Doctor's OPD Guide
Drug & OPD Guide
Doctor on Duty Treatment Guide
INTRODUCTION
Utilizing the Doctor's OPD Guide will lead to improved patient satisfaction, better clinical outcomes, and a more organized and efficient outpatient department. This guide is an essential tool for any healthcare professional dedicated to providing high-quality outpatient care.
We hope that this guide serves as a valuable resource in your daily practice, helping you deliver exceptional care to your patients while maintaining a well-organized and efficient OPD
TABLE OF CONTENTS
GASTRIC ULCER (PEPTIC ULCER) MANAGEMENT*
DUODENAL ULCER (PEPTIC ULCER) MANAGEMENT*
GERD (GASTRO-ESOPHAGEAL REFLUX DISEASE) MANAGEMENT*
ORAL ULCER (APHTHOUS ULCER) MANAGEMENT*
ADULT CONSTIPATION MANAGEMENT*
IRRITABLE BOWEL SYNDROME (IBS) MANAGEMENT*
H. PYLORI INFECTION (HELICOBACTER PYLORI INFECTION) MANAGEMENT*
TYPHOID FEVER (ENTERIC FEVER) MANAGEMENT*
MALARIA FEVER (FALCIPARUM MALARIA) MANAGEMENT*
URINARY TRACT INFECTION (UTI) MANAGEMENT*
FEVER WITH BURNING MICTURITION MANAGEMENT*
Child and Adult with Ear Discharge/Infection Rx*
Fever with Dry Cough +/- Sore Throat Treatment
Fever with Productive Cough - Rx
Tonsillitis / Pharyngitis - Rx
Acute Sinusitis (Sinus Infection) - Rx
Asthmatic Patient with Severe Coughing - Rx
Chronic Hepatitis C Infection - Rx
Chronic Hepatitis B Viral Infection - Rx
GASTRIC ULCER (PEPTIC ULCER) MANAGEMENT*
- *Pain:* Epigastric, can radiate to the back.
- *Onset:* Immediately after eating.
- *Aggravated by:* Eating, lying down, or vomiting.
- *Appetite:* Patient may be afraid to eat.
*Investigations:*
- *H. pylori Stool Antigen*
- *Upper Gastrointestinal (UGI) Endoscopy*
*Treatment:*
1. *Omeprazole 40 mg (e.g., Risek, Losec):* Take one capsule daily, 30 minutes before food.
2. *Antacid Syrup (e.g., Hilgas, Gaviscon Advance):* 2 teaspoons twice daily or once daily, especially if signs of reflux or discomfort persist.
3. *Levosulpiride 25mg or 50mg (e.g., Levopraid, Scipride):* Take one tablet twice daily, 30 minutes before food.
If constipation occurs:
4. *Lactulose Syrup (e.g., Duphalac) or Sodium Picosulfate (e.g., Laxoberon)*
If nausea and vomiting persist:
5. *Domperidone 10mg (e.g., Motilium):* Available in tablet or syrup form
DUODENAL ULCER (PEPTIC ULCER) MANAGEMENT*
- *Pain:* Epigastric discomfort.
- *Onset:* 2-3 hours after eating and often at midnight.
*Treatment:*
1. *Omeprazole 40 mg (e.g., Risek, Zoltar):* Take one capsule daily, 30 minutes before food.
2. *Antacid Syrup (e.g., Hilgas, Gaviscon Advance):* 2 teaspoons twice daily or once daily if symptoms of reflux or discomfort persist.
3. *Levosulpiride 25mg or 50mg (e.g., Levopraid, Scipride):* Take one tablet twice daily, 30 minutes before food.
If constipation occurs:
4. *Lactulose Syrup (e.g., Duphalac) or Sodium Picosulfate (e.g., Laxoberon)*
If nausea and vomiting persist:
5. *Domperidone 10mg (e.g., Motilium):* Available in tablet or syrup form
GERD (GASTRO-ESOPHAGEAL REFLUX DISEASE) MANAGEMENT*
*Clinical Characteristics:*
- *Retrosternal Burning Pain (Heartburn):* Worsens while lying down (at night/after eating).
- *Pressure Sensation:* In the chest.
- *Belching, Regurgitation, Dysphagia.*
*Treatment Duration:* 5-6 weeks (Max 8 weeks).
*Investigations:*
1. *Upper Endoscopy:* UGD.
2. *24-hour Esophageal pH Monitoring.*
3. *Esophageal Manometry.*
*Treatment Plan:*
1. *Dexlansoprazole (e.g., Razodex 30mg or 60mg):* Take one capsule daily, 30 minutes before food.
2. *Levosulpiride 25mg or 50mg (e.g., Levopraid, Scipride):* Take one tablet twice daily, 30 minutes before food.
3. *Antacid Syrup (e.g., Hilgas, Gaviscon Advance):* 2 teaspoons at bedtime.
*Alternative Treatment for GERD:*
1. *Omeprazole 40 mg (e.g., Risek):* Take one capsule daily, 30 minutes before food.
2. *Itopride 50mg (e.g., Ganaton):* Take twice daily, 30 minutes before meals (useful in psychogenic dyspepsia).
3. *Escitalopram 5mg/10mg (e.g., Estar, Citanew):* Take one tablet after breakfast, once daily
ORAL ULCER (APHTHOUS ULCER) MANAGEMENT*
*Clinical Characteristics:*
- *Appearance:* A round sore or painful sores inside the mouth.
- *Swelling:* Swollen skin around the sores.
