Common Pediatric Drugs And Doses: Ultimate List

Table of Contents

Acyclovir

Tab 200, 400, 800| Inj 50mg/ml | Syp 5m/200mg,
5ml/400mg | Cream 5%

Indication: HSV Encephalitis, Varicella Zoster

Dose:

HSV encephalitis:
- 20 mg/kg/dose x TDS x IV for 14-21 days (60mg/kg/day)
Varicella zoster (Chicken Pox):
- PO: 20 mg/kg/dose QID for 5 days (Start treatment within 24 hrs of onset of rash)
- IV: 5-10mg/kg/dose TDS for 5 -10 days
Herpes Labialis
- >12 Years: Cream Acyclovir 5% LA x 5 times a day x 4 days
- Max dose: Oral: 80mg/kg/24 hr

Notes: Adequate hydration should be maintained during therapy. Administer slowly(over one hour) to prevent renal damage. Use with caution in liver disease and epilepsy. Do not refrigerate solution because it can cause precipitation of the drug.

Adrenaline/ Epinephrine

1ml = 1mg (1:1000) |0.1mg/ml (1:10000) * 1ml Adrenaline
(1mg) + Inj NS 9ml |Racemic epinephrine 2.25%

Indication: Anaphylaxis, Croup, Asystole, Bradycardia, Bronchospasm

Dose:

Bronchodilator

Subcutaneous- 0.01 ml/kg/dose ( 1:1000 solution) (max. single dose 0.5 mL)
- Repeat Q15 min × 3–4 doses (Also use in angioedema, urticaria, anaphylactic shock)
Nebulization (Post extubation, Anaphylaxis,Croup):
- Croup:
  - 0.5ml/kg per dose (max 5ml) of 1:1000 over 15 minutes (can be repeated every 15-20 mintues upto 3 to 4 dose. Cardiac monitoring required
    - Max. doses: ≤4 yr: 2.5 mL/dose; >4 yr: 5 mL/dose
  - Racemic epinephrine 2.25%: 0.5 mL/dose diluted to 3 mL with NS via a nebulizer over 15 min Q3–4 hr
- Neonate (Post extubation):
  - Epinephrine (1:1000) 1ml= 0.1ml of racemic epinephrine
  - 0.25-0.5ml of racemic epinephrine solution diluted with NS to a total volume of 3 ml given by nebulizer over 15
    minutes.

Hypersensitivity

IM: 0.01 mg/kg per dose (max 0.5mg per dose) of 1:1000 solution (Repeat after 15-20 minutes)

Side effects: Increased heart rate, nervousness, sweating, pallor, headache

Notes: Racemic epinephrine is mixture of the R- and L- forms (isomers) of epinephrine. It is more potent at reducing laryngeal edema.

Adrenaline and Noradrenaline (IV Infusion)

Indication: Hypotension, Shock

Dose:

0.1-1mcg/kg/min
- (Wt in Kg x 0.6)mg in 25ml NS or 5% Dextrose
  - 1ml/hr- 0.4mcg/kg/min
Wt in Kg x 0.6)mg in 50ml NS or 5% Dextrose
- 1ml/hr- 0.2mcg/kg/min

Side effects: Increased heart rate, hypertension, anxiety

Albendazole

Tab 200, 400 mg | Syp 10ml/ 400mg

Indication: Helminthic infections, Neurocysticercosis

Dose:

Not recommended for <1 yr
For 1-2 Years:
- Give 200mg PO HS (Single Dose)
For >2 Years:
- Give 400mg PO HS (Single Dose)
Neurocysticercosis:
- 15 mg/kg/day in 2 divided doses for 28 days (Max: 800 mg/day)

Side effects: Nausea, headache, dizziness

Notes: Corticosteroids should be administered 1-2 days before initiating albendazole therapy in patients with neurocysticercosis and should be followed by concurrent steroid and anticonvulsant therapy for the first week. Bioavailability is increased with fatty meal.

Adenosine

Inj 6mg/2ml

Indication: ·Paroxysmal supraventricular tachycardia (PSVT)

Dose:

Neonate:
- 0.05mg/kg/dose rapid IV push followed by NS flush. If not effective by 1-2 minutes, increase dose by 0.05mg/kg/dose every 1-2 minutes to maximum single dose of 0.25mg/kg until termination of SVT.
Child:
- 0.1–0.2 mg/kg (initial max. dose: 6 mg) by rapid IV push over 1–2 seconds; may increase dose by 0.05-mg/kg increments every 2 min to a max. of 0.25 mg/kg (up to 12 mg), or until termination of SVT. Max. subsequent single dose: 12 mg.
>50kg or Adult
- 6 mg rapid IV push over 1–2 seconds; if no response after 1–2 min, give 12-mg rapid IV push. May repeat a second 12-mg dose after 1–2 min if required. Max. single dose: 12 mg

Notes: Always administer by IV site closest to the heart antecubital vein or via CVP. Half-life of Adenosine is around 10 seconds so it should be given rapidly. Contraindicated in second or third degree A-V block, sick sinus syndrome.

Albumin (5%, 20%, 25%)

Indication: Hypoalbuminemia, Hypovolemia, Hypoprotenemia, Burns, Acute liver failure

Dose:

Use 5% Albumin in neonate
Hypoalbuminemia: 0.5-1gm/kg/dose given over 4 hours. Repeat every 1-2 days
Hypovolemia: 0.5g/kg/dose infuse over >60 min. Rapid infusion over 10-20 min in hypovolemic shock.
Max: 1 g/kg/day in neonates and 6 g/kg/day in
children

Side effects: Fluid overload, hypersensitivity reactions, hypertension

Notes: Rapid infusion may result in vascular overload. Rate of infusion should be 2-4 ml/min of 5% and 1 ml/min of 25% albumin. Albumin 5% should be used for hypovolemic patients and 25% should be used for patient with fluid or sodium restriction.

