Treatment Guideline

BEST GENERAL PRACTICE

Drugs in common use

Placeboes

B.co 1 tab dailyVitamin C 1 tab tds (1tab = 100mg)FeSO4 1 tab bd (1tab = 200mg)Ca lactate 1 tab daily (1tab = 300mg)Folic acid 1 tab daily (1tab = 5mg)

Multivitamin syrup

Biolysine 120 ml adult : 2 tsp/day, child : 1 tsp/dayEnervon – C plus 120 ml child 1-12 y : 1 tsp/dayMultiplexDelices (syrup/drop)Polybion 250 ml adult : 2 tsp/day, child : 1 tsp/bd B CoNutrifil 200 ml 3 tsp x bd before mealPlyvisol 100 ml 1 tsp/dayBecadex 200 ml 2 tsp/dayCrovit 100 ml 1 tsp/dayCytacon (Cyanocobalamin) adult : 2 tsp x bd, child : 1 tsp x bd vit B 12

Multivitamin syrup with iron

Ferosovite 200 ml adult : 2 tsp x tds iron/B Co CI0 in childrenFerradol adult : 2 tsp x tds child : 1 tsp x tdsCysatone 300 ml 2 tsp x bdHaem up liquid/gems 2 tsp/1 gem x bd

Multivitamin tablets

Biofer once a dayOptilets – M once a dayZeest once a day Vit : A, C, E, zincMatrifort once a day Vit : A, D3, CGuardian once a dayEvion once a day Vit. E 200mg, 400mg, 600mg

Multivitamin capsules

Vita plus 1 cap/dayEnervon – C 1 cap/day Vit.C + B.CoVit – EC 1 cap/day Vit.E 200 mg + vit.c 150 mgCovit-M

Product of Faculty of Medicine, Colombo. 1

Syrups

Amoxicillin 125mg/5ml 1 cap = 250mgUp to 10 years - 125mg/8H

Augmentin infant drops 62.5mg/ml x 20ml ( powder for suspension )Usual dose - 25mg/kg/day devided 8 HIf severe - 50mg/kg/day devided 8 H

Augmentin syrup 156mg/5ml, 228mg/ml x 70ml, 100mlBrufen 100mg/5ml 1 tab = 200mg, 400mg

1 – 2 y - 50mg tds3 – 7 y - 100mg tds8 – 12 y - 200mg tds

Cephalexin 125mg/5ml, 250mg/5ml 1 cap = 250mg, 500mgUnder 1 year - 125mg/12H1 – 5 y - 125mg/8H6 – 12 y - 250mg/8H

Cloxacillin 125mg/5ml 1 cap = 250mgUnder 2 y - 125mg/6H2 – 6 y - 250mg/6H

Erythromycin 125mg/5ml 1 tab = 250mgUpto 2 y - 125mg/6H2 – 8 y - 250mg/6H

Nalidixic acid 300mg/5mlOver 3/12 : max. dose 50mg/kg daily in 4 devided doses

PCM 120mg/5ml 1 tab = 500mgUnder 2 months - 60mg for post imm: pyrexiaUnder 3 months - 10mg/kg3/12 to 1 y - 60-120mg1 – 5 y - 120–250mg6 – 12 y - 250–500mg

Penicillin 125mg/5ml ( Phenoxymethylpenicillin)1 tab = 250mg

Upto 1 year - 62.5mg/6H1 – 5 y - 125mg/6H6 – 12 y - 250mg/6H

Phenergan 5mg/5ml 1 tab = 10mgLess than 2 y - Not recommended2 – 5 y - 5mg/bd5 – 10 y - 10mg/bd

Piriton 2mg/5ml 1 tab = 4mgUnder 1 y - not recommended1 – 2 y - 1mg/bd2 – 5 y - 1mg/6H6 – 12 y - 2mg/6H

Salbutamol 2mg/5ml ( Asthalin ) 1 tab = 2mg, 4mg2mg/10ml Ascoril

Less than 2 y - 100 mic.g/kg x tds2 – 6 y - 1 mg/tds6 – 12 y - 2 mg/tds


May be repeated every 6 H

General problems

Appetite stimulants

Peritol Can be given to infants, children and adults tds x 7 dayssyrup x 150 ml 103 /=tablet 1.90

Antiematic, Vertigo

Domperon Domperidone 10 mg tablets, syrup = 1 mg / ml x 30 mlAdult 1-2 tab 6 HChild 0.3 mg / kg 6 HLess risk of dystonic reactions

Motilium Domperidone supp = 30mgAdult 1 supp 8 H>2y 1/2 supp bd

Mosart Mosapride citrate tab = 2.5 mg, 5 mg5 mg tds before/after meals

Phenergan Promethazine 10 mg, 25 mg tabletsAdult - 25 mg bd5 – 10 y - 10 mg bd2 – 5 y - 5 mg bdLess than 2 y - Not recommended