- *Difficulty:* Problems with chewing or tooth brushing due to tenderness.
- *Irritation:* Irritation of the sores by salty, spicy, or sour foods.
- *Appetite:* Loss of appetite.
- *Inability:* Difficulty eating or drinking.
- *Triggers:* Stress or anxiety.
*Treatment Note:* Aphthous ulcers typically heal within 10-14 days and leave no scar.
1. *Omeprazole 40 mg (e.g., Risek, Ruling):* Take one capsule daily, 30 minutes before meals.
3. *Folic Acid 5mg:* Take one tablet twice daily (BD).
*2nd Alternative Treatment:*
1. *Esomeprazole 40mg (e.g., Nexum, Esso):* Take one capsule daily, 30 minutes before food.
2. *Metronidazole 400mg (e.g., Flagyl, Metrozine):* Take one tablet three times daily (TDS).
3. *Folic Acid 5mg:* Take one tablet twice daily (BD).
4. *Vitamin-B Complex (e.g., Neurobion):* Take one tablet twice daily (BD).
5. *Triamcinolone Oral Emollient (e.g., Kenalog in Orabase):* Apply twice daily (BD).
ADULT CONSTIPATION MANAGEMENT*
*Clinical Characteristics:*
- *Inability to Defecate:* For days or weeks.
- *Abdomen:* Distended and tympanitic.
- *DRE (Digital Rectal Exam):* Hard, impacted stools distending the rectum.
- *Tenesmus:* A constant urge to defecate with little or no stool passage.
*Physical Examination:*
- *Abdominal X-ray:* To rule out bowel perforation.
*Findings:*
- *Dilated Bowel Loops.*
- *Fecal Shadows:* In the colon and rectum.
- *Air-Fluid Levels:* May be visible.
*Treatment Plan:*
1. *Identify and Treat Any Underlying Conditions.*
2. *Lifestyle Changes:* High-fiber diet, increased fluid intake, and regular exercise.
3. *If Severe:* Consider Kleen enema or soap enema.
*Medications:*
1. *Lactulose Syrup (e.g., Lilac, Duphalac):* 12-60 ml every 4-6 hours initially, then 30ml orally once daily (OD). Alternatively, *Laxoberon (Sodium Picosulphate)* can be used. If diabetic, consider *Laxoberon Tablets or Drops/Tab. Skiles*.
2. *Omeprazole 40 mg (e.g., Risek, Zoltar):* Take one capsule daily, 30 minutes before meals.
3. *Ispaghol Husk:* Take once daily at bedtime (HS).
*Management of Constipation in Children:*
2. *Spasler-P Syrup:* 1-2 teaspoons twice or three times daily (BD/TDS).
IRRITABLE BOWEL SYNDROME (IBS) MANAGEMENT*
*Clinical Characteristics:*
- *Altered Bowel Habits:* May include diarrhea and/or constipation.
*Physical Examination:* Normal.
*Diagnostic Criteria:* Rome IV criteria for IBS.
- *Regular Consultations:* Reassurance that the disease, although chronic, is benign.
- *Lifestyle Changes:* Dietary adjustments, plenty of fluids, high-fiber foods.
- Gas-producing foods (e.g., beans, onions, prunes).
- *Physical Activity and Stress Management.*
2. *Metronidazole 400mg (e.g., Flagyl, Klint):* Take as prescribed.
3. *Omeprazole 40 mg (e.g., Risek, Ruling):* Take one capsule daily, 30 minutes before food.
4. *Folic Acid 5mg:* Take one tablet daily (0+0+1).
5. *Librax:* Two times a day (1--+--1).
*2nd Alternative Treatment:*
1. *Mebeverine 200mg (e.g., Despas MR):* 1 tablet twice daily (1+0+1).
2. *Metronidazole 400mg (e.g., Flagyl, Klint):* Take as prescribed.
3. *Dexlansoprazole 30 mg (e.g., Razodex):* Take one capsule daily, 30 minutes before food.
4. *Escitalopram 5mg/10mg (e.g., Estar):* 1 tablet in the morning (1+0+0).
5. *If Diarrhea:* Use Loperamide. *If Constipation:* Use Ispaghol Husk and Lactulose Syrup (e.g., Duphalac, Lilac).
6. *If Not Responsive:* Add low-dose oral steroids, *Prednisolone 5mg (e.g., Deltacortril)* as needed
H. PYLORI INFECTION (HELICOBACTER PYLORI INFECTION) MANAGEMENT*
*Clinical Characteristics:*
- *Burning Pain:* In the abdomen.
- *Feeling Hungry:* Even with a normal diet.
*Treatment Duration:* 14 or 21 Days.
*Investigations:*
1. *H. Pylori Stool Antigen Test.*
2. *Urea Breath Test.*
3. *Upper Endoscopy (UGD).*
*Treatment Plan:*
1. *Clarithromycin 500mg (e.g., Klaricid, Claritek):* Take one tablet twice daily (1--+--1).
2. *Amoxicillin 1g (e.g., Amoxil, Zeemox):* Take one capsule twice daily (1--+--1).
3. *Omeprazole 40 mg (e.g., Risek, Omezol):* Take one capsule daily (OD), 30 minutes before food.
*Additional Medication for Depression:*
4. *Escitalopram 5mg/10mg (e.g. Citanew):* Take one tablet after breakfast (OD).
*FOR CHILDREN:*
1. *Clarithromycin Syrup 125mg/250mg (e.g., Klaricid, Claritek):* 2 teaspoons twice or three times daily (BD/TDS).