Aminophylline

Inj 25mg/ml

Indication: : Asthma, Apnea of prematurity, Bradypnea

Dose:

Acute bronchospasm (Asthma/Reactive airway
disease)
- IV:
  - Loading dose of 6 mg/kg diluted to 1 mg/ml and infuse over 30 min followed by 0.6-1.5 mg/kg/hr as continuous infusion, if already on oral therapy, omit loading dose.
- PO:
  - 15-20 mg/kg/day divided every 4 to 6 hours
  - Ensure there is no history of administration of theophylline in the past 24 hours.
Apnea of prematurity
- Loading dose: 5–6 mg/kg IV over 30 minutes
- Maintenance dose: 1–2 mg/kg/dose 8 hourly (After 12 hours of loading dose)
- Continuous infusion: 0.2mg/kg/hr

Side effects: : Seizures, tachyarrhythmias, feeding intolerance in neonates, gastroesophageal reflux, vomiting, CNS irritability

Notes: : With hold dose if heart rate greater than 180 beats/min

Amikacin

Inj 100mg/2ml | 250mg/2ml | 500mg/2ml

Indication: Gram-negative bacilli (E. coli, Klebsiella, Proteus, Enterobacter, Serratia, Pseudomonas, Mycobacterium tuberculosis and Atypical mycobacteria)

Dose:

Neonates (IV, IM):
- 15mg/kg/dose OD
Infants and children:
- 15mg/kg/day OD
Anti tubercular dose:
- 15-30 mg/kg/day (Max dose: 1 g)

Side effects: Nephrotoxicity, ototoxicity

Notes: Hold the drugs when if there is AKI (Raise cretinine level) or give the renal dose.

Amoxicillin

Syp- 5ml/125mg | Drop- 1ml/100mg | Cap- 500mg | DT250mg

Indication: LRTI, Pneumonia, Otitis Media, Sinusitis, Enteric fever

Dose: (PO)

Neonates:
- 20-30 mg/kg/day BD
- Infants and Children:
  - 50-80 mg/kg/day TDS or BD
    - Max: 2-3g/24 hr
- Tonsillitis/pharyngitis (S. pyogenes):
  - 50 mg/kg/24 hr TDS or BD PO × 7 days
    - Max. dose: 1 g/24 hr
- Enteric fever:
  - 100 mg/kg/day for 14 days

Side effects: Diarrhea, rash, hypersensitivity reactions

Notes: Common side effects of Amoxicillin is diarrhea. If diarrhea occur, stop the medicine and give Syp Bifilac and send the Stool R/M/E.

Amoxyclav (Amoxicillin- Clavulanic Acid)

Cap- 625mg (500mg +125mg)|DT- 375mg (250mg
+125mg)|Syp- 5ml (200mg+28.5mg)

Indication: Tonsillitis, LRTI, Pneumonia (Same as amoxicillin in addition β-lactamase producing M. catarrhalis, H. influenzae, Niesseria and S. aureus, Klebsiella)

Dose: ( Based on Amoxicillin component)

1-3 months:
- 30 mg/kg/day PO BD
>3 months and children:
- 50-80 mg/kg/day PO TDS
IV-100mg/kg/day TDS for 7-14 day

Side effects: Diarrhea, rash, hypersensitivity reactions

Ampicillin

Inj 100mg, 250mg, 500mg | Cap 250mg, 500mg | Syp
5ml/125mg

Indication: EONNS, Sepsis, Meningitis (Active against Streptococci, Pneumococci, Enterococci, some strains of H. influenzae, Salmonella, Shigella, E. coli and Klebsiella)

Dose:

Neonate:
- 100mg/kg/dose BD
Infants and Children:
- IV: 100-200 mg/kg/day QID
- PO: 50–100 mg/kg/day QID (Max dose: 4 g/24
  hr)
Sepsis: 200mg/kg/day TDS
Meningitis: 300mg/kg/day TDS

Side effects: Diarrhea, rash, hypersensitivity reactions

Ampiclox

Syp- 5ml/125mg, 5ml/250mg | Drop- 1ml/100mg | Capsule250mg, 500mg | DT-125mg, 250mg | IV- 500mg, 1gm

Indication: EONNS, Pneumonia, Bronchiolitis, LRTI

Dose:

IV
- Neonate:
- 200mg/kg/day BD
- Infant and children:
- 200mg/kg/day QID (Max-4gm)
PO
- 100mg/kg/day QID

Side effects: Diarrhea, rash, hypersensitivity reactions

Antacid

5ml/ 200mg (AlOH) + 200mg (MgOH) + 25mg (Simethicone)

Indication: Acid reflux, Peptic ulcer disease, bloating

Dose:

5 to 15 ml PO TDS
(Weight/2 ) ml BD/ TDS

Side effects: Constipation, diarrhea, nausea It is usually taken prior to your food almost 30 to 45 minutes before.

Anti-Tubercular

Always add pyridoxine to prevent peripheral neuropathy
Dose: 10mg PO OD x 6 months

Notes: : Pulmonary TB and EP TB are treated for 6 months (2 months of HRZE + 4 months HR). All severe forms of EP TB are treated for 9-12 months. This includes TB meningitis, TB osteomyelitis, military TB, TB pericarditis/effusion, and other severe forms of TB (2 months HRZE+ 7-10 months HRE, a total of 9 to 12 months duration)

Atropine

Inj 0.4mg/ml, 0.6mg/ml, 1mg/ml

Indication: Bradycardia, OP Poisoning

Dose:

OP Poisoning:
- IV- 0.05-0.1 mg/kg every 5-10 minutes until sign of atropinization. Start Atropine Infusion as (20% of atropinization dose (ml)/hr)
- OR,
  - <12 years: 0.05mg/kg IV
  - > 12 yrs: 1-2 mg/dose IV
Sinus bradycardia:
- Neonate:
  - 0.01–0.03 mg/kg/dose IV/IM every 10–15 min when required up to a total maximum of 0.04 mg/kg. (Administer IV over 1 min)
- Child:
  - 0.02 mg/kg/dose IV Q5 min × 2–3 doses when required
  - Max. single dose: 0.5 mg in children, 1 mg in adolescents
  - Max total dose: 1 mg children, 2 mg adolescents
Bronchospasm
- Inhalation- 0.03-0.05 mg/kg/ dose 3-4 times/day (Max: 2.5 mg/dose) in 2.5ml NS every 6-8 hours via nebulizer

Side effects: Dry mouth, blurred vision, tachycardia

Notes: : Give IV by rapid IV push as slow injection may result in paradoxical bradycardia. Contraindicated in thyrotoxicosis, tachycardia, obstructive disease of GI tract, obstructive uropathy, glaucoma.