Maxolon Metoclopramide tablets 5 mg / 10 mg, syrup 5 mg / 5 ml, Paediatric liquid 1 mg / ml

Adult 10 mg tdsYoung adults 5 mg tds9 – 14 y (over 30 kg) 5 mg tds5 – 9 y (20 – 29 kg) 2.5 mg tds3 – 5 y (15 – 19 kg) 2 mg tds1 – 3 y (10 – 14 kg) 1 mg tdsUpto 1 y (upto 10 kg) 1 mg bdDystonic reactions particularly in children, females, elderly & debilitatedNever use with Stemetil

Dexamethasone also has an anti-emetic effect

Vestibular vertigo, Meniere’s syndrome ( dizziness, tinnitus, nausea, headache )

Betaserc Betahistine diHCL tab = 8 mg, 16 mg8 – 16 mg tds

Stemetil (Prochlorperazine) tab = 5 mg, syrup = 5 mg / 5 ml, supp. = 5 mgAdult 10 mg tdsChild over 10 kg 250 mic.g / kg tdsSupp. not recommended in childrenDystonic reactions particularly in children, elderly & debilitatedNever use with Maxolon

Avomine Promethazine teoclate tab = 25mgAdult 1tab tds5-10y 1/2 tab tdsMotion sickness 1 tab @ bedtime & 1 tab 2 hrs before the travel


Cinnarizine 15 mg tablets Vestibular disorders ( vertigo, tinnitus, nausea, vomiting )

Adult 30 mg tdsChild 5 – 12 y 15 mg tds

Motion sicknessAdult 30 mg 2 hrs before travel, 15 mg every 8 HChild 5 – 12 y 15 mg 2 hrs before travel, 7.5 mg every 8 H

Vomiting in pregnancyPromethazineProchlorperazineMetoclopramideIV fluid, Electrolyte correction, Nutritional supportIf doesn’t settled in 48 hrs, specialist opinion

Symptomatic treatment of allergy

ClopheniraminePiriton 4 mg daily

CetirizineAllercet, Cetrizet, Adezio 10 mg tabletsTriz 10 mg tablets, syrup 5mg/5ml

Adult 10 mg bdChild over 6 y 5 mg bdChild 2 – 6 y 2.5 mg bd

Cetirizine dihydrochlorideEKON-D.T. 10mg daily

Fexofenadine HCLAllegra tab = 30 mg, 120 mg, 180 mgAllerstat, Altiva, Allefast tab = 120 mg, 180 mg

Adult & child >= 12 y 60 mg bd / 120 mg once a dayChild 6 – 11 y 30 mg bd

LoratadineZeos, Lorax, Clarityne, klarol tab = 10 mg, syrup = 5 mg / 5 ml x 60 mlLoridin rapitab tab = 10 mg

Adult & child >= 12 y 10 mg dailyChild 6 – 12 y > 30 kg 10 mg daily

< 30 kg 5 mg dailyAstemizole

Stemiz once daily tab = 10mg, susp. = 5mg/5mlPromethazine hydrochloride

Phenergan tab = 10mg, 25mgAdult 20mg tds5-10 y 10mg bd2-5 y 5mg bd< 2 y not recommended

injection = 25mg/mldeep IM adult 25-50mg

5-10 y 6.25-12.5mgSlow IV 25-50mg as a solution containing 2.5mg/ml in water for inj.

Pheniramine maleateProduct of Faculty of Medicine, Colombo. 4

Avil 25mg tablets>12y 1 tab tds

Prednisolone 5 mg tabletsAdult 2 tab bd 2 days

1 tab bd 2 days½ tab bd 3 days

Dexamethazone 0.5 mg tablets2 tab tds

PCM 2 tab tdsAstifen ketotifen hydrogen fumarate

Tab = 1 mg, syrup = 1 mg / 5 ml x 60 mlAdult 2 tab bdChild >3y 1 tab bdI0 – prevention & treatment of multisystem allergies, allergic skin reactions, allergic

rhinitis. not effective in aborting established attack of asthmaAsmafen tab = 1 mg, syrup = 1 mg / 5 ml x 60 ml

Adult 2 tab bdChild > 3 y 1 tab bdI0 – prevention & treatment of multisystem allergies, allergic skin reactions, allergic

rhinitis. not effective in aborting established attack of asthma

Dental painMeftal (Mefenamic acid) cap=250mg, tab=500mg

Adult 500mg x tdsChild 25mg/kg/day in devided doses

Migrain

Acute attack

If on OCP stop themPCM 2 tab 6H orAspirin 3 tab 6H after food (1 tab = 300mg )Diclofenac Potassium

