Archive

Sinusitis

#

1. Symptoms

    1. Headache

    2. Feeling of پری

    3. thick mucosal discharge

    4. fever

    5. Hx of URI more than 10 days ago

    6. a period of resolving symptoms then worsening of them

2. Treatment

    1. Amp ceftriaxone 50mg/kg IV stat

    2. Susp amoxicillin 250mg/5ml w/2cc bid for 10 days #1

        1. or susp co-amoxiclav 457mg/5ml w/2 bid

    3. Syrup acetaminophen 120mg/5ml w/2cc qid

    4. Elixir diphenhydramine 12.5mg/5ml w/3cc qid #1

        1. syrup guaifenesin qid

3. Trade Name

    1. Susp Farmentin 643 w/3 #1 bid (co-amoxiclav)

    2. susp Faramox 400mg/5ml (200mg/5ml) (Amoxicillin)

4. As tab

    1. Tab co-amoxiclav 625mg tds for 2 weeks

    2. Tab amoxicillin 500mg tds for 2 weeks

5. in case of Penicillin hypersensitivity:

    1. Levofloxacin 20mg/kg/day

        1. or Tab clindamycin 300mg tds for 3 weeks (30mg/kg/day)

6. If no response to treatment, refer to ENT man

Pharyngitis

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1. symptoms

    1. 3-15 y/o

    2. sore throat

    3. exudate in oropharynx

2. Treatment

    1. Amp penicillin 6-3-3 #(1 for <27kg, 2 for >27kg) + **Penicillin Test**

        6: 600 unit P. Benzathine

        3: 300 unit P. procaine

        3: 300 unit P. G potassium

        1. or Amp penicillin benzathine 1,200,000 #(1 in >27kg and 1/2 in <27kg)

        2. or tab penicillin V 500 mg tds #30

        3. or susp Penicillin V 250mg/5ml tds #1 10 cc for >27kg and 5cc for <27 kg

        4. or Tab co-amoxiclav 625mg tds #28 (45mg/kg/day)

        5. or Syrup Farmentin 643 w/3 #1

    2. in case on hyper sensitivity

        1. Tab erythromycin 300 mg tds #30 for >5y/o

            1. or tab azithromycin 250 mg #6, 2 tab stat then 1 tab qd

        2. Syrup erythromycin 200mg for 3-5 y/o

            1. or syrup azithromycin 200mg/5ml #1

    3. Susp acetaminophen 120mg/5ml w/2 cc qid

    4. susp diphenhydramine 12.5mg/5ml #1 qid

    5. tab altadin #1 q4h میکدنی for adults only

    6. Drop NaCl 0.65% #1 q4h for nasal congestion

3. DDx: EBV

    1. pharyngitis + exudate

    2. myalgia + fever + malaise

    3. neck and submandibular lymphadenopathy

    4. leukocytosis + atypic lymphocyte + thrombocytopenia

    5. Tx: if thrombocytopenia + purpura ⇒ steroids

Pediculosis

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1. Pruritus, secondary infection in itching areas, ova on hair

2. Treatment

    1. clothes in closed bag for 2 weeks

    2. >2m/o

        1. Shampoo permethrin 1% after bath for 10 min on hair, repeat 7 days later, group B in pregnancy

        2. Lotion Malathion for 12-8 hours on dry hair then washed, repeat 1 week later

            1. or Cap co-trimoxazole 400/80mg bid for 3-5 days then repeat next week

    3. Body pediculosis

        1. Lotion Lindane (contra indicated in children and pregnancy)

            1. or Cream permethrin 5% on body for 8-12 hours then washed

    4. children and pregnancy

        1. Sulfur precipitate 5%

        2. vaseline 90 gr

Otitis media

#

1. more common in children

    if <6 m/o or 6 m/o-2 y/o with severe disease or >2 y/o with otorrhea and severe ⇒ immediately start treatment. otherwise, can wait for 2 days. if the pt did not got better, start treatment.

2. Treatment

    1. Anti biotics

        1. Syrup amoxicillin 250 mg/5cc bid #1 90mg/kg/day

        2. or syrup Farmenting (co-amoxiclav) 643 bid #1 weight/3 cc

        3. or Tab co-amoxiclav 625mg tds #30

        4. If penicillin hypersensitivity or no cure after 24-48 hours

            1. Amp ceftriaxone 1gr IM #3 qd for 3 days 50mg/kg

            2. or Syrup azithromycin 100mg #1 weight/2 stat then weight/4 for 4 days

    2. Irrigation

        1. Serum N/S 500 cc for irrigation #1

    3. Pain killer

        1. Susp acetaminophen 120 mg/5cc weight/2 cc qid #1

Measles, Rubella

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1. Measles (سرخک)

    1. symptoms

        1. 1-2 week of incubation period

        2. low grade fever

        3. photophobia

        4. cough

        5. koplik spots in buccal before rash

        6. maculopapular rash in head and neck and descending

    2. contagious from 1 week before rash up to 5 days after them

    3. Treatment

        1. Elixir diphenhydramine w/3 qid

        2. Syrup acetaminophen w/2 qid

2. Rubella (سرخجه)

    1. symptoms

        1. 2-3 week of incubation

        2. low grade fever

        3. sore throat

        4. lymphadenopathy in neck

        5. pink small regular maculopapular rash in face and descending

            1. in 24 hours seen in all part of body

            2. resolve in 3 days

    2. contagious from 1 week before till 1 week after rash

    3. if pregnant pt has contact: check Rubella AB IgG

    4. Treatment

        1. Elixir diphenhydramine w/3 qid

        2. Syrup acetaminophen w/2 qid