Azithromycin

Syp- 5ml/100mg, 5ml/200mg| Tab- 100mg, 250mg, 500mg|
Inj 500mg

Indication: URTI, Typhoid fever, Scrub Typhus, LRTI, Pneumonia, Pertusis

Dose: 10-20 mg/kg/day PO OD for 5 fays (Max: 500 mg/day)

Pharyngitis/Tonsilitis (2-15 yrs)
- 12 mg/kg/24 hr PO once daily × 5 days (max.
  dose:500 mg/24 hr
Typhoid: 20 mg/kg/day PO OD x 7 days
Intravenous: 10-20mg/kg/day OD

Side effects: : Nausea, vomiting, diarrhea, abdominal pain

Betamethasone

Ointment 0.1% W/W

Indication: : Phimosis

Dose: 0.1% LA BD x 15 days

Side effects: Fibrosis

Notes: Tell parents to apply ointmen to forskin after cleaning it. Then, retract the foreskin for about 1 minute. Tell them not to leave the foreskin retracted as it might cause paraphimosis.

Bifilac (Pre and Probiotic granules)

5ml/Lactic acid bacillus, Streptococcus fecalis, Colistridiumbutyricum, Bacillus mesentricus

Indication: : Diarrhea, Irritable bowel syndrome, Gut flora imbalance

Dose:

<2yr- 2.5ml BD;
>2yr- 5ml BD x 5 days
Or
<10kg: 2.5ml PO BD x 5days
>10kg: 5ml PO BD x 5 days

Side effects:Bloating, gas, upset stomach

Brica-BM (Pediatric)

(Bromhexine Hcl 4 mg + terbutaline sulphate 1.5 mg )/ 5ml

Indication: Productive cough, Asthma

Dose:

<3 year: 2.5ml TID
3-6 year: 2.5-5ml TID
7-15 year:5-10ml TID

Side effects: GI side effects, headache, dizziness, sweating, skin rashes, tremor, headache, nervousness, restlessness, transient hypoglycaemia, dizziness, drowsiness, insomnia, dry mouth

Budecort MDI

200mcg Budesonide/dose

Indication: Asthma, Reactive Airway Disease

Dose:

200mcg 1 puff BD
Max: 1mg/day

Side effects: Throat irritation, cough, hoarse voice, oral candidiasis (Tell patient to rinse mouth after each use either use water or give breastfeeding )

Buscopan (Hyoscine Butyl Bromide)

Inj 20mg/ml | Tab 10mg , 20mg

Indication: Abdominal colic, Renal colic

Dose:

Oral:
- 5-12 Years: 10mg/dose PO TDS x 2 days then
  SOS
- 12-18 years: 20mg/dose PO TDS
IV:
- < 6 years: 5mg/dose TDS
- 6-12 years: 5-10 mg/dose TDS
- >12 years: 20mg/dose TDS

Side effects: Dry mouth, dizziness, blurred vision, constipation

Caffeine Citrate

Inj 20mg/ml

Indication: Idiopathic apnea of prematurity

Dose:

Loading dose:
- 20 mg/kg IV over 30 mintues
Maintenance dose:
- Give after 24 hours of loading dose
- 5 -10 mg/kg/day caffeine base OD IV (Given
  over 10 minutes)

Side effects: Tachycardia, extrasystole, restlessness, arrhythmia, insomnia, restlessness, excitement, nervousness, scintillating scotoma, tinnitus, muscular tremor, headache, light headedness, urticaria, dry skin, rash, vomiting, nausea, diarrhea, stomach pain,
necrotizing enterocolitis, gastritis, diuresis, hyperglycemia.

Calcium gluconate

Inj 100 mg/mL (10%)

Indication: Hypocalcemia

Dose:

Hypocalcaemia
- Loading:
  - 1-2ml/kg (100-200mg/kg) of calcium gluconate 10% as a single dose IV over 5-10 minutes (Slowly not >10ml)
- Maintenance:
  - 2-8ml/kg/day (200-800mg/kg/day) IV infusion over 24 hours
- Cardiac arrest and hyperkalemia :
  - 100 mg/kg/dose IV over 10 minutes

Side effects: Hypotension, bradycardia, arrhythmias, hypercalcemia, hypophosphatemia.

Notes: : 10% Ca gluconate means 100mg/ml of Ca gluconate- 8-9mg/ml of elemental Ca). IV solution should be diluted to 50 mg/ml and be given slowly over 1 hr under monitoring. Use with caution in patient on digitalis therapy

Calvit

Syp 10ml/ 200IU (Vitamin D3)+ 400mg (Calcium
Phosphate) | Tab Calvit

Indication:Calcium Deficiency, Growing pain

Dose: (Based on Calcium Phosphate)

PO: 75 mg/kg/day PO BD x 10-15 days
> 12 Year
- Tab Calvit 1 tab PO OD TDS x 10-15 days

Side effects: Constipation, Nausea

Calamine Lotion

Calamine 15%, Zinc Oxide 5%, Menthol 0.5%

Indication: Topical anti-pruritic, Skin soothing and
protective

Dose: Applied to affected area three times daily for
up to 5-10 days.