50mg stat, repeated after 2 H & 6 H ( max. 200mg/day )Cafergot (Ergotamine tartrate = 1mg, caffeine = 100mg)

1–2 tab stat (don’t repeat in less than 4 days)Max : 4 tabs/24H, 8 tabs/week1 supp. (Ergotamine tartrate = 2mg, caffeine = 100mg)1 supp stat (don’t repeat in less than 4 days)Max : 2 supp/24H, 4 supp/weekChild not recommended

Imigran (Sumatriptan succinate; tab = 50mg)50–100mg single doseIf responded, another dose in 24H ( don’t exceed 300mg/24H)If not reponded don’t repeat in same attack

DomperonAdult 1-2 tab 6HChild 0.3 mg/kg 6H

Phenergan 25mg stat + bd


Prophylaxis

Flunarin (Flunarizine HCL) tab = 5mg, 10mgGiven as a single dose in evening b’cos of sedationAdult 10mg/dayChild 5mg/day

Propranolol(Inderal)40mg bd 2 weeks

Amitriptyline ( tab = 10 mg )10mg nocte, maintnence of 50–75mg nocte 2 weeks


Musculoskeletal System

Backache

Brufen Ibuprofen (1 tab = 200mg, 400mg, 600mg)400mg 6H/tds (after food) max. dose 1.2 – 1.8 g/day

Diclofenac Sodium Tab = 25mg, 50mg ; Supp = 12.5mg, 25mg, 50mg, 100mgVoltaren SR tab = 75mg, 100mg

25mg tdsMax. dose by any route 150mg/dayChild 1–12 y : 1–3 mg/kg daily in devided dosesVoltaren SR tab = 75mg, 100mg once a day

Diclofenac Potassium Tab = 25mg, 50mg25mg tds (Max. dose 150mg/day)

Celebid Celecoxib – selective COX – 2 inhibitor (1 cap = 100mg, 200mg)100mg daily/bd

Esoz 20mg bdOmeprazole 20mg ODFamotidine 20mg bdDigene 2 tab tdsDigene syrup 1 tsp tdsDiazepam 10mg(2tab) nocte

Musculoskeletal pain

Female – not very significantMale – examine completely (ca prostate, renal, thyroid)

BrufenTramadol (Morphine salt) cap = 50mg

50-100mg 6H (not more than 400mg/day)Combine with anti emetic

Diazepam 1 tab nocte

AlternativelyIndometacin cap = 25mg, 50mg

50mg x tdsVoltaren 1tab tdsCelecoxibNaproxen tab = 250mg, 500mg (Under 16 years not recommended)

500mg initially, then 250mg x 8H Meloxicam tab = 7.5mg, 15mg

7.5mg/dayDon’t exceed 15mg/day. Should be taken as a single dose during a meal.

Piroxicam cap = 10mg, 20mginitially 20mg/day, maintenance 10mg/once a dayContraindication in children

NSAID contraindicated in, hypersensitivity, pregnancy, active peptic ulcerCaution in elderly, renal, hepatic, cardiac impairment


Rheumatoid arthritis

Indometacin 25mg (1 cap) tds after mealAludrox 2 tab tdsPrednisolone 10mg bd Vit C ,BCo 1 tab tds

Cervical spondylosis

Brufen 1 tab tdsAludrox 2 tab tdsMethylsalicylate BalmVit C ,BCo 1 tab tds

Good joint function

Joint care forte1 tab x tds with mealsTemp. relief of osteoarthritis, increase joint mobility

Cartisafe-forte1tab x bd

RejucalciumCartifix capsules


Cardio Vascular System

MI

GTN 1 tab sos (0.5 mg)Aspirin ½ tab nocteISDN 1 tab tds for 3 daysPCM 2 tabs tds for 3 days

Hypertension > 140/90 mmHgHCT 12.5-25mg maneFrusemide 20-40mg mane


Endocrine

DiabetesIx- FBS 12 h fasting. Can drink water. Normal < 110-125 mg/dl < DM

PPBS 2 h after lunch. Normal < 140-200 mg/dl < DMHbA1c control over previous 3/12 5.6 % - 6.4 %


Respiratory System

Common cold

PCM 2 tab tdsPiriton 1 tab nocteVitamin C 50mg tds tab = 50mg, 100mg, 200mg, 500mg

If the patient pass yellow sputumAmoxicillin 500mg tdsCephalexin capsule = 250 mg, 500 mg

Blucef tabs (cephalexin sugar flavoured = 125mg, 250mg)Adult + children > 12 y 500 mg tds

