antivirals

Herpes simplex genral infection, herpes zoster, viral gingivostomatitis

*acyclovir ( 20mg/kg/d) 1 or 2 doses

R/ lovir 400 tab ( 10 LE ) 1/2 R/ zovirax 200 susp ( 40 LE)

R/ zovirax 200-400 tab ( 30 LE )3) Antifungals :

a) local : R/ oracure miconaz micoban oral gel for oral candidiasis and aphthous ulcers

3

R/ miconaz candistan cream 3

b) systemic : ( 5mg/kg/d ) rarely used in severe systemic fungal infection

R/ diflucan 50 syrup/ 50 cap

R/ fungican 150 cap ( 5mg/kg/d single oral dose )

4) Antiprotozoal : for amoeba and giardia ( 50 mg/kg/d) devided in 3 dosesR/ flagyl 125/200 susp 3 10

R/ flagyl 250/500 tab 1*3*10

R/ fladazole 500 tab ( single oral dose ) 4

5) Antihelminths :

R/ bendax 100 susp 5 3 10 3

R/ bendax 200 tab 3 10

R/ epiquantel 600 susp ( 40 mg/kg/d ) single oral dose

R/ betricide 600 tab ( 40 mg/kg/d ) single oral dose

6) Antipyretics anti-inflammatories :

a) paracetamo : ( 15 mg/kg/dose 3-4 times daily )i.e. ( 50 mg/kg/d)

R/ cetal 100 drops ( 2drops/kg/dose 3-4 times daily )

R/ cetal 125 supp

R/ paramol 125 syrup

R/ cetal 250 syrup

R/ cetal 500 tab

R/ perfalgan vial ( 10mg/1ml i.e. 50mg/5ml ) vial = 100 ml i.e. 1000mg/vial Given only IV infusion with IV fluids or very slowly IV injection

Dose for children < 10 kg is 7.5 mg/kg/dose 3 doses/d ( max 60mg/kg/d) Dose for children > 10 kg is 15 mg/kg/dose 3 doses/d (max 690mg/kg/d)

b) ibuprofen : ( 50mg/kjg/d )

R/ brufen 100 syrup 200/400/600 tab

c) combination of paracetamol and ibuprofen :

R/ cetafen megafen susp ( 100 brufen+ 160 paracetamol )

R/ cetafen megafen tab ( 200 brufen + 325 paracetamo )

d) diclofenac/ketoprofen : 1mg/kg/dose 2-3 times daily ( better to be avoided in children < 1 yr )

R/ dolphin-k drops ( 2 drops/kg/dose)

R/ dolphin 12.5 supp ( 1-3 yrs)

25 supp ( 3-5yrs )

50 supp ( 5-10 yrs)

K ( 75 ) ( 10 yrs )

R/ dolphin-k cataflam ketofan - ketolac 50 tab

R/ dolphin-k ketofan - ketolac amp

e) nimesulide : 2mg/kg/dose 2-3 times daily

R/ sulide 50 susp

R/ sulide 100 tab

f) meloxicam : 0.5mg/kg/dose 1-2 doses daily

R/ anticox 7.5 cap/ 15 tab

** most commonly used :

Cetal- paramol paracetamol pyral ( very safe and good drugs )( given for any age )

Dolphin supp ( very effective but better avoided before 1 yr age )

Ketofan ketolac amp ( for older children 10 yrs )

7) Resp. sys. Drugs :

a) nasal decongestants :

-- nasal drops : 10 3 3-5

Not given > 5 ds as it will cause dryness and inf of the nose

R/ otrivin balkis ND

R/ otrivin baby ND (its just saline for nasal washing i.e. not decongestant)

-- oral : not used if with bronchitis as it dryness of bronchi and coughR/ rhinostop OD 1drop/kg/dose 3 times daily

R/ sine-up balkis congestal suryp ( 1ml/kg/d) 3 times daily

N.B. congestal not given before 1 yr age

R/ congestal 500 tab

b) cough suppressants : for dry non productive cough as severe bronchitis and early pneumonia