Side effects: Mild itching, tingling, or irritation

Notes: Should not be applied in open wound or broken
skin

Candid Mouth paint

Clotrimazole 1% w/v

Indication: Oral Candidiasis

Dose: LA TDS x 5days

Side effects: Mouth Irritation

Cefixime

Syp: 5ml/50mg, 5ml/100mg | DT: 50mg, 100mg, 200mg,
400mg

Indication: : UTI, Diarrhea, Enteric Fever, Mesentric
adenitis

Dose:

10-20mg/kg/day BD
Enteric fever: 20mg/kg/day x 14 days
Adolescent: 200mg PO BD x 7 days

Side effects: Pseudomembranous colitis, Nausea, Diarrhea, Abdominal Pain, Headache

Carbamazepine

Syp 100mg/5ml| Tab 200mg, 400mg

Indication: Prophylaxis of generalized tonic-clonic, partial, mixed partial or generalized seizures, Trigeminal neuralgia or diabetic neuropathy, Bipolar disorders; myotonic muscular dystrophy

Dose:

< 6 years
- Initial: 10–20 mg/kg/24 hr PO ÷ BID-TID (QID for suspension)
- Increment: Q5–7 days up to max. dose of 35 mg/kg/24 hr PO
6-13 years
- Initial: 10 mg/kg/24 hr PO ÷ BID up to max. dose: 100 mg/dose BID
- Increment: 100 mg/24 hr at 1 wk intervals (÷ TIDQID) until desired response is obtained.
- Maintenance: 20–30 mg/kg/24 hr PO ÷ BID-QID; usual maintenance dose is 400–800 mg/24 hr; max. dose: 1000 mg/24 hr.
- >12 years
  - Initial: 200 mg PO BID Increment: 200 mg/24 hr at 1 wk intervals (÷ BID-QID) until desired response is obtained. Maintenance: 800–1200 mg/24 hr PO ÷ BID-QID
  - Max dose:
    - 12–15 yr: 1000 mg/24 hr
    - >15 yr: 1200 mg/24 hr

Side effects: Exacerbation of seizure, sedation

Cefotaxime

Inj 500mg, 1gm, 2gm, 10gm

Indication: Pneumonia, UTI, Meningitis, Pyelonephritis, Epiglotitis, SSTI, Bone and joint, Intraabdominal and genitourinary tract infections (Used in neonate or patient with impaired liver function)

Dose:

Neonates (0-4 weeks)
- < 7 days:
  - < 2kg: 50mg/kg/dose BD
  - > 2kg: 50mg/kg/dose TDS
- > 7days:
  - <1.2 kg: 50mg/kg/dose BD
  - 1.2-2kg: 50mg/kg/dose TDS
  - >2kg: 50mg/kg/dose QID
- Infant and children
  - <12 years or <50 kg:
    - 100-200 mg/kg/day IV/IM in 6-8 hourly divided doses for 7-14 days.
    - For severe infections, meningitis use the dose of 200 mg/kg/day.
  - >12 years or >50 kg:
    - 1-2 g /doseIV/IM every 8 hours for 7-14 days. For severe infections, meningitis use the dose of 2 g/day. (Max: dose: 12 g/day)

Side effects: Diarrhea, Rash, Nausea, Injection site inflammation, hypersensitivity (rash, pruritus, fever, urticaria and anaphylaxis), pseudomembranous colitis

Cefpodoxime

Syp: 5ml/50mg, 5ml/100mg | Drop: 1ml/100mg | Tab:
100mg, 200mg | DT: 50mg

Indication:Pharyngititis or tonsilitis, Acute maxillary sinusitis, skin and skin structure infections, UTIs, ASOM

Dose: 10mg/kg/day/BD x 5- 10 days

Side effects: Nausea, allergic reaction

Ceftriaxone

Inj 250mg, 500mg, 1gm, 2gm

Indication: Meningitis, Typhoid, Pneumonia, Otitis media, Pyelonephritis, Septicemia, UTI

Dose: : IV

Infants and children:
- Mild to moderate infection: 50-75 mg/kg/day every 12 hourly (Max dose: 2gm/24hr)
- Meningitis and typhoid fever: 100mg/kg/day every 12 hourly (Max dose: 2gm/dose)
- Ceftriaxone: 75-100 mg/kg/day BD
Adolescent: 1–2 g/dose Q12–24 hr IV/IM; max. dose: 2 g/dose and 4 g/24 hr

Side effects: Injection site inflammation, rash, pruritus, fever, eosinophilia, urticaria, anaphylaxis

Cefuroxime

Inj 750mg, 1.5mg | Tab 125mg,250mg, 500mg| Syp 125,
250mg/5ml

Indication: Bone and joint infection, sepsis, URTI, UTI, Otitis media, acute bacterial sinusitis, Impetigo

Dose:

IV/IM
- Neonate <7 days: 100 mg/kg/day divided 12 hourly IV
  - >7 days: 150 mg/kg IV/IM divided 8 hourly.
- > 3 mo
  - Mild/moderate infection: 75–100 mg/kg/24 hr ÷ Q8 hr; max. dose: 1500 mg/dose
  - Severe infection: 100–200 mg/kg/24 hr ÷ Q6–8 hr; max. dose: 1500 mg/dose
PO
- 3 months-12 years: 20-30mg/kg/day BD for 10
  days (Max: 1g/day)
- >13 yrs: Tab: 250 mg BD

Side effects: Pseudomembranous colitis, nausea and vomiting, diarrhea, rash, urticaria, angioedema, pruritus, false positive urine glucose test, positive direct Coombs tests

Cetirizine

Tab 5mg, 10mg | Syp 5mg/ml

Indication:Allergic rhinitis, Urticaria

Dose:

6 month- 2 year: 2.5mg PO OD (Max: 5mg/24hr)
2-5 year: 2.5-5mg PO OD or BD
>6 year– adult : 5-10 mg PO once daily

Side effects: Headache, pharyngitis, GI symptoms, dry mouth, and sedation

Notes: Generally not recommended for treating URIs in infants. No proven benefits in infants and young children with URIs.