Erithromycin 250mg 8H

Fever with cough

Panadeine (PCM : 500mg, codeine phosphate : 8mg)Adult 2 tab 6HChild ½ - 1 tab 6H

Not for >3 consecutive days

Cough – Productive

TusQ – XAdult 2 tsp tds6 – 12 y 1 – 2 tsp tds1 – 6 y ½ - 1 tsp tds

Karesal (Bromhexine HCL:mucolytic, Salbutamol:bronchodilator)Piriton expectorant 1 tea spoon – tds

Cough – Dry

TusQ – DAdult 2 tsp tds6 – 12 y 1 – 2 tsp tds1 – 6 y ½ - 1 tsp tds

Corex D 1 tea spoon – tdsRest, boiled water, steam inhalation add menthol crystals

Sinusitis ( frontal headache, facial pain & tenderness, nasal discharge )

AcuteDoxycycline 50mg bd cap = 50mg, 100mgCefaclor 375mg bd tab = 125mg, 250mg 10-14 daysCo – amoxiclav 625mg bdLoratadine 1tab manePCM 2 tab tdsNasal decongestantSteam inhalation with menthol crystals


If severeDoxycycline 100mg bdPrednisolone

ChronicChange from previous antibioticCo – amoxiclav 625mg bd 4/52Cefuroxime 250mg bd 4/52

Tonsillitis

Penicillin V Phenoxymethyl penicillin tab = 250mgChild 250mg tds 10 daysAdult 500mg tds 10 days

Amoxycillin 500mg tds 10 daysErythromycin 500mg 6H 10 daysPCM 2 tab tdsPiriton 1 tab nocte or bdPrednisoloneSalt water to wash the mouth

Nasal congestion

Adult Decon nasal dropsChild Nasavion paediatric nasal drops

Decon paediatric nasal dropsChronic runny nose, nasal congestion, sneezing

Beclate aquanase (238/=)> 6 y 1 spray each nostril x bd


Lower respiratory tract conditions

Pneumonia

Amoxicillin 500mg tdsOr ciprofloxacin 500mg bdPCM 2tabs tdsPiriton 4mg bdVit C ,BCo 1 tab tds

- 7days - Refer or

Cloxacillin 250mg 6hSalbutamol 4mg nocte

CoughAmoxicillin 250mg tdsSalbutamol 4mg nocteIf allergy – Piriton

TPEDEC (Hetrazan) 100mg (2tab) tds /21days(6mg/kg body weight)Prednisolone 10mg tds /2daysPiriton 1tab nocteVit C ,BCo 1 tab tdsCoreX Syrup

Loffler’s syndrome

Mebendazole 100mg (1tab)bd /3daysPiriton 2mg (1/2 tab)bdVit C ,BCo 1 tab tds

Chronic primary persistence cough

Codeine syrup 1 teaspoon tdsHetrazan 2tab bd /2weeksPrednisolone 5mg bd Pead- Dexamethazone 1tab tds/2days

Codeine ??? 1 teaspoon tds

Catarrh

Astemizole (Stemiz) 10mg nocte Piriton 4mg nocte /1monthPrednisolone 10mg mane /3 weeksEphedrine nasal dropsSalbutamol 2mg nocte



Asthma

Salbutamol 4mg tds 4daysTheophylline

Adult 125 mg tdsChild 125 mg/2 tdsDeriphyllin Etofylline+Theophylline tab=150mg, 300mg

PCM 2tab SOSPrednisolone Piriton 1tab nocte 6days

In children – Salbutamol 2mg/5ml ( Asthalin ) 1 tab = 2mg, 4mg

2mg/10ml (Ascoril)Less than 2 y - 100 mic.g/kg x tds2 – 6 y - 1 mg/tds6 – 12 y - 2 mg/tds

Prednisolone Amitone ketotifen fumarate

Tab = 1 mg, syrup = 1 mg / 5 ml x 100 mlAdult & adolescents 1 mg bd> 3 y 1 mg bdInfants + upto 3 y 0.25 ml / kg bdWomen taking Amitone should not breast feedI0 – chronic Tx of mild atopic asthma, prophylactic agent to be used in continuous basis. Not effective in acute incidences.

Ketasma ketotifen fumarateTab = 1 mg

Adults I tab bd6/12-3 y ½ tab bdI0- prophylaxis of bronchial asthma, allergic skin conditions & multi system allergy.

