ped. drugs

Short notes on ped. Drugs .

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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 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 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/ ibidroxil—biodroxil 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

1000-800

18 600-500

12

 The 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 ½ 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 )

R/ R/ R/ R/ R/

4) Antiprotozoal : for amoeba and giardia ( 50 mg/kg/d) devided in 3 doses flagyl 125/200 susp 10 3 flagyl 250/500 tab 1*3*10 fladazole 500 tab ( single oral dose ) 4 5) Antihelminths : bendax 100 susp 5 3 10 3 bendax 200 tab 10 3

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 : 5-3

3

10

Not given > 5 ds as it will cause dryness and inf of the nose R/ otrivin – balkis ND R/ otrivin baby ND (it’s just saline for nasal washing i.e. not decongestant) -- oral : not used if with bronchitis as it ↑ dryness of bronchi and cough R/ 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 daily R/ 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 amp d) 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 ½ R/ foradil diskus ( formeterol : long acting β2 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 ½ 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 centers Used 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 3-2 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 eff  R/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 3 10-5) ) c) multivit. : R/ bebe-vit drops R/ fruital syrup 5 R/ chewa vit tab R/ supravit tab R/ 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 2 nd day without bathing , then put it again in 3 rd day without bathing, then in the 4 th 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

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