2. *Amoxicillin Syrup 125mg/250mg (e.g., Amoxil, Zeemox):* 2 teaspoons twice or three times daily (BD/TDS).
3. *Famotidine Syrup (e.g., Peptiban, Acicon):* 2 teaspoons twice daily (BD/TDS).
*H. Pylori Eradication Therapy:*
*Standard Triple Therapy (14 Days):* PPI + 2 antibiotics
- *Clarithromycin + Amoxicillin + Omeprazole/Esomeprazole*
*2nd Line Therapy (14 Days):* Levofloxacin-Based Triple Therapy
1. *Levofloxacin + Amoxicillin + Omeprazole/Esomeprazole*
*Bismuth-Based Quadruple Therapy (14 Days):*
2. *Tetracycline + Metronidazole + Bismuth + PPIs (Omeprazole)*
*Non-Bismuth-Based Quadruple Therapy (14 Days):*
3. *Tetracycline + Metronidazole + Clarithromycin + Omeprazole*
TYPHOID FEVER (ENTERIC FEVER) MANAGEMENT*
*Clinical Characteristics:*
1. *Fever:* Starts low and gradually increases up to 104.9°F.
2. *Headache.*
3. *Vomiting.*
4. *Weakness and Fatigue.*
5. *Muscle Aches.*
6. *Relative Bradycardia.*
7. *Loss of Appetite.*
8. *Abdominal Pain.*
9. *Rash:* Rose spots.
10. *Diarrhea & Constipation in Children.*
*Treatment Duration:* 7 to 14 Days.
- *2nd Week:* Antigen test/Widal.
*Treatment Plan:*
1. *Azithromycin 500mg (e.g., Zetro, Bactizith, Azomax):* Take one tablet daily (OD) (0--0--1).
2. *Mefenamic Acid 250mg/500mg (e.g., Ponstan, Ponstan Forte):* Take three times daily (TDS) or twice daily (BD) (1--1--1 or 1-0-1).
3. *Lysovit or Syrup Tres Orix Forte:* Take 2 teaspoons twice daily (2--0--2).
4. *Omeprazole 40 mg (e.g., Zoltar, Risek):* Take one capsule daily (OD), 30 minutes before food.
*If Nausea/Vomiting:*
5. *Domperidone (e.g., Motilium Syrup 1mg/ml, Tab 10mg):* Take 30 minutes before food.
*For Children:*
1. *Azithromycin Syrup 200mg (e.g., Zetro, Bactizith) or Cefixime Syrup 100mg/200mg (e.g., Cefspan, Cefiget):* 1-2 teaspoons twice or three times daily (BD/TDS).
2. *Antipyretic Syrup (e.g., Brufen, Brufen Plus, Panadol, Panadol DS):* 1-2 teaspoons three times daily (TDS) or twice daily (BD).
3. *Lysovit Syrup:* 1-2 teaspoons twice daily (BD) or once daily (OD).
*Alternative Drugs for Typhoid Fever:*
*Antibiotics:*
- *Fluoroquinolones:* Ciprofloxacin*, Ofloxacin, Moxifloxacin.
- *Cephalosporins:* Cefixime, Ceftriaxone* (Titan, Rocephin).
- *Macrolides:* Azithromycin* (Macroab, Azomax).
- *Chloramphenicol: Use with caution; may cause aplastic anemia.
- *Sulphonamides:* Sulfamethoxazole + Trimethoprim (Septran).
*NSAIDs:*
- Ibuprofen, Paracetamol, Mefenamic Acid.
*Tonics:*
- *Glyve Sol, Tresorix, Lysovit, Leaderplex.*
MALARIA FEVER (FALCIPARUM MALARIA) MANAGEMENT*
*Clinical Characteristics:*
1. *Fever* with chills and rigor.
2. *Headache/Body ache.*
3. *Sweats.*
4. *Fatigue.*
5. *Nausea and Vomiting.*
6. *General Malaise.*
7. *Dry (nonproductive) cough.*
8. *Muscle or Back Pain or Both.*
9. *Loss of Appetite.*
- Complete Blood Count (CBC), Urea, Creatinine, Electrolytes, Liver Function Tests (LFTs).
- Blood/Urine Culture and Sensitivity (C/S).
Treat all malaria cases as falciparum until proven otherwise.
1. *Artemether + Lumefantrine (e.g., Artem, Artheget):*
- *DS Tablet (40/240mg):* Take twice or three times daily (BD/TDS).
- *DS Plus Tablet (80/480mg):* Take one tablet twice daily (1-0-1 BD).
2. *Paracetamol (e.g., Panadol, Calpol):* Take one tablet three times daily (1-1-1 TDS).
1. *Artesunate + Sulfadoxine Pyrimethamine (e.g., Genart-SP, Sinda-MP).*
2. *Paracetamol (e.g., Panadol, Calpol):* Take one tablet three times daily (1-1-1 TDS).
3. *Multivitamin Syrup (e.g., Lysovit, Glyvenol):* Take 2 teaspoons twice or once daily (BD/OD).
3. *Multivitamin Syrup (e.g., Lysovit, Leaderplex):* 2 teaspoons twice or once daily (BD/OD).
LIVER ABSCESS OPD MANAGEMENT*
*Clinical Characteristics:*
1. *Fever:* Continuous or spiking.
2. *Chills.*
3. *Right upper quadrant pain* and *abdominal pain.*
4. *Anorexia* and *weight loss.*
5. *Malaise.*
6. *Jaundice.*
7. *Hepatomegaly.*
8. *Cough/Dyspnea.*
*Investigations:*
- Complete Blood Count (CBC), Urea, Creatinine, Electrolytes (U/C/E), Liver Function Tests (LFTs), Prothrombin Time (PT) & International Normalized Ratio (INR).
- Ultrasound (U/S) Abdomen, Chest X-ray (CXR).
- Hepatitis B Surface Antigen (HBsAg) and Anti-HCV.
- CT scan of the abdomen with contrast.
- U/S guided aspiration.
- Pus Culture and Sensitivity (C/S).
- Anti-amoebic antibodies.
- Total Protein, Serum Albumin/Globulin Ratio (TPAGR).
*Treatment Plan:*
1. *Ciprofloxacin 250mg/500mg (Ciproxen):*
- 1 tablet three times daily (1+1+1 TDS) or twice daily (1+0+1 BD).
2. *Metronidazole 400mg + Diloxanide Furoate 500mg:*
- 1 tablet three times daily (1+1+1 TDS) or 2 tablets three times daily (2+2+2 TDS).
3. *Mefenamic Acid (Mefnac/Mefnac DS):*
- 1 tablet three times daily (1+1+1 TDS).
4. *Omeprazole 40 mg (Risek/Ruling):*
- 1 capsule once daily (0+0+1 OD), 30 minutes before food.
*Alternative Drugs:*
*Anti-amoebic:*
- *Metronidazole (Tab/Syp):* Flagyl, Metrozine.
- *Tinidazole (Tab):* Fasygen 200mg.
- *Nitazoxanide (Tab/Syp):* Izato 100mg.
- *Diloxanide Furoate + Metronidazole:* Entamizole DS.
*Analgesic/Antipyretic:*
- *Mefenamic Acid:* Ponstan/Ponstan Forte.
- *Nimesulide:* Nims.
*Antibiotics:*
- *Ciprofloxacin (Tab/Syp/Inj):* Novidat.
- *Amoxicillin (Tab/Syp/Inj):* Amoxil.
- *Ceftriaxone (Inj):* Titan/Rocephin.
- *Gentamicin (Inj):* Genticin.
*Others:*
- *Iodoquinol.*
- *Chloroquine (Tab/Syp):* Resochine/Nivaquine-P.
- *Hydroxychloroquine 200 mg (Tab):* HCQ.
URINARY TRACT INFECTION (UTI) MANAGEMENT*
*Clinical Characteristics:*
1. *Mild fever* with or without chills.
2. *Burning micturition.*
3. *Abdominal (Suprapubic) pain.*
4. *Painful urination (Dysuria).*
5. *Frequent urination* with very little urine output.
6. *Urgent urination.*
7. *Malaise.*
8. *Stress/Anxiety.*
*Investigations:*
- Complete Blood Count (CBC), Urea, Creatinine, Electrolytes (UCE).
- Urine Detailed Report (D/R).
- Urine Culture and Sensitivity (C/S).
- Ultrasound (U/S) KUB (Kidneys, Ureters, Bladder).
- X-ray KUB.
*Treatment Plan:*
*UTI in Adults*
1. *Levofloxacin 250mg/500mg (Leflox/Cravit):*
- 1 tablet three times daily (1-1-1 TDS) or twice daily (1-0-1 BD).
- OR
- *Cefixime 400mg (Cefspan/Cefiget):* 1 capsule once daily (0-1-0 OD).
2. *Diclofenac Sodium 50mg/100mg (Voren/Voltral):*
- 1 tablet twice daily (BD).
3. *Sodium Acid Citrate Syrup (Citralka):*
- 2-3 teaspoons in a glass of water twice or three times daily (BD/TDS).
4. *Cran Max Pro Sachets:*
- 1 sachet in a glass of water twice daily (BD) or once daily (OD).
*UTI in Children*
1. *Ciprofloxacin 125mg/250mg Syrup (Novidat):*
- 1-2 teaspoons three times daily (TDS) or twice daily (BD).
- OR
- *Cefixime 100mg/200mg Syrup (Cefspan/Cefiget):* 1-2 teaspoons twice daily (BD) or once daily (OD).
2. *Ibuprofen Syrup (Brufen/Brufen DS):*
- 1-2 teaspoons three times daily (TDS) or twice daily (BD).
3. *Cran Max Aqua Syrup:*
- 1-2 teaspoons twice daily (BD) or three times daily (TDS).
*UTI in Pregnancy*
1. *Co-Amoxiclav 375mg/625mg/1g (Augmentin/Amclav):*
- 1 tablet three times daily (1-1-1 TDS) or twice daily (1-0-1 BD).
- OR
- *Cephalexin 250mg/500mg (Keflex/Ceporex):* 1 capsule three times daily (1-1-1 TDS) or twice daily (1-0-1 BD).
2. *Paracetamol 500mg (Panadol/Calpol):*
- 1 tablet twice daily (BD) or three times daily (TDS).
3. *Cran Max Pro Sachets:*
- 1 sachet in a glass of water twice daily (BD) or once daily (OD).
*If Nausea/Vomiting:*
4. *Doxylamine 10mg + Vitamin-B6 10mg (Envepe/Femiroz):*
- OR
- *Meclizine + Vitamin-B6 (Navidoxine).*
- Second-line Rx:
- *Ondansetron (Tab/Inj Onset/Onseron).*
- *Metoclopramide* (causes extrapyramidal symptoms (EPS) so should be avoided)
FEVER WITH BURNING MICTURITION MANAGEMENT*
*Clinical Characteristics:*
1. *Fever.*
2. *Lower abdominal pain.*
3. *Burning micturition.*
4. *Dysuria.*
5. *Hematuria.*
*Investigations:*
- Complete Blood Count (CBC).
- Urea, Creatinine, and Electrolytes.
- Urine Detailed Report (D/R).
- Urine Culture and Sensitivity (C/S).
- Ultrasound (U/S) KUB (Kidneys, Ureters, Bladder).
- X-ray KUB.
*Treatment Plan:*
*For Adults*
1. *Levofloxacin 250mg/500mg (Leflox/Qumic):*
- 1 tablet three times daily (1-1-1 TDS) or twice daily (1-0-1 BD).
- OR
- *Cefixime 400mg (Cefspan/Cefiget):* 1 capsule once daily (0-0-1 OD).
2. *Mefenamic Acid 250mg/500mg (Ponstan/Ponstan forte):*
- 1 tablet three times daily (1-1-1 TDS) or twice daily (1-0-1 BD).
- OR
- *Paracetamol 500mg (Panadol/Calpol):* 1 tablet three times daily (1-1-1 TDS).
3. *Sodium Acid Citrate Syrup (Citralka):*
- 2 teaspoons in a glass of water twice or three times daily (BD/TDS).
*If Nausea/Vomiting:*
4. *Domperidone Syrup/Tablet (Motilium Syrup 1mg/ml, Tab 10mg):*
- 30 minutes before food.
*For Children*
1. *Nalidixic Acid Syrup 250mg (Negram/Nilacid):*
- OR
- *Ciprofloxacin Syrup 125mg/250mg (Novidat/Mytill):*
- OR
- *Co-trimoxazole Syrup (Septran/Septran DS):*
- 1-2 teaspoons three times daily (TDS) or twice daily (BD).
2. *Antipyretic Syrup (Brufen/Brufen Plus/Panadol/Panadol DS):*
- 1-2 teaspoons three times daily (TDS) or twice daily (BD).
3. *Cran Max Aqua Syrup (Hilton) or Cenova Syrup (Getz):*
- 1-2 teaspoons twice daily (BD) or once daily (OD).
*If Nausea/Vomiting:*
4. *Gravinate Syrup:*
- 1-2 teaspoons twice daily (BD) or three times daily (TDS).
Child and Adult with Ear Discharge/Infection Rx*
Treatment for Children
1. *Antibiotics:*
- Syp Augmentin / Syp Augmentin DS
*OR*
- Syp Cefadroxil 125mg/250mg (Duricef)
*Dosage:* 1-2 teaspoons BD/TDS
2. *Pain Relief:*
- Syp Brufen / Brufen DS
*OR*
- Syp Dollor / Dollor DS
*Dosage:* 1-2 teaspoons BD/TDS
3. *Ear Drops:*
- Cipocain *OR* Otocain Ear Drops
*Dosage:* 2-3 drops 3-4 times a day
Treatment for Adults
1. *Antibiotics:*
- Tab Co-Amoxiclav 375mg, 625mg, 1g (Augmentin, Amclave)
*OR*
- Cap Cefadroxil 250mg, 500mg (Duricef/Cedrox)
*Dosage:* TDS/BD
2. *Pain Relief:*
- Tab Mefenamic Acid (Ponstan/Ponstan Fort)
*Dosage:* TDS
*OR*
- Tab Naproxen Sodium 250 mg, 500mg (Neoprox/Flexin)
*Dosage:* BD
3. *Ear Drops:*
- Cipocain *OR* Otocain Ear Drops
*Dosage:* 2-3 drops 3-4 times a day
Sore Throat Treatment *
*Common Symptoms (C/C):*
- Fever, possibly with chills and rigor
- Coughing
- Headache/Ear pain
- Throat pain
- Difficulty swallowing
- Swollen uvula
Treatment for Adults
1. *Antibiotics:*
- Cap Ampicillin 250mg/500mg (Penbritin)
*OR*
- Cap Azithromycin 250mg/500mg (Macrobac/Azomax)
*Dosage:* TDS/BD or BD/OD
2. *Pain Relief:*
- Tab Mefenamic Acid (Ponstan, Mefnac)
*Dosage:* TDS/BD
3. *Gargle:*
- Mouthwash for gargle: Dissolve Aspirin tablets in water
*Dosage:* Gargle 2-3 times a day
Treatment for Children
1. *Antibiotics:*
- Syp Co-Amoxiclav 156 mg (Augmentin / Amclave)
*Dosage:* 1-1-1 or 1-0-1 (TDS/BD)
2. *Pain Relief:*
- Syp Paracetamol (Panadol DS/Calpol Plus)
*Dosage:* 1-2 teaspoons TDS/BD
3. *For Additional Symptoms (Sneezing, Itchy Throat, Flu):*
- Syp T-Day 2.5mg *OR* Softin 5mg *OR* Syp Neo-Antial
*Dosage:* 0-0-1 (OD)
Fever with Dry Cough +/- Sore Throat Treatment
*Common Symptoms (Upper Respiratory Tract Infection):*
- Tab Co-Amoxiclav 375mg/625mg/1g
*Dosage:* 1-1-1 or 1-0-1 (TDS/BD)
- Cap Azithromycin (Macrobac/Azomax/Zetro) 250mg *OR* Tab 500mg
*Dosage:* 0-0-1 or 1-0-0 (BD/OD)
- Syp Hydryllin DM *OR* Syp Corex-D
- Tab Loratidine 10mg (Softin/Lorin NSA)
*Dosage:* 0-0-1 or 1-0-1 (OD/BD)
- Tab Paracetamol (Panadol/Calpol)
Fever with Productive Cough - Rx
Diagnosis: Lower Respiratory Tract Infection
Clinical Features (C/C):
- *Fever*
- *Productive Cough*
- *Sputum Production*
- *Post Nasal Drip*
- *Rapid Breathing or Difficulty Breathing*
- *Wheezing*
- *Cyanosis (Skin Turning Blue Due to Lack of Oxygen)*
- *Chest Pain or Tightness*
Treatment Plan (Rx):
1. *Antibiotics*
- *Tab Clarithromycin* 250mg/500mg (Klaricid/Claritek): 1-1-1/1-0-1 (TDS/BD)
OR
- *Cap Cefixime* 400mg (Cefspan/Cefiget): 0-0-1 (OD)
2. *Cough Syrup*
- *Syp Hydryllin* OR *Syp Cofrest* OR *Pulmonol*: 2 Teaspoonfuls (TDS/BD)
3. *Antihistamine*
- *Tab Loratidine* 10mg (Softin/Lorin NSA): 0-0-1, 1-0-1 (OD/BD)
4. *Antipyretic*
- *Tab Paracetamol* (Panadol/Calpol): 1-2 Tablets (TDS/BD)
If high fever: 2+2+2
Tonsillitis / Pharyngitis - Rx
Clinical Features (C/C):
- *Fever* (may be associated with chills and rigor)
- *Coughing*
- *Headache/Ear Pain*
- *Throat Pain*
- *Difficulty Swallowing*
- *Swollen Uvula*
- *Enlarged Juxtadiagestric Nodes*
Treatment Plan (Rx):
1. *Antibiotics*
- *Tab Co-Amoxiclav* 375mg/625mg/1g (Augmentin, Amclave): 1-1-1, 1-0-1 (TDS/BD)
2. *Analgesic/Anti-inflammatory*
- *Tab Mefenamic Acid* (Ponstan Forte, Mefnac DS): 1-1-1, 1-0-1 (TDS/BD)
OR
- *Tab Voren* 50mg/100mg (Diclofenac Sodium): 1-0-1 (BD)
3. *Antihistamine* (if patient presents with sneezing, itchy throat, flu symptoms)
- *Tab Fexet* 60mg/120mg/180mg: 0-0-1 (OD)
4. *Gargles*
- *Saltwater Gargle* OR *Medicated Gargle* (Benzarin, Listerine): Gargle 2-3 times a day
Pediatric Treatment Plan (Rx):
1. *Antibiotics*
- *Syp Co-Amoxiclav* 156mg (Augmentin/Amclave) OR 312mg (Augmentin DS/Amclave DS): 1-1-1, 1-0-1 (TDS/BD)
2. *Antipyretic/Analgesic*
- *Syp Paracetamol* (Panadol DS/Calpol Plus): 1-2 tsp (TDS/BD)
3. *Antihistamine* (if patient presents with sneezing, itchy throat, flu symptoms)
- *Syp T-Day* 2.5mg OR *Syp Softin* 5mg OR *Syp Neo-Antial*: 0-0-1 (OD)
Pyelonephritis - Rx
- *Abdominal (Suprapubic) Pain*
- *Painful Urination (Dysuria)*
Investigations:
- *CBC, Urea, Creatinine, Electrolytes*
- *Urine D/R (Urine Detailed Report)*
- *Urine C/S (Urine Culture and Sensitivity)*
- *U/S KUB (Ultrasound Kidney, Ureters, Bladder)*
- *X-Ray KUB*
- *CT KUB (Best)*
- *Intravenous Pyelogram (IVP)*
Treatment Plan (Rx):
1. *Antibiotic*
- *Cap Cefixime* 400mg (Cefspan/Cefiget): 0-0-1 (OD)
2. *Analgesic/Anti-inflammatory*
- *Tab Diclofenac Sodium* (Voren): 1-0-1 (OD)
3. *Urinary Alkalinizer*
- *Syp Sodium Acid Citrate* (Citralka): 2 tsp BD/TDS in a glass of water
4. *Supplement*
- *Cran Max Pro Sachets*: 1 sachet in a glass of water BD/OD
Alternative Treatment Plan:
1. *Antibiotic*
- *Tab Moxifloxacin* 400mg (Cefiget, Maxlox): 0-0-1 (OD)
2. *Analgesic/Anti-inflammatory*
- *Tab Diclofenac Sodium* (Voren, Voltral): 1-0-1 (OD)
3. *Urinary Alkalinizer*
- *Syp Sodium Acid Citrate* (Citralka): 2 tsp BD/TDS in a glass of water
4. *Supplement*
- *Cran Max Pro Sachets*: 1 sachet in a glass of water BD/OD
Pediatric Treatment Plan:
1. *Antibiotic*
- *Syp Ciprofloxacin* 125mg/250mg (Novidat): 1-2 tsp TDS/BD
OR
- *Syp Cefixime* 100mg/200mg (Cefspan/Cefiget): 1-2 tsp BD/OD
2. *Analgesic/Anti-inflammatory*
- *Syp Ibuprofen* (Brufen/Brufen DS): 1-2 tsp TDS/BD
3. *Supplement*
- *Syp Cranmax Aliua*: 1-2 tsp BD/OD
Acute Sinusitis (Sinus Infection) - Rx
Clinical Features (C/C):
- *Anosmia*: Loss of smell
- *Nasal Blockage/Obstruction*
- *Congestion/Cough*
- *Discharge*: Purulent, discolored nasal discharge
- *Ear Pressure/Fullness*
- *Facial Pain, Fever*
- *Generalized Malaise/Fatigue*
- *Headache/Halitosis*
Investigations:
- *CBC (Complete Blood Count)*
- *X-Ray PNS (Paranasal Sinuses)*
- *CT Scan PNS*
Treatment Plan (Rx):
1. *Antihistamine + Decongestant*
- *Tab Fexofenadine 60mg + Pseudoephedrine 120mg* (Fexet-D): 0-0-1 (OD)
2. *Antibiotic*
- *Tab Co-Amoxiclav* 375mg/625mg/1g (Augmentin, Amoxiclav): 1-1-1 (TDS) or 1-0-1 (BD)
3. *Analgesic/Anti-inflammatory*
- *Tab Mefenamic Acid* (Ponstan, Ponstan Forte): 1-0-1 (BD)
4. *Vaporization*
- *Steam Inhalation*: 2-3 times/day
2nd Alternative Treatment Plan:
1. *Antihistamine*
- *Tab Fexofenadine* 120mg (Fexet, Telfast): 0-0-1 (OD)
2. *Antibiotic*
- *Tab Clarithromycin* 250mg/500mg (Klaricid/Claritek): 1-0-1 (BD)
3. *Analgesic/Anti-inflammatory*
- *Tab Aceclofenac* 100mg (Acenac, Acelo): 1-0-1 (BD)
4. *Vaporization*
- *Steam Inhalation*: 2-3 times/day
3rd Alternative Treatment Plan:
1. *Antihistamine*
- *Tab Loratidine* 10mg (Fexet, Telfast): 0-0-1 (OD) or 1-0-1 (BD)
2. *Antibiotic*
- *Tab Moxifloxacin* 400mg (Oxiget, Avelox): 0-0-1 (OD)
3. *Analgesic/Anti-inflammatory*
- *Tab Diclofenac Potassium* 50mg (Caflam, Cataflam): 1-0-1 (BD)
4. *Vaporization*
- *Steam Inhalation*: 2-3 times/day
Asthmatic Patient with Severe Coughing - Rx
Clinical Features (C/C):
- *Post Nasal Drip*
- *Cough*
- *Sputum*
- *Shortness of Breath*
- *Wheezing*
- *Sneezing*
- *Chest Pain*
Investigations:
- *Chest X-ray*
- *CBC (Complete Blood Count)*
- *PFTs (Pulmonary Function Tests)*
- *Sputum C/S (Culture and Sensitivity)*
Treatment Plan (Rx):
1. *Nebulization*
- *Atem* + 2cc N/S (Normal Saline): Nebulization 6-8 hourly (1-1-1-1/1-1-1)
2. *Nebulization*
- *Atrovent* + 2cc N/S (Normal Saline): Nebulization 6-8 hourly (1-1-1-1/1-1-1)
3. *Leukotriene Receptor Antagonist*
- *Tab Montelukast Sodium* 10mg (Monitiget/Mytika): 0-0-1
4. *Antihistamine*
- *Tab Fexofenadine* 120mg (Telfast/Fexet): 0-0-1
5. *Antibiotic*
- *Tab Clarithromycin* 500mg (Klaricid/Claritek): 0-0-1
6. *Cough Syrup*
- *(Hydrillin/Acefyl/Bronochol)*
7. *Steroids*
- *If not responsive, consider adding steroids*
Emergency Treatment for Asthmatic Patient with Airway Irritation Due to Excessive Sputum and Post Nasal Drip:
- *Intravenous Treatment (Slow Administration)*:
- *Inj Hydrocortisone* 100mg/250mg/500mg (Solu-Cortef)
- *Inj Pheniramine Maleate* 25mg/ampule
Allergic Rhinitis - Rx
In long-standing cases of allergic rhinitis, the following may be observed:
- *Pale, Boggy Nasal Mucosa with Hypertrophic Turbinates*
- *Cobblestone Appearance of the Posterior Pharyngeal Wall*
Associated Allergic Conditions:
Long-standing allergic rhinitis can predispose patients to:
- *Recurrent Sinusitis*
- *Otitis Media*
Treatment Plan (Rx):
1. *Avoid Exposure to Allergens* (e.g., pollen, dust)
2. *Antihistamine*
- *Tab Fexofenadine* 120mg (Fexet/Telfast): 0-0-1 (OD)
3. *Analgesic/Anti-inflammatory*
- *Tab Aceclofenac* 100mg (Acenac, Acelo): 1-0-1 (BD)
4. *Intranasal Spray*
- *Rhinosone Nasal Spray*: 3 sprays per nostril, 2-3 times a day
If Severe or History of Allergy/Asthma:
5. *Intranasal Corticosteroid*
- *Fluticasone Propionate 0.05%* (Flixonase/Flexosone): 3 sprays per nostril, 2-3 times a day
Alternative Drugs:
Antiallergic Drugs:
- *Fexofenadine + Pseudoephedrine* (Fexet-D, Telfast-D)
- *Fexofenadine* 60mg/120mg/180mg (Fexet, Telfast)
- *Loratadine* 10mg (Lorin NSA, Softin)
- *Desloratadine* 5mg (Deslora)
- *Cetirizine* (Tab Rigix 3mg)
Analgesic/Antipyretic:
- *Aceclofenac*: Tab Acenac 100mg
- *Diclofenac Potassium*: Tab Caflam 50mg
- *Flurbiprofen*: Froben 50mg/100mg, Cap Froben 200mg (SR)
- *Mefenamic Acid* (Ponstan/Ponstan Forte)
- *Nimesulide*: Tab Nims 100mg
Nasal Sprays:
1. *Fluticasone Propionate 0.05%* (Flixonase/Flexosone)
2. *Fluticasone Furoate 27.5mcg* (Avamys Nasal Spray)
3. *Ephedrine 5mg/ml + Fluprednisolone 0.025mg/ml + Naphazoline 1.25mg/ml* (Rhinosone Nasal Spray)
4. *Xylometazoline HCL 0.1%* (Xynosine/Xolisan Nasal Spray)
5. *Azelastine Hydrochloride 0.1%* (Azosin)
6. *Flunisolide 0.025%* (Tarisin Nasal Spray)
7. *Mometasone Furoate 50mcg* (Hivate)
8. *Sodium Cromoglycate 4%* (Oxycrom-P)
9. *Na Cromoglycate 2% + Xylometazoline HCL 0.025%* (Oxycrom)
Chronic Hepatitis C Infection - Rx
*Incubation Period:* 2 weeks to 6 months
- *Asymptomatic* in 80% of cases
- *Symptomatic* (see "Acute Viral Hepatitis")
- *Malaise, Fever, Myalgias, Arthralgias*
- *RUQ Pain, Tender Hepatomegaly*
- *Nausea, Vomiting, Diarrhea*
- *Jaundice, Possibly Pruritus*
Chronic Course Features:
- Commonly seen in *asymptomatic individuals* (up to 85%), as the disease may go undiagnosed and treatment may be delayed or never initiated (carrier state).
- Findings are often mild and nonspecific (e.g., *fatigue*).
- *Liver Cirrhosis* (up to 25% of cases) within 20 years of infection.
- *Extrahepatic Features* (common).
Investigation:
- *CBC, U/C/E, LFTs, PT & INR*
- *U/S Whole Abdomen, CXR*
- *HBsAg and Anti-HCV*
- *HCV RNA PCR*
Treatment Plan (Rx):
1. *Antiviral Therapy*
- *Cap Sofosbuvir* 400mg (Sofomac/Sofohil/Sofiget): 0-0-1 (OD)
- *Cap Daclatasvir* 60mg (Maclinza/Clavir/Daclaget): 0-0-1 (OD)
- *Tab L-Methylfolate* 400mcg (Myfol/Maxfol/Folate): 0-0-1 (OD)
2. *HCV with Cirrhosis: Add-on Therapy*
- *Cap Ribavirin* 400mg (Viron/Novia/Ribazole): 0-0-1 (OD)
3. *For Constipation (if present):*
- *Syp Lactulose* (Duphalac/Lilac) 20-30ml HS
4. *For Acid Suppression:*
- *Cap Esomeprazole* 40mg (Nexum/Esso): 0-0-1 (OD), 30 minutes before food
2nd Alternative Treatment Plan (Rx):
1. *Combination Antiviral Therapy*
- *Cap Sofosbuvir 400 mg + Velpatasvir 100 mg*
- OR *Cap Sofosbuvir 400 mg + Ledipasvir 90 mg* (Syneget-LS): 0-0-1 (OD)
2. *Add-on Therapy:*
- *Cap Ribavirin* 400mg (Viron/Novia/Ribazole): 0-0-1 (TDS)
3. *Supplementation:*
- *Tab L-Methylfolate* 400mcg (Myfol/Maxfol/Folate): 0-0-1 (OD)
Chronic Hepatitis B Viral Infection - Rx
- *Most Patients:* Are inactive, non-contagious carriers.
- *Cirrhosis:* Stigmata of chronic liver disease (25% of cases).
- *Extrahepatic Manifestations* (10-20% of cases):
- *Membranous Glomerulonephritis*
- *CBC, U/C/E, LFTs, PT & INR*
- *Tenofovir Disoproxil Fumarate 300mg*
- OR *Tab Entecavir* (Ecavir 0.5mg/Tacavir 0.5mg/1mg): 0-0-1 (OD)
- *Tab L-Methylfolate 400mcg* (Myfol/Maxfol/Folate): 0-0-1 (OD)
3. *For Constipation (if present):*
- *Syp Lactulose* (Duphalac/Lilac) 20-30ml HS
- *Cap Esomeprazole 40mg* (Nexum/Esso): 0-0-1 (OD), 30 minutes before food
Important Notes (Ν.Β.):
- *Nucleoside/Nucleotide Analogs:* Indicated for patients with both decompensated and compensated liver disease and non-responders to interferon treatment:
- *Tenofovir* (DOC)
- *Entecavir*
- *Pegylated Interferon Alfa (PEG-IFN-a):* Especially recommended in younger patients with compensated liver disease.
- *Regimen:* Shorter than nucleoside/nucleotide analogs.
- *Contraindications:*
- *Decompensated Cirrhosis*
- *Psychiatric Conditions*
- *Pregnancy*
- *Autoimmune Conditions*
- *Leukopenia or Thrombocytopenia*
- *Coinfection with HDV:* Best treated with *PEG-IFN-a*.
Surgical Treatment:
- *Liver Transplantation:*
- In cases of *end-stage liver disease* due to HBV.
- In cases of *fulminant hepatic failure* (emergent transplantation).