R/ cyrinol cough cut syrup ( 1 ml/kg/d ) 3 times dailyR/ selgon drops ( 1drop/kg/d)

R/ selgon ing supp

**selgon is used only in severe cases non responsive to syrup forms as it acts on brain center

c) mucolytic expectorants : for productive cough

R/ toplexil bronchophane bisolvon muco surup ( 1ml/kg/d ) 3 times daily

R/ bisolvon tab bisolvon ampd) bronchodilators : for asthma and bronchiloitis

--salbutamol : ( not effective before 1.5 yrs ) ( short time of action 4-5 hrs )

R/ salbovent farcolin syrup ( 1ml/kg/d ) 3 times daily

R/ farcolin nebulizer solu ( for nebulizer )

--theophylline : very effective for any age, long time of action 12 hrs but dangerous if overdose it may cause arrhythmia ( 20 mg/kg/d) ( max 600 mg/d)

R/ minophyllin-N 125 amp

R/ minophylline 300/500 amp ( with IV fluids or very slow IV inj. Over 10-15 min)

R/ etaphylline 100 syrup ( 1ml/kg/d) 3 times daily

R/ etaphylline minophylline ped. Supp ( 100 mg)

R/ etaphylline minophylline 500 adult supp

R/ quibron-T SR tab R/ foradil diskus ( formeterol : long acting 2 agonist ) for older children with asthma

e) combinations :

R/ allvent syrup ( terbutaline + expectorant )

R/ farcosolvin ( theophylline + expectorant ) ** all syrup forms dose is 1 ml/kg/d ** most commonly used :

R/ otrivin ped balkis ND/syrup congestal syurp/tab

R/ cyrinol bronchophane etaphylline allvent syrup

R/ selgon supp etaphylline supp

8) Digestive sys.:

a) antiacids :R/ mucogel farcogel epicogel susp 3

R/ zantac ranitidine 150/300 tab

R/ rani eff

b) antiemetics :

--metoclopramide : ( 0.5mg/kg/d) oral,rectral,IV,IM

Overdosage : torticollis, eye rolling, facial spasms

Antidote for overdose : R/ phenergan syrup ( 0.5 ml/kg single dose and stup metoclop.R/ primperan amp ( 10mg/2ml) i.e. 0.1 ml/kg/day i.e. 1ml/10kg

R/ primperan tab (10mg/tab)

R/ primperan ing supp ( 10mg/supp)

R/ primperan adult supp (20mg/ supp)

R/ primperan syrup (5mg/5ml) i.e. 0.5ml/kg/d 2-3 times daily

R/ primperan drops ( 1drop/kg/dose) 2-3 times daily

--vit. B6 :

R/ cortigen B6 50 amp ( for children < 10 yrs) 12

R/ cortigen B6 100 amp ( if > 10 yrs )

** very safe , very good , and with no SE

-- domperidone :

R/ motileum motinorm susp (1ml/kg/d) 3 times daily

R/ motileum motinorm tab 12

--chlorpromazine:only in severe cases not responsive to previous as it acts on brain centersUsed for adults and older children only > 10 yrs

SE : sedation, disturbed consciousness

R/ neurazine 25 amp

R/ neurazine 25 tab

c) spasmolytics : R/ sapsmotal drops ( 2drops/kg/dose) 3 times daily ( 1 yr )

R/ spasmin in supp ( 1-5 yrs)

R/ buscopan visceralgin ( 0.5 mg/kg/d)

Syrup (5mg/5ml)

Tab (10mg/tab)

Amp(20mg/1ml)

d) antidiarrheal :

R/ kapect smechta diax streptoquin susp 3-5 2-3

R/ diax streptoquin enteroquin entocid tab

R/ aquaream-Z syrup ( zinc) 5 10

WHO : zinc supplement for 10 ds after diarrhea to replenish body stores

e) laxatives :

R/ lactulose laxolac syrup 0.5ml/kg/d 2-3 times daily

R/ picolax drops ( 1drop/kg/single daily dose)