Charcoal (Activated)

Indication: To prevent absorption of any orally ingested poison

Dose:

Infants: 1 g/kg/dose orally, repeat every 4-6 hours.
Children: 1-2 g/kg/dose or 25-50 g/dose orally; repeat every 4-6 hours.
Adolescents: 5-10 times the estimated weight ofthe drug/chemical ingested (or 50-100 g dose); repeat every 4-6 hours

Side effects: Vomiting, constipation, black stools, intestinal obstruction

Ciprofloxacin

Tab: 250mg, 500mg, 750mg | DT: 250mg| Syp 5ml/125mg,
250mg |Ointment 0.3% w/w | Ear/Eye Drop 0.3% +
(Dexamethasone 0.1%)

Indication: Pyelonephritis, Pneumonia, Typhoid, Appendicitis, Gastroenteritis, Cholera, conjunctivitis, ASOM, Otitis externa

Dose:

Oral:
- 30-40 mg/kg/day PO divided into 12 hourly doses (Maximum: 500 mg/dose) for 10-21 days.
IV:
- 20-30 mg/kg/day IV in 8-12 hourly divided doses (Maximum: 1.2 g/day) for 10-21 days
Conjunctivitis:
- Ointment LA HS x 5 days
Acute otitis externa (≥1 yr and adult):
- 0.25 mL to affected ear(s) BID × 7 days
ASOM with tympanostomy tubes or acute otitis
externa (≥6 mo and adult):
- 4 drops to affected ear(s) BID × 7 days

Side effects: Arthralgia, pseudomembranous colitis, erythema nodosum, Stevens-Johnson syndrome, reversible haematological disorders.

Notes: Use with caution in patients with seizures and renal problems

Clindamycin

Inj 150mg/ml, 300, 600mg

Indication: Active against aerobic gram-positiveStaphylococci and Streptococci and anaerobc bacteria such as Fusobacterium, Bacteroids and Actinomyces

Dose:

<7 days
- <2kg: 5mg/kg/dose IV BD
- > 2kg: 5mg/kg/dose IV TDS
>7 days
- <1.2kg: 5mg/kg/dose IV BD
- 1.2-2kg: 5mg/kg/dose IV TDS
- >2kg: 5-10mg/kg/dose TDS or QID
Child and adolescent:
- PO: 10–40 mg/kg/24 hr ÷ Q6–8 hr; max. dose: 1.8 g/24 hr
- IM/IV: 25–40 mg/kg/24 hr ÷ Q6–8 hr; max. dose: 2.7 g/24 hr

Side effects: Clostridium difficile colitis, antibioticassociated colitis, pseudomembranous colitis, abdominal pain, nausea, and vomiting, maculopapular rash, urticaria, hypersensitivity reaction, jaundice, eosinophilia, DRESS syndrome, hypotension.

Cotrimoxazole (TMP-SMX)

Syp 5ml/ Trimethoprim-40mg and Sulphamethoxazole200mg

Indication: : UTI prophylaxis, Bacillary dysentery, Otitis media

Dose:

<2 months: Contraindicated.
Mild to Moderate Infections:
>2 months
- IV -8-10 mg TMP/kg/day in 2 divided doses.
- PO- 15-20 mg TMP/kg/day in 4 divided doses.
  - Max: 320 mg/day trimethoprim and 1.6 g/day of sulfamethoxazole.
Prophylaxis:
- 150 mg TMP/m²/day PO in 2 divided doses /hr for 3 days/week on consecutive or alternate days
- Or, 2 mg TMP/kg/dose PO every day, or 5 mgTMP/kg/dose two times weekly

Colistin (Colistimethate)

Inj 1, 2 Million I/U

Indication: : MDR gram negative infection,
Pseudomonas lung infection in cystic fibrosis

Dose:

Neonates, Infants and Child (<60kg)
- 25,000 units/kg/dose every 8 hour
- Dilution for IV infusion: Dilute in NS to
  concentration of 40,000units/ml and infuse
  over 30 min
- Dilution for slow IV injection: Dilute in NS to
  concentration of 90,000units/ml

Side effects: : Dizziness, paresthesia, tingling sensation,neurotoxicity, nephrotoxicity, acute respiratory failure

Cyclopam (Dicyclomine)

Drop (1ml/10mg) | Syp (5ml/10mg) | Inj 1ml/10mg

Indication:Infantile colic, renal colic

Dose: (PO)

Infants >6 months:
- 5 mg 3-4 times a day; Max: 20 mg/day orally.
Children:
- 10 mg 3-4 times a day; Max: 40 mg/day orally.
To be taken half to one hour before meals.

Side effects: Dry mouth, thirst and dizziness, tachycardia, decreased sweating, blurred vision.

Dobutamine

Inj 250mg/vial

Indication: Hypotension persisting after adequate fluid volume replacement, cardiac failure, septicemia

Dose: 5-20 mcg/kg/min

2.5-15 mcg/kg/minute as continuous infusion and titrate to response (Max: 20 microgram/kg/min in newborn and 40 mcg/kg/minute in children)

Side effects:Chest pain, tachycardia, angina, ectopic beats, palpitation, hypertension, nausea, vomiting, tingling sensation, paraesthesia, dyspnea, headache, hypersensitivity (rash, fever, bronchospasm), hypokalemia

Dopamine and Dobutamine (Infusion)

Indication: Used to support blood pressure in conditions like septic shock or heart failure

Dose:

(wt in kg x 6)mg in 25ml 5% dextrose or NS
- 1ml/hr for 4mcg/kg/min or at 4ml/hr for 16mcg/kg/min
(wt in kg x 6)mg in 50ml 5% dextrose or NS
- 1ml/hr for 2mcg/kg/min or at 4ml/hr for 8mcg/kg/min.

Side effects: Increased heart rate, hypertension, palpitations, chest pain.

Dexamethasone (Dexona)

Inj 4mg, 8mg| Tab 0.5mg

Indication: BPD, Cerebral edema, meningitis, Croup, Raise ICP, Inflammation, Spinal cord compression

Dose:

Airway Edema:
- 0.25-0.5mg/kg/dose once IV given 4 hours before extubtion. May repeat q8h for a total of 4 dose
Croup:
- 0.6 mg/kg/dose orally/IM/IV, Max: 16 mg
Asthma exacerbation:
- 0.6 mg/kg/dose (max. 16 mg/dose) PO/IV/IM Q24 hr × 1 or 2 doses; use beyond 2 days increases risk for metabolic adverse effects
Inflammation:
- 0.08-0.3 mg/kg/day orally/IV/IM in 2-4 divided doses.
Meningitis:
- 0.15mg/kg/dose IV in 4 divided doses for 2-4 days 10-20 minutes prior or simultaneously with antibiotics.
Cerebral Edema:
- 1-2 mg/kg/dose IV/IM stat; Maintained on 1-1.5 mg/kg/day IV/IM in 4-6 divided doses; Max: 16 mg/day.
Spinal Cord Compression:
- 2 mg/kg/day in in 4 divided doses

Side effects:: Hypertension, Insomnia, mood changes, increased appetite, weight gain.

