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1. symptoms
1. crampy abdominal pain
2. inflammatory diarrhea
3. weight loss
4. bloating
5. malodor diarrhea
6. anorexia
2. Dx
1. 3 times S/E
2. Giardia Cyst or Antigen
3. Treatment
1. Susp furazolidone 6mg/kg/day (2/2cc) qid (susp 50mg/5ml, tab 100 mg)
1. or tab metronidazole 15mg/kg/day tds (syrup 125mg/5ml, tab 250 mg)
2. or Tab tinidazole 500 mg #5 SD (50mg/kg, max dose 2gr)
3. or Tab mebendazole 200mg #15 tds
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1. Vesicular with discharge
1. Dx: Genital Herpes
2. Treatment
1. Tab acyclovir 400mg #30 tds
2. Singular, painless without discharge
1. Dx: syphilis
2. Tx:
1. Amp Penicillin G Benzathine 1,200,000 IU/vial (Penador) #2 IM
3. Genital warts:
1. Vaccination:
1. Prefilled syringe Gardasil 0-1-6 m
4. Chancroids:
1. Singular, 1-2cm in diameter, painful and erythematous stalk
2. Tx:
1. Tab erythromycin 400mg qid for 7 days
1. or Amp Ceftriaxone 250mg SD
2. or Tab azithromycin 1gr SD
5. Inguinal granuloma
1. Tx:
1. Tab TMP-SMX 800-160 bid for 20 days
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1. Start treatment in first 24 hours
2. treatment
1. tab acyclovir 400mg #15 tds for 5 days
2. oint acyclovir #1 topical use
3. if relapsing
1. Tab acyclovir 400mg bid for 6 months
4. if pregnancy
1. Tab acyclovir 400mg bid for 6 months
5. for infancy or severe cases
1. Vial acyclovir 8mg/kg/dose q8h IV
2. refer theses patients
1. Treatment for 2 month
1. oint mupirocin 2% bid
1. oint zinc oxide 20% tds
2. Cap cefalexin 500 mg qid for 5-7 days
3. Serum N/S for irrigation
2. there is no need for treating pseudofolliculitis
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1. Who to admit?
1. all <28 days/old
1. admit for IV Ab therapy
2. sepsis w/u
2. 1-3 m/o
1. if have good condition, NL lab data ⇒ no need for Ab therapy
2. if ill or abnormal lab data ⇒ admit for IV ab therapy
3. 3-36 m/o
1. if <38 C fever ⇒ acetaminophen + daily F/U
2. if >38 C fever ⇒ acetaminophen + daily F/U + Ab therapy + check
1. ESR, CRP
2. U/A, U/C
3. B/C
4. CBC, diff
3. Ab therapy
1. Cefixime 8mg/kg
1. or Co-amoxiclav 80mg/kg/day
4. sepsis w/u if lab data was abnormal
2. Acetaminophen in pediatrics: 10mg/kg
1. Tab 325, 500 mg in older>6y/o
2. susp 120mg/5ml 1/2*w cc
3. susp 125, 325 mg q6h
4. Drop 100mg/ml 2*w drop
5. Soft gel cap 325, 500 mg in older >6y/o
3. Ibuprofen 5-10mg/kg/dose tds
1. tab 200, 400 mg
2. susp 100mg/5ml
3. in Musculoskeletal disease is useful due to anti-inflammatory effect
4. no use in infancy
4. FUO
1. OPD: >3 weeks
2. Inpatient: > 1 week
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1. Typical case:
1. a child with ear’s pain
2. a swimmer with ear’s pain
2. Approach
1. at first check tympanic membrane
1. intact: Dx ⇒ External Otitis
2. perforated: refer the pt to the specialist
2. if the canal is full of debris, try to clean it at first to take a look at the membrane
3. Treatment
1. pH lowering agents:
1. Otic drop Boric acid 2% 5drop qid
2. or Otic drop acetic acid 2% 5drop qid
2. Pain killer
1. Susp ibuprofen 100mg/5cc, 5mg/kg or 1-2cc/kg/d qid
2. Susp acetaminophen 120mg/5cc weight/2 cc qid
3. Tab acetaminophen 500 mg qid
3. Anti biotics
1. Otic drop ciprofloxacin 3% 4 drops qid
2. or Otic drop ofloxacin 3% 4drops qid
3. or Cap ciprofloxacin 500 mg bid #10
1. for DM pt, immunodeficient pt or severe disease
4. Steroids
1. otic drop dexamethasone 0.1% 4drops tds
2. or Otic drop betamethasone 0.1% 4drops tds
5. Steroids and Ciprofloxacin can be prescribed even in perforated membrane
1. Otic drop Polymyxin-NH 4drops tds (neomycin, hydrocortisone, polymyxin B)
1. do not use in perforated membrane
2. Otic drop ciprosonate 4drops tds
6. Anti fungal