NebulisationIpratropium Bromide 0.5 mlSalbutamol 0.5 ml for 10 – 15 minN/Saline 1 ml

Status asthmaticusNebulise with Salbutamol 1mg + Normal saline 2ml SOS / hourlyHydrocortisone 100mg IVPrednisolone 20mg statPCM 2 tabAmoxicillin 250mg tdsBCo 1 tab60% O2

WheezingSalbutamol 4 mg tds (2 tabs)Steam inhalation


Gastro Intestinal Tract

Apthous ulcer

1. Simple mouth washesI0 – to relieve the pain of traumatic ulceration- sodium chloride mouth wash- Thymol glycerin mouth wash

2. Antiseptic mouth washesI0 – IIry bacterial infection- Chlorhexidine gluconate mouth wash x bdS / E – mucosal irritation (discontinue if desquamation)Warn about reversible brown staining of the teethLeave an interval of at least 30 min with mouth wash & tooth paste. (may be incompatible with some ingredients of tooth paste)- Betadine mouth wash x 6HDon’t continue for more than 14 days, b’cos significant amount of I are absorbed)- Oralon gel (chlorhexidine gluconate)- Bonjela oral gel

3. CorticosteroidsI0 – oral ulceration, recurrent apthous ulcer, erosive lichenoid lesions.- Hydrocortisone lozenges x 6HAllowed to dissolve slowly in the mouth in contact with the ulcer

4. Local analgesics- Strepsils pain relief plusR – lozenges- Strepsils pain relief plus sprayR

Traumatic ulcersOrrepaste single/bd/tds

Biliary colicBuscopan ( Hyoscine Butylbromide 10 mg tab )

Adult 20 mg 6H6 – 12 y 10 mg tds

Pro – Banthine ( Propantheline Bromide 15 mg tab )Not recommended in childrenTds : 15 mg, 15 mg, 30 mg ( max. 120 mg daily )

Colospas ( Mebeverine HCL tab = 135 mg )1 tab tds preferably 20 min before mealNo anti-cholinergic S/E

Metrogyl ( Metronidazole 400 mg tablets, susp = 200mg/5ml )Adult 400 mg tdsChild 7.5 mg / kg tds

GastritisEsoz Esomeprazole tab=20mg, 40mg

Once daily x 4-8/52Domperidone 10mg tds Aludrox 2 tab tds ( 1 hour after meal)Actal Aluminium hydroxide tab = 360 mg

2 tab with little water x 6H, b/w meals & at bed timeFamotidine 20 mg bd


Omeprazole 20mg one before meal once daily- 3 weeks

Prednisolone 5mg manePrevent dietery habits, smoking , drugs, head raise in sleepingORPCM 2 tab tdsAludrox 2tab tdsDexamethazone 1 tab bdAcinil syrup 2 tsp tdsFamotidine 20 mg tdsOmeprazole 1 capsule daily maneDigene tablet/gel

Safe for use during pregnancyGaviscon liquid susp = 200ml

Adult + >12 y 10-20ml6-12 y 5-10mlAfter meals & at bed time

Upper abdomen – billiaryBuscopan 10 mg tds (1tab)Or Probanthine 15mg tds (1tab)Refer Children Probanthine ½ tab tds

Loss of appetitePeritol, Apetamin-P Cyproheptadine HCL tab = 4mg, syrup = 2mg/5ml x 150ml

2-6 y 1tsp x tds / ½tab x tds7-14 y 1-2tsp x tds / 1tab x tds 7 daysAdult 2tsp x 6H / 1tab x 6H

Peridectin? 4mg tdsVit C ,BCo 1 tab tdsTheragran 1 tab /dayCaminetine mint 1 tea spoon tdsCysatone syrup 2 tea spoon bd

Constipation

To maintain regularityLilac syrup (Lactulose) 110 /=

Starting dose (ml / day) Maintenance dose (ml / day)Adult 30 15 – 306 – 14 y 15 10 – 151 – 5 y 10 5 – 10Infants 5 2.5 – 5

Cremaffin liquid x 170 mlCan be used safely in pregnancy. Best taken at bed time (2 tsp) & if needed again in the morning.

Fibogel orange Ispaghula husk high fibre drink1 sachet in 150ml of cold waterAdults & >12 y 1 sachet in morning & evening


Dulcolax 2 tab nocteKlean enema 120/=

After administration keeping same posture(PR pos) for 3-5 min until desire to urge is strong Cold water ? bd – after nocte mealSenalcot 2-4 tab nocteVit C ,BCo 1 tab tds

In childrenDulcolax syrup, suppocitery, tabSmall children refer

HemorrhoidsPCM 2 tabs tdsPiriton 1 tab nocteDulcolax 10 mg nocteFybogel sachet with water orNormocol 1-2 sachetFeSO4 1 tab tds2% lignocaine gel

Glyvinol 1 bd

Worm treatment

<1 year Not needed (Warm tx given only after age of 1 year)1-2 years

Pyrantel pamoate ( Combantrin) tab = 125 mg, syrup = 50 mg / ml6/12 – 2 y 1 tab / ½ tsp2 – 9 y 2 tab / 1 tsp single dose9 – 13 y 3 tab / 1½ tsp