Dextrose

5%, 10%, 25%

Indication: Hypoglycemia, Hyperkalemia

Dose:

Hypoglycemia:
- Neonates:
  - 2 ml/kg/ dose of 10% solution) followed by 4-6 mg/kg/min infusion
- Infants and children:
  - 0.5-1 g/kg/dose (2-4 ml/kg/dose of 25% solution) Or 5ml/kg/dose of 10% Dextrose
Hyperkalemia:
- 0.5-1 g/kg of 25% or 50% solution combined with 1 unit of regular insulin for q 5 g dextrose, to be infused over 2 hr

Diazepam

Inj 5mg,10mg| Tab 2mg, 5mg, 10mg |Rectal gel

Indication: Status epilepticus, skeletal muscle relaxant in tetanus, general anxiety, febrile seizures, preoperative sedation

Dose:

Status epilepticus:
- Per rectal (Rectal Gel):
  - 2-6 years: 0.5 mg/kg/dose repeat after 4-12 hours as per requirement.
  - 6-12 years: 0.3 mg/kg/dose, repeat after 4-12 hours as per requirement.
  - Above 12 years: 0.2 mg/kg/dose repeat after 4-12 hours as per requirement.
- Intravenous:
  - Neonate: 0.3–0.75 mg/kg/dose IV Q15–30 min × 2–3 doses; max. total dose: 2 mg
  - 6 months-5 years: 0.2–0.5 mg/kg/dose IV Q15–30 min; max. total dose: <5 yr: 5 mg; ≥5 yr: 10 mg. May repeat dosing in 2–4 hr, as needed.
  - Above 5 years: 1 mg slow intravenous infusion every 2-5 minutes; Max: 10 mg: can be repeated after 2-4 hours if needed.
- Sedative/muscle relaxant
  - IM or IV: 0.04–0.2 mg/kg/dose Q2–4 hr; max. dose: 0.6 mg/kg within an 8-hr period.
  - PO: 0.12–0.8 mg/kg/24 hr ÷ Q6–8 hr

Side effects: : Respiratroy depression (Rapid IV push), apnea, hypotension

Domperidone

Tab 10mg| Syp (5ml/5mg)| Drop (1ml/10mg)

Indication : Nausea and vomiting, reflux esophagitis, dyspepsia

Dose: : (PO)

1 month-12 years:
- 0.2-0.4 mg/kg/dose 3-4 times a day before food.
12-18 years:
- 10-20 mg 3-4 times a day

Side effects: : Dystonic reactions, reversible raised serum prolactin levels that may lead to galactorrhoea and gynaecomastia, hypertensive crises in patients with pheochromocytoma, urticaria and abdominal cramps.

Contraindicated in GI obstruction or perforations. May increase prolactin secretion leading to gynecomastia in males and galactorrhea in females

Doxycycline

Cap 100mg | Inj 100mg/ml

Indication:Rickettsial fevers, Scrub typhus, malaria, cholera

Dose:

<8 years:
- Not recommended due to tooth discoloration and enamel hypoplasia (However, AAP recommends doxycycline as the drug of choice for rickettsial disease regardless of age)
>8 years:
- Bacterial infections, severe acne vulgaris,Rickettsial fever, Malarial fever:
- < 45kg:
  - 2.2 mg/kg/dose PO/IV 12 hourly 7-10 days (Max dose: 100 mg/dose). In malaria: Use along with quinine.
- > 45kg:
  - 100mg/dose BD PO IV

Side effects: Tooth discoloration in children <8 years, hypersensitivity reaction, photosensitivity, skin reaction, pericarditis, hepatitis

Enalapril

Tab 2.5mg, 5mg, 10mg | Inj 2.5mg/2ml

Indication:Hypertension, Hypertensive crisis, CCF, Proteinuria

Dose:

Hypertension:
- Use in children above 1 month of age.
- Oral:
  - 0.1-0.5 mg/kg/day PO OD or in 2 divided doses. Max: 40 mg/day. Adjust according to blood pressure.
IV:
- 0.01-0.02 mg/kg/day in two divided doses.
Hypertensive crisis:
- 0.05-0.1 mg/kg given as an intravenous injection.

Side effects: Neutropenia, agranulocytosis, anemia, thrombocytopenia, pancytopenia, rash, pruritus, arthralgia, fever, eosinophilia, hypotension, angioedema, cough

Ezevac Enema (30ml)

Glycerin 15% w/v , Sodium chloride 15% w/v , Purified water

Indication: impacted stool, constipation

Dose:

2.5 ml/Kg
2–4yrs: 15ml
5–11yrs: 30ml

Side effects: Upset stomach, Stomach cramps, Gas, Diarrhea, Burning, Rectal irritation.

Flucloxacillin

Inj 500mg, 1000mg | Syp 5ml/125mg | Cap 250mg, 500mg

Indication: Used to treat infections caused by penicillin-resistant Staphylococcus species.

Dose:

Oral –
- Adult: 250 mg 4 times daily. Dose may be doubled in severe infections.
- Child: <2 yr 62.5 mg 4 times daily; 2-10 yr 125 mg 4 times daily.
IV:
- Adult: 0.25-1 g 6 hrly, via slow inj over 3-4 min, or by infusion. Dose may be doubled in severe infections.
- Child: <2 yr Quarter of the adult dose; 2-10 yr Half of the adult dose.

Side effects:Rash, nausea, vomiting, diarrhea

Ferofolic (Iron)

Drop 1ml/20mg | Syp 5ml/220mg (elemental iron)

Indication:Used to prevent or treat iron and folic acid deficiencies

Dose:

PO
- Prophylaxis:
  - <2yrs: 1-2 mg/kg/day of elemental iron (Max: 15 mg/day).
  - >2yrs: 2 mg/kg/day of elemental iron (Max 30 mg/day).
- Deficiency: 4 -6 mg/kg/day of elemental iron OD/BD (Max: 15mg elemental Fe/24hr)

Side effects: GI irritation, nausea, diarrhea, dark stools, constipation, urine discoloration, teeth staining.

Notes: Avoid in patient requiring frequent blood transfusion. When using for iron deficiency anemia, treat for additional 3-4 months after Hb return to normal in order to replenish total body iron stores.

Fentanyl

Inj 50mcg/ml

Indication: Sedation, pain relief, preoperative medication, adjunct to anesthesia

Dose:

Neonates and infants
- Intermittent doses: 1-4 mcg/ kg/dose; may be
  repeated every 2-4 h r (For Sedation)
- Continuous infusion: 1-5 mcg/kg/hr.
1-12 yr
- Pain:
  - IM, IV: 1-3 mcg/ kg/dose; may be repeated
    after 30 minutes; continuous infusion: 1-5
    mcg/kg/hr
> 12 yr
- Pain: IM, IV: 0.5-1 mcg/kg/dose; may be
  repeated after ½ to 1 hour.
Anesthesia: IM, IV: 2-50 mcg/kg

Side effects: respiratory depression, hypotension, chest wall or jaw muscle rigidity (if given without muscle relaxants)

Contraindicated: Rraised ICP, severe respiratory depression, hepatic or renal problems

Notes: For IV administer slowly over 5-10 minutes. Rapid IV infusion may cause skeletal muscle rigidity, impaired ventilation, apnea, laryngospasm

Fexofenadine

Syp 5m/30mg | Tab 60, 120, 180

Indication:Cough, urticarial, allergic rhinitis

Dose:

6mo-2yrs: 15mg BD
2-12 yrs: 30mg BD
>12 yrs: 60mg BD or 180mg OD

Or,

<5kg- 2.5ml
5-10kg- 5ml
10-20kg- 7.5ml
>20kg – 10ml.

Side effects: Insomnia, dizziness, flatulence, diarrhea, abdominal pain, dyspepsia, vomiting, epistaxis, throat irritation, nervousness, appetite increase, agitation, nightmares, dry mouth

Notes: Medication as a single agent may be administered with or without food. Do not administer antacids with or within 2 hr. of fexofenadine dose.

Fusidic Acid

Cream 2%

Indication:Staphylococcal skin infections

Dose: LA TDS x 5 days

Side effects: Skin irritation, rash, itching

Glycopyrrolate

Inj 0.2mg/ml

Indication: Pre-anesthetic medication, Drooling, Control of Secretions, Neuromuscular Blockade reversal

Dose: 0.01mg/kg/dose TDS

Control of Secretions:
- 0.004-0.01 mg/kg IM/IV every 6 hours.
- 0.04-0.1 mg/kg orally every 6 hours.
Drooling:
- Under 3 years: Safety and efficacy not
  established.
- 3-16 years:
  - 0.02 mg/kg orally every 8 hours initially
    and can be increased by 0.02 mg/kg every
    5-7 days if needed; Max: 0.1 mg/kg every 8

Side effects: : Urinary hesitancy and retention, cycloplegia, xerostomia, blurred vision and photophobia

Hydrocortisone

Inj 100mg, 200mg| Tab 20mg

Indication: Acute asthma, Anaphylaxis, Arthritis, Adrenal insufficiency, Toxic shock, anti-inflammatory or immunosuppressive

Dose:

Neonate
- Hypoglycaemia (If hypoglycaemia persists
  despite GIR >12mg/kg/min): 2.5mg/kg q12h for
  24 to 48 hours
- Vasopressor-resistant hypotension:
  - Day 1 (Initial dose): 1mg/kg/dose q8h x 3 doses
  - Day 2 : 0.5mg/kg/dose IV q12 h x 2 doses
  - Day 3: 0.25 mg/kg/dose IV q12h x 2 doses
  - Day 4: 0.125 mg/kg/dose IV x 1 dose
    - If BP improves and other vasopressors have been weaned off, treatment may stop after 24 hours.
Anaphylaxis and acute asthma
- Loading: 5mg/kg/dose (Max: 250mg)
- Maintenance: 2mg/kg/dose TDS
Inflammation (<12 years):
- 2.5-10 mg/kg/day given as 3-4 divided oral
  doses or 1-5 mg/kg/day either
  intramuscularly or intravenously once or
  twice a day.

Side effects:Weight gain, high blood pressure, muscle weakness, mood and behavior changes

Flexon (Ibuprofen +Paracetamol)

Syp 5ml/100mg+ 125mg

Indication: : Used for relieving pain, reducing inflammation, and lowering fever

Dose:

10-15 mg/kg/dose
Fever:
- (Weight/ 2) ml TDS x 3 days then SOS

Side effects: Nausea, vomiting, constipation, diarrhea,gas, heartburn.

Insulin (Regular Human Insulin)

nj 40IU, 100IU

Indication: Treatment of insulin dependent diabetes mellitus, hyperkalemia, diabetic ketoacidosis.

Dose:

Only regular insulin can be given IV or IM.
Neonates:
- Regular insulin 0.01-0.2 unit/kg/hr (Usual Starting dose: 0.05 units/kg/hr) continuous infusion or 0.1-0.2 unit/kg q 6-12 hr SC.
For continuous infusion
- Dilution: Take 0.1ml of Insulin (=4 units) + 3.9ml WFI = 1 unit/ml then take 2 ml insulin (1 unit/ml) + 18ml WFI = 0.1unit/ml
- Flow rate (ml/hr) = [dose (units/kg/hr) x weight (kg)] / concentration (units/ml)
- Start insulin if glucose level remains >250mg despite efforts to reduce GIR
- Check glucose level every 30 minutes
- If glucose remains >180 mg/dl, titrate in increments of 0.01units/kg/hr
- If hypoglycaemia occurs, discontinue insulin and give 10% Dextrose 2ml/kg IV
Children:
- 0.5-1 unit/kg/day in divided doses SC, adjust dose as per blood glucose level.
Diabetic ketoacidosis:
- IV; Loading dose of 0.1 unit/kg followed by maintenance continuous infusion of 0.1 unit/ kg/hr, adjust as per blood glucose level.
Hyperkalemia:
- (Treat with IV calcium and sodium bicarbonate before giving insulin). Add 1 unit of regular insulin in 5 gm of dextrose solution, infuse at a rate of 0.5- 1 gm/kg over 30 min followed by 0.1 unit/kg SC or IV.

Ipratropium bromide (Nebulization)

Nebulization Solution: 500mcg/2ml

Indication: : Recurrent wheezing, severe respiratory distress , Asthma, RAD

Dose:

< 12 years: 250mcg (1ml)
> 12 years: 500mcg (2ml).
Can be given every 20 minutes for 3 dose followed by PRN
Give every 6 hourly and gradually taper

Side effects: Dry mouth, cough, dizziness, nausea.

Ivermectin (PO)

Tab 3mg, 6mg, 12mg

Indication: Tropical pulmonary eosinophilia, Filariasis, pediculosis, scabies

Dose:

200 microgram/kg/dose taken orally as one dose; can be repeated in 3-12 months
Scabies: Prescribe only when weight is >15Kg

Side effects: : Abdominal pain, asthenia, fatigue, myalgia, diarrhea, anorexia, nausea, constipation, vomiting, vertigo

Ketamine

Inj 100mg/ml

Indication: Anesthesia induction and maintenance, Analgesia

Dose:

Only to be given to children who are 3 months or older.
0.5-1.5 mg/kg IV. May give 0.5-1 mg/kg IV after 10 mins after initial dose. Max: 2 mg/kg

Side effects:Hypo-hypertension, tachy-bradycardia, respiratory depression, apnea

Ketorolac (Oral, IV)

Inj 30mg/ml | Tab 10mg

Indication: Moderate to severe acute pain

Dose:

Under 2 years: Safety and efficacy not established.
IV/IM
- 2-16 years:
  - 0.5 mg/kg IM/IV every 6 hourly for 5 days. Max: 15 mg/day.
>16 years but
- <50 kg: 15 mg IV/IM every 6 hourly. Max: 60 mg/day.
- >50 kg: 30 mg IV/IM every 6 hourly. Max: 120 mg/day.
Oral:
In children >16 years
>50 kg or more:
- 20 mg orally once followed by 10 mg every 4 to 6 hours. Maximum dose: 40 mg/day.
<50 kg:
- 10 mg orally once followed by 10 mg every 4 to 6 hours. Maximum dose: 40 mg/day.

Lactulose

Syp 15ml/10mg

Indication:Constipation, Hepatic encephalopathy

Dose:

Constipation:
- 1.5–3 mL/kg/24 hr PO ÷ BID; max. dose: 60
  mL/24 hr
Hepatic Encephalopathy:
- For infants:
  - Use 2.5-10 ml/day (corresponds to 1.7-6.67g/day) orally in divided doses and adjusted to ensure passing 2-3 soft stools per day.
- For children and adolescents:
  - 40–90 mL/24 hr PO ÷ TID–QID

Side effects: Nausea and vomiting, flatulence and intestinal cramps, which are usually transient. Excessive dosage can lead to diarrhea with potential complications such as loss of fluids, hypokalemia, and hypernatremia.

Notes: : Target in hepatic encephalopathy is to produce 2-3 soft stools/day. Do not give to patient who are undergoing electrocautery procedure.

Lorazepam

Inj 2,4mg/ml

Indication: : Status epilepticus, anxiolytic, sedation

Dose:

Status epilepticus
- Neonate, infant, child, and adolescent: 0.05–0.1 mg/kg/dose IV over 2–5 min. May repeat dose in 10–15 min. Max. dose: 4 mg/dose.
Anxiolytic and sedation
- Infant and child: 0.05 mg/kg/dose Q4–8 hr PO/IV; max. dose: 2 mg/dose. May also give IM for preprocedure sedation.

Lasix (Furosemide)

Inj 10mg/ml

Indication:Edema, CCF, Hypertension

Dose:

0.5-2 mg/kg/day IV/IM/Oral in 1-3 doses, maximum of 2 mg/kg/day in neonates and 6 mg/kg in infants and older children.
Continuous infusion: 0.05 mg/kg/hr. and titrate to response.

Side effects: Dizziness, lightheadedness, dehydration,electrolyte imbalance, hypotension, dizziness, fluid and electrolyte imbalance, ischemic hepatitis.

Levetiracetam

Syp: 5ml/500mg| Inj 100mg/ml

Indication:Epilepsy. Adjunctive therapy in partial, myoclonic and tonic-clonic serizure

Dose:

Loading – 60 mg/kg IV over 10 min [or no more than 3 mg/kg/min] (Max dose: 4500 mg),
repeat 2-3 times of seizure persist
Maintenance – Start 20mg/kg/day till 60mg/kg/day BD

Side effects: Drowsiness, dizziness, unusual tiredness, weakness.

Levocetirizine (L-CTZ)

Syp 5ml/2.5mg

Indication:Allergic rhinitis, urticaria

Dose:

6 month- 2 year: 2.5mg PO OD (Max: 5mg/24hr)
2-5 year: 2.5-5mg PO OD or BD
>6 year- adult : 5-10 mg PO once daily

Side effects: Somnolence, fatigue, asthenia, urinary retention, nasopharyngitis, xerostomia, fever, diarrhea, vomiting, cough, pharyngitis, otitis media, epistaxis

Lidocaine/Xylocaine

Inj 1%, 2%, 4% | Gel 2%

Indication: Local anesthetic, relief of pain in postherpetic neuralgia, ventricular arrhythmias

Dose:

Antiarrhythmic:
- Start with bolus of 0.5-1 mg/kg /dose IV/ET Max: 100 mg. Continuous infusion: 20-50
  mcg/kg/min IV. Monitor ECG simultaneously.
Local anaesthetic-Local infiltration:
- Without epinephrine: max. dose of 4.5 mg/kg/dose (up to 300 mg); do not repeat within 2 hr.
- With epinephrine