R/ glycerine inf/adult supp 10

R/ bisadyl inf/adult supp

R/ enemax enema

**most commonly used :

R/mucogel susp R/ rani effR/cortigen primperan

R/ buscopan spasmin

R/ diax kapect

R/ picolax glycerine

9) Antihistaminics : all them 0.5ml/kg/d

**better avoided before 2 yrs except fenistil can be given for severe cases

a) highly sedatives : R/phenergan syrup (0.5ml/kg/d) 3 times daily

b) moderately sedatives : R/ fenistil syrup (0.5ml/kg/d) 2 times daily

R/ fenistil oral drops (2drops/kg/d) 2 times daily

c) non sedatives : R/ histaminal syrup/tab 2 times daily

R/ histazine-1 syrup/tab 1 time daily

R/ evastine syrup/tab 1 time daily

10) vitamins and iron:

a) iron :

--prophylactic dose : 15mg/day for 1 mo.

--therapeutic dose : 6mg/kg/d for 1mo.

--in ttt of anemis give therapeutic dose for 1mo. Then prophylactic dose for 2mo.

R/ fer-in sol drops (dropper = 15 mg) 15 R/ sytron syrup (27.5mg/5ml)

R/ ferose syrup (50mg/5ml)

R/ ferose tab (100mg/tab)

R/ haemoton haemacaps cap ( 350mg/cap)

b) vit D & Ca:

R/ decal B12 pedical hical calcical syrup (400 IU vit D + 50 mg Ca)

R/ devarol amp ( for shock therapy of rickets 3 (

--prophylactic dose : 5

--therapeutic dose in rickets : 20-30 (5-10 3 )

c) multivit. :

R/ bebe-vit drops

R/ fruital syrup 5

R/ chewa vit tab

R/ supravit tabR/ vitamount males/females/pregnant/stress cap

11) topical drugs :a) soothing agents :

**for napkin dermatitis:

R/ zinc oxide 10% oint

R/ babay cream

**for pruritis and rashes:

R/ calamine lotion

R/ bringo lotion

b) antimicrobials :

--fuscidic acid is best antistaph : R/ fusiderm oint

--gentamycin is commonest used : R/ garamycin cream/oint

--terramycin is not used before 8 yrs : R/ terramycin topical oint

c) antifungals :

R/ daktarin miconaz candistan topical creams

d) antiparasitics : ( anti scabies )scabies ttt : hot bath + brushing body with soft brush then put lotion allover the body except head and neck , then put lotion in 2nd day without bathing , then put it again in 3rd day without bathing, then in the 4th day morning hot bath and soft brush.

R/ benzanil 25% lotion

R/ scabine 1% lotion

R/ prioderm 0.5% lotion

12) topical steroids :indications : severe allergic & inflammatory conditions e.g. severe napkin dermatitis, severe itching, infantile eczema.

Contraindic : viral infection e.g. chicken pox, herpes simplex, & TB or syphilis

**creams are used for acute wet lesions, oint. For chronic dry lesions

**use steroids as short as possible

R/ hydrocortisone cream ( weak but safe )

R/ kenacort betaderm ( strong but SE )

Combinations : steroids + antimicrobial +/- antifungal

R/ polyderm triderm mixderm for monilial inf, severe napkin dermatitis

R/ kenacomb

R/ fusicort

13) ear preparations :

R/ otocalm ( for ear pain ) used in otitis media or externa

R/ otosept ( antiseptic ) for externa

R/ otophenicol cipro ED ( AB for inf )

R/ remowax ( wax softner )

14) eye prep :

R/ ocuphenicol cipro tabrin ED ( AB ) for inf e.g. conjunctivitis

R/ boric acid lotion 2%

R/ terramycin garamycin eye oint. R/ tobradex ED ( tobrin + dexamethasone ) for allergic conjunctivitis

R/ prisoline ED ( decongestant + antihistaminic ) for allergy or allergic conjunctivitis