1. prescribe in refractory cases, immunodeficiency, DM
2. Solution clotrimazole 1% bid
3. or Cream ketoconazole 1% bid
4. A common prescription:
1. Otic drop Boric acid 2% 5drops qid
2. Susp acetaminophen 120mg/5cc w/2 qid
3. Otic drop ciprofloxacin 3% 4drops qid
4. Otic drop dexamethasone 0.1% 4drops tds
1. Symptoms:
1. in 6-12 y/o
2. very acute and dangerous course
3. high grade fever
4. sore throat
5. dyspnea
6. dysphagia
7. drooling
8. less common: croup like baring cough
9. usually no prior URI symptoms
2. Orders:
1. Neck x-ray AP and Lateral (for thumb sign)
2. Intubation and proper airway as needed
3. Amp ceftriaxone 50-75 mg/kg/day bid for 7 days
1. or amp cefotaxime 100-200mg/kg/day q6h
2. or amp meropenem 60 mm/kg/day q8h
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1. Treatment
1. Vial ceftriaxone 250mg #1 IM
2. Tab acetaminophen 500mg #20 qid
3. Tab doxycycline 100mg #30 bid
4. R/O torsion if highly suspicious with CDSono
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1. IV therapy
1. for adults:
1. Serum 1/3 2/3 1-2 lit IV infusion
2. for Children
1. start with N/S 20cc/kg in 20 minutes repeat if needed *3
2. Dehydration: w*(5-10-15)*10cc
3. Maintenance (100-50-20cc/kg)
4. if febrile >38C ⇒ 120cc/1 C
5. Type of serum: HS + DW5%
1. Serum DW5% ? cc + 30meq kcl + 112meq NaCl ⇒ 1/2 in 8 hours and 1/2 in 16 hours
6. for each time defecation ⇒ 10cc/kg cc from HS + DW5%
7. for each time vomiting ⇒ 4cc/kg cc from serum N/S 1 lit + 10meq/lit kcl
2. N/V
1. Amp ondansetron 4mg IV (0.15mg/kg)
1. or Amp plasil 10mg IV (0.1-0.2 mg/kg)
3. Abdominal pain
1. Amp hyoscine #1 IM
1. or Amp dicyclomine #1 IM
2. or Tab dicyclomine 10 mg qid #20
3. or Elixir dicyclomine 10mg qid #1
4. Inflammatory diarrhea ⇒ use Ab therapy
1. >48 hrs
2. bloody
3. >40 C fever
4. >50 y/o and severe abdominal pain
5. tropical passenger
6. >70 y/o
7. immunodeficient
8. severe watery diarrhea (vibrio)
9. chef or hospital staff
5. Ab therapy
1. Tab ciprofloxacin 500 mg #6 po bid
2. for pregnancy and <18 y/o
1. Tab azithromycin 500 mg #3 qd
3. or
1. Amp ceftriaxone 1 gr IV stat
2. Amp Apotel 1gr IV stat
4. for Giardia, Amebic
1. Tab metronidazole 250 mg #20 tds
5. if Hx of Ab therapy or suspicious of C. diff
1. Tab metronidazole 500 mg tds #30
1. or Vial vancomycin 1gr #10 PO
2. Cap familact #60 BID
6. Non-inflammatory diarrhea
1. Tab loperamide 2mg po #8, 2tab stat, 1tab/defecation, max 8 tabs
1. or Tab diphenoxylate and atropine #8 q6h for 2 days
7. Pro-biotics in 2 hours post Ab therapy
1. Cap familact #60 bid for adults
2. Drop Pedilact 5 drops bid (1m/o-2y/o)
3. Sachet Kidilact BID (mixed with food)
8. PO hydration
1. Mild:
1. Powder ORS 50cc/kg in 4 hours
2. Moderate to severe
1. Powder ORS 75cc/kg in 4 hours
3. Handmade ORS: 4 tea spoon of sugar + 1/2 tea spoon of salt in 1 lit H2O
9. Fever + N/V + Inflammatory diarrhea
1. Amp ondansetron 0.15mg/kg
2. syrup acetaminophen 10-15mg/kg qid
1. or amp acetaminophen 150 mg IV stat
3. Syrup zinc sulfate 5mg/5ml 0.5mg/kg bid
4. syrup azithromycin 120mg po start then 60 mg po qd for 4 days
10. Check
1. S/E, S/C
2. U/A, U/C
3. CBC, diff
4. B/C
5. NA, K, BUN, Cr
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1. Treatment
1. oint zinc oxide 2% #1 PRN
1. or Powder sucralfate #1 PRN
2. Oint hydrocortisone 1% bid #1
3. For bacterial infection:
1. Oint mupirocin 2% bid #1
4. For candida infection with satellite lesions
1. cream clotrimazole 1% bid #1
1. or oint nystatin bid #1
2. or cream ketoconazole 2% bid #1
2. do not use steroids with anti fungal
3. if after 3 days of treatment with anti biotics, the pt is still symptomatic with new satellite lesions, treat candida
4. DDx: millia
1. keratin pearl
2. no need for treatment