>2 yearsMebendazole 100 mg bd 3 days

Combine withPiriton 4mg bdIf < 2yrs Phenergan 1tsp bd

Diarrhea – blood and mucus, foul smelling, bulky, just after food

MetronidazoleFlagyl tab = 200 mg, susp = 200 mg / 5 ml

Upto 1 y 125 mg1 – 5 y 250 mg 8 H x 3 d, then 12 H5 – 10 y 500 mg> 10 y adult dose ( 400 mg x tds )

Furamide 500 mg 8 hourly(For amoebiasis 10 days)PCM 2 tabs tdsProbanthine 15 mg tdsVit C ,BCo 1 tab tds


FeSO4 1 tab

Diarrhea – wateryORSLamotil ( tab = 2.5 mg) 2 tab stat, 1 tab tds for 2 daysNalidixic acid 1 tab tdsCiprofloxacin

Adult 500 mg bd 3dChild 250 mg bd

Probanthine 15 mg tdsFurazolidone 1 tab tdsPhenergan 10 mg tdsPCM 2tab tdsVit BCo 1 tab tdsIf very severeLamotil 100 mg (2 tab) stat, 1 tab sosOrImorium (Loperamide) 2 tab stat

Diarrhea – blood and mucus, scanty stools, fever, tenesmus, increased frequencyErythromycin 250 mg 6 hourly orTetracycline 15 mg 6 hourlyProbanthine 15 mg tdsPCM 2 tab tdsPhenergan 10 mg tdsVit C ,BCo 1 tab tdsFurazolidone 1tab 6 hourly

Advice to take lot of fluids

ORCiprofloxacin 500 mg x bd x 7days

Typhoid fever

Ciprofloxacin 500mg x bd x 14days

Diarrhea – in childrenFurazolidone 1/2tab tdsNalidixic acid ½ tab tdsPhenergan ½ tab tdsPCM according to wtVit C ,BCo 1 tab tds

If severe, Normal saline, Nalidixic acid, lime juice, amoxicillin, Furazolidone

If vomiting Domperidone 10mg stat (it is the best drug for vomiting those who have diarrhoea)Then 10mg tds

Persisting vomitingPhenergan 10 mg IM stat, 1 tab/syrup tds


PCM 2 tab tds

If H. pylori suspectAmoxycillin 500mg tdsMetronidazole 400mg tdsOmeprazole 20mg bd

- 1week

Abdominal painBuscopan 2 tab tds

ORPCM 2 tab tdsPiritonDiazepam 1 tabProbanthine 15 mg tdsChildren, Buscopan ¼ tab tds

Vomiting (drug induce)Metoclopramide 10mg tdsIf history of vertigo - Stemetil 5mg tds

Or any antihistamineCinnarizinePhenergan

History of motion sicknessPromethazine 25mg nocteDay before journey and 1 h before if necessary Domperidone 30mg suppositoryPromethazine 25mg IMMetoclopramide 10mg IMWith additional distressMotilium 1tab tds

In pregnancyPhenergan 10mg tdsIf not settle referPrevent - Phenergan IM -25mg

Maxolon 10mg IM

Abdominal colicsBuscopan 2 tab tds( 1tab in children)Or Probanthine 15mg tds ( 1h before meal)Carminate mint 1 tea spoon tdsPhenergan 10mg bd

High protein energy need during recovery from illness/surgery“Resource high protein preparation” with milk


Genito Urinary Tract

Ureteric colicBuscopan 25mg IMVoltaren 75mg IMVoltaren suppository 50mgRefer

UTI

Nitrofurantoin tab = 50 mg, 100 mgAcute uncomplicated infection

50 mg x 6H x 7 d ( with food )Severe chronic recurrent infection

100 mg x 6H x 7 d ( with food )Not given when less than 3/12

Paed dose over 3/12 3 mg/kg daily in 4 divided dosesSafer in pregnancy

BlucefCepodem Cefpodoxime proxetil tab = 100mg, 200mg

200mg x bd x 2/52Cefuroxime axetil

125mg-250mg x bd x 2/52Norbactin Norfloxacin tab = 100mg, 200mg, 400mg, 800mg

Acute UTI 400mg x bd x 7-10 daysRecurrent/chroni/relapsing 400mg x bd x 4/52

Cifran ciprofloxacin tab = 250mg, 500mgMild 250mg x bd x 7 daysSevere 500mg x bd x 14 days

Vit C 1 tab tds (for acidity)

In children5mg/kg per day in 3 divided doses

or nalidixic acid 1g???? 6 hourly for 7 daysChild 50 mg/kgOr Co-trimoxazole 2 tab bdChild – Amoxicillin syrup

HT/oedemaHCT 25 mg mane can increase up to 100 mgOr Atenolol 1 tab mane


Infectious diseases

Varicella – zoster / Herpes – zoster

Acyclovir tab = 200 mg, 400 mg, susp = 200 mg/5 ml, 400 mg/5 mlAdult 800 mg 5times/day 7 daysChild 20 mg/kg 6H 5 days>6 y 800 mg 6H 5 days2 – 5 y 400 mg 6H 5 days< 2 y 200 mg 6H 5 days

Malaria

Chloroquine 1 tab (150 mg) Day 1 4 tabDay 2 4 tabDay 3 2 tab after food

In children Day 1 10 mg/kgDay 2 10 mg/kgDay 3 5 mg/kg

Primaquine 15 mg/day for 14 days ( 1tab 7.5 mg)Children 250 microgram/kg per day for 14 days

Chemoprophylaxis Chloroquine over 12 years 300 mg6 to 12 years 225 mg

weeklydose 5mg/kg 1 to 5 years 150 mgstart 1 weeks prior 6 weeks to 1 year 75 mgand continue weekly in the area under 6 weeks 37.5 mgthen continue for 4 weeks after coming

Chikun gunyaChloroquine 250mg x daily


Dermatology

Gradual bleeching of hyperpigmented skinEldopaque (have sunblock)

Thin application to the affected area x bd. Do not rub in.Eldoquin (no sun block)

Apply same as above. Intended to night time use only.

Dry skinAloe and vitamin E cream (tube 50g)Cotaryl cream bd x after bath (tube 50g)

Skin & wound sepsisCloxacillin adult 500 mg x 6H

2 – 6 y 250 mg x 6H< 2 y 125 mg x 6H

Ciprofloxacin mild 500mg x bd x 7 daysSevere 750mg x bd x 14 days

EczemaSupricort cream ( Fluocinolone acetonide ) x 15g

All eczeema, psoriasis, seborrhoeic dermatitisSupricort-N cream x 15g

When above conditions are complicated by bacterial infectionPossible thinnest application. Acute-tds. Resolving-single application.Condis powder wash 1:3000 try for 2 daysCandid –B- Cream LA bdBetamethasone (potent topical steroid) cream apply 2–3 times/day affected area, with/without occlusion

Betnovate cream 5 g, 15 g - all eczemaBetnovate – N cream 5 g, 15 g - all eczema + 2ry bacterial infectionBetnovate – C cream 5 g, 15 g - all eczema + 2ry bacterial infection +/- fungal

If infectedErythromycin/ Cloxacillin/ Beclometasone creamInitiate Prednisolone courseResistant dermatoses

Clobetamil (clobetasol propionate)Clobetamil-G (clobetasol propionate+gentamycin)Do not continue more than 7 days.

Fungal infection

Antifungal & anti – inflammatory propertiesCloben cream 15 g ( clotrimazole & beclometasone dipropionate )Benezole cream (Beclomethasone dipropionate, Neomycin sulphate, Miconzole nitrate)

Candidiasis, dermatophytes (ring worm) of the skin, nail, hair, pityrasis Ketoconazole 200 mg mane for 14 daysClotrimazole (Candid) 15 mg 20 daysVitamine A and DCandid cream for 6/52 (wash the area well & dry thoroughly)Candid-B cream LA for fungal & eczematous features


For nail Candazole 1% bd for 2 weeks

Sweat rash Calamine lotionPrickly heat powderAnti-histamine – PiritonPrednisolone

Systemic antifungalGriseofulvin tab=125mg, 500mgAdult 250mg x bdChild 10mg/kg x daily

AcneEudyna creamErydermC-mycin gel normal skinC-mycin lotion oily skin5% benzoyl peroxide solution bd (Benoxyl 5)Retin A cream 0.5% 30g nocteTretinum cream 0.025%S ointment (s+ salicylic acid )Doxicycillin 1tab nocte / 6-8 weekPenoxal cream bd

Acne vulgarisAlbiotin Clindamycin phosphate solution 10mg/ml x 30ml

Thin film to the affected area x bd. Shake well before use.

ScabiesScaboma ( lotion & cream )

Single application of both lotion & cream after bath, from neck downwards and left it for 24 hours

Scabion cream / lotion ( Crotamiton / Sulphur )More than 5 years25% BB cream – avoid head -24htreat the whole house If infected Erythromycin or CloxacillinLess than 5yearsS ointment- 3% sulphur

Bacterial skin infectionsErithromycinSupirocin cream

Dandruff/Seborrhoeic dermatitisKeto plus shampoo (ketoconazole, Zinc pyrithione)

Twice a week for 4 weeks. Then once weekly.Triben-AD shampoo (ketoconazole, Zinc pyrithione)Zinoral shampoo (ketoconazole 2% w/v)Selsun shampoo (selenium sulphide 2.5%)

Twice a week for 2 weeks. Then weekly.Dansel lotion x 60ml


Anti lice Tx

Nukenz permethrin 0.25%

EmlaLocal anaesthetic cream. Applied under occlusive dressing. Peak anaesthetic effect after

minimum of 60 min.


Ear, Nose, Throat

EpistaxisSitting upContinuous pressure by thumb for 5 minMeasure BP

Foreign body in throatTongue depressor Put forceps after putting in to hot water

Tonsillitis

AcuteOtitis MediaAzithromycin 500mg/day x 3days

Otitis externa

Chloramphenicol, Genta, Ciprofloxacin or Cephalexin ear drops 2-3 drops x tdsPCM 2tab x tdsAmoxicillin 250mg x tdsDexamethazone + Neomycin (Dexuna) 2-3 drops tdsPhenergan 10 mg nocte (If vomiting or sleepless)Boric / Spirit ear drops to 2ry earBCo –vit C 1tab tdsBoric powder

Ear wax2% NaHCO3 ear drops tds /3daysRemove or waxsol for 2 daysWaxsol – fill the ear with waxsol with dropper provided on the next night apply waxsol as before RemovePCM 2tab tdsDiazepam 5mg noctePiriton 1 tab nocteVit C ,BCo 1 tab tdsAmoxycillin 250 mg tds

Eczema of pinnaBetamethasone cream / ointment tds(Betnovate)Piriton 4mg (1tab) nocte for 6 daysPCM 2tab tdsVit C ,BCo 1 tab tdsCloxacillin 250 mg /6hourly before mealGemson Violet 1% lotion


Ophthalmology

NO STEROIDSChloramphenicol eye drops 2 drops / 4hourly(Not in allergic conjunctivitis)OR Gentamicin eye drops 2 drops / 2hOp Chloramphenicol ointment before sleepPCM 2tab tdsVit C ,BCo 1 tab tdsFeSO4 1 tabBrufen 200 mg tdsSeparate towel, warm water, rest.

Allergic conjunctivitis

Patanol 1 drop bd 8H apartNa chromoglycate eye drops QdsOr Betamethasone eye drops Piriton Prednisolone Gentamicin

GlaucomaPilocarpine eye drops tdsTimolol eye drops bd(contraindicated in asthma, COPD, HT, bradicardia)Acetazolamide 250mg bd(side effect- Cardiac arrhythmias)

BlepharitisNizoral shampooNeomycin + Hydrocortisone drops/ ointment

Allergic conjunctivitisCromal (cromaline sodium) 1 drop 6 hourly for 2 monthsSpersallerg 1 drop tdsLoridil ½ nocteTears naturale (artificial tears)

Dry eyesMoisol eye drops


Gynaecology

ImpotenseCupid (Sildenafil citrate)

50 mg 1 hr before sexual act. Max. dose 100 mg

MenorrhegiaMefenamic acid (Ponstan) 500 mg x tds

To ensure menstruationNorethisterone 10mg tds /2days(primolat –N ) 5 mg tds /2days

5 mg tds /2days

Postponement of menstruationNorethisterone 5mg tdsStart 3 days before the expected date of menstruation; bleeding occurs 2-3 days after stopping of drug.

DysmenorrheaMefenamic acid (Ponston) 250-500 mg tdsPCM 2tab 6hOr Diclofenac Na 50mg tds

Bleeding per vaginumMefenamic acid 500 mg tds for 5 – 7 days at the beginning of the menses and continue 6 cyclesNorethisterone 1 tab tds for 10 days

Vaginal candidiasisCandid V vaginal cream for 2/52 (Clotrimazole)Candid V3 200mg vaginal tablets, daily x 3 daysNystatin 500,000 units 6 hourly, continue 2 days after lesions dissolve.Nystatin 100,000 IU/ml suspensionCandistatin 100,000U vaginal tablet

LeucorrheaMetronidazole 200 mg tds for 7 daysAmoxicillin 250 mg tds for 5 daysPiriton or Dexamethazone

Pelvic infllamatory diseaseAmoxycillin 500 mg tdsMetronidazole 400 mg tds

During pregnancy nutritional supplementPreglac milk

Episiotomy cut bleedingCloxacillin


21 days

Other

Medical Certificate

This is to certify that Mr / Mrs ……….. has been treated for ……….. and recommended leave of ……days from ……. to ………

Medical Claim

This is to certify that Mr / Mrs ……… has been treated for ……….. and charged Rs ……… for his treatments.


Documents

Treatment Guideline