Pediatric Primary Care (140 page)

  Increase fluid intake.

  Do not take more than 2 inhalations at any one time to prevent paradoxical bronchoconstriction.

  Rinse mouth after inhalation.

AMOXICILLIN–ANTIBIOTIC

Brand Name

Amoxil (generic also available)

Uses

Treat otitis media, upper and lower respiratory tract, soft tissue, skin, GI, GU, and gonorrhea infections. Used to treat: Gram-positive cocci:a Staphylococcus aureus, Streptococcus pyogenes, Streptococcus faecalis, Streptococcus pneumoniae. Gram-negative cocci: Neisseria gonorrhoeae, Neisseria meningitides. Gram-positive bacillus: Corynebacterium diphtheriae, Listeria monocytogenes. Gram-negative bacillus:
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Salmonella;
also used in bacterial endocarditis prophylaxis.

Availability

Suspension: 125/5 mL, 200/5 mL, 250/5 mL, 400/5 mL. Tablets: 500 mg, 875 mg. Pediatric drops: 50 mg/mL. Tablets, chewable: 125 mg, 200 mg, 250 mg, 400 mg. Capsules: 250 mg, 500 mg.

Indications/Routes/Dosage

Ear, nose, throat, GU, skin/structure infections: Children < 20 kg: 20-40 mg/kg/day divided q8-12h. Children, adults > 20 kg: 250-500 mg q8h or 500-875 mg 2 times/day.

Lower respiratory tract infections: Children < 20 kg: 40 mg/kg/day divided q8-12h. Children, adults > 20 kg: 500 mg q8h or 875 mg tablets 2 times/day.

Acute uncomplicated gonorrhea, epididymitis-orchitis: Adults: 3 g once with 1 g probenecid PO follow with tetracycline or erythromycin.

Acute otitis media: Children: 80-90 mg/kg/day divided bid for those at high risk.

Adverse Reactions

Mild diarrhea, rash, oral/vaginal candidiasis; superinfection, colitis, allergic reaction-anaphylaxis.

Implications

  Take all of medication.

  Report rash or severe diarrhea.

  Discard suspension after 14 days.

AMOXICILLIN-CLAVULANATE–POTASSIUM ANTIBIOTIC

Brand Name

Augmentin

Uses

Treat lower respiratory infection, otitis media, sinusitis, skin infections, urinary tract infections caused by susceptible strains of Gram-positive and Gram-negative organisms.

Availability

Oral suspension: 125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5mL. Tablets: 250 mg, 500 mg, 875 mg. Tablets, chewable: 125 mg, 200 mg, 250 mg, 400 mg.

Indications/Routes/Dosage

Recurrent or persistent otitis media caused by
Streptococcus pneumoniae, Haemophilus influenzae
, or
Moraxella catarrhalis:
Augmentin ES-600. Children older than 3 months: 90 mg/kg/day, based on amoxicillin component, PO q12h for 10 days.

Lower respiratory infections, otitis media, sinusitis, skin infections, urinary tract infections caused by susceptible strains of Gram-positive and Gram-negative organisms: Adults, children weighing > 40 kg: 250 mg (based on amoxicillin component) PO q8h or 500 mg q12h. May use 500 mg PO q8h OR 875 mg PO q12h for more severe infections. Children weighing 40 kg: 20 to 45 mg/kg, based on amoxicillin component and severity of infection, PO daily in divided doses q8-12h.

Children 3 months of age or older: 30 mg/kg/day PO in divided doses q12h.

Adverse Reactions

Nausea, vomiting, diarrhea, agitation, confusion, dizziness, insomnia, enterocolitis, pseudomembranous colitis, abdominal pain, vaginitis, anemia, thrombocytopenia, hypersensitivity reactions.

Implications

  May decrease effectiveness of hormonal contraceptives.

  
Note:
oral suspensions have varying clavulanic acid content.

  Continue antibiotic for full length of treatment, take with meals.

AZITHROMYCIN–MACROLIDE ANTIBIOTIC

Brand Name

Zithromax

Uses

Treat community-acquired pneumonia, otitis media, pharyngitis, tonsillitis, dental prophylaxis in patients allergic to penicillin, uncomplicated gonococcal infections, chlamydial infections.

Availability

Powder for oral suspension: 100 mg/5 mL, 200 mg/5 mL, 1000 mg/packet. Tablets: 250 mg, 500 mg, 600 mg. Injection: 500 mg.

Indications/Routes/Dosage

Otitis media: Children older than 6 months: 10 mg/kg PO daily for 3 days OR 10 mg/ kg PO on day 1 then 5 mg/kg once daily on days 2-5.

Pharyngitis, tonsillitis: Children older than 2 years: 12 mg/kg (max 500 mg) PO daily for 5 days.

Dental prophylaxis: Adults: 500 mg PO 1 hour before procedure. Children: 15 mg/ kg PO 1 h before procedure.

Chlamydial infections: Adults, adolescents older than 16 years: 1 g PO as a single dose.

Adverse Reactions

Dizziness, headache, fatigue, palpitations, chest pain, nausea, vomiting, diarrhea, abdominal pain, cholestatic jaundice, pseudomembranous colitis, candidiasis, vaginitis, rash, photosensitivity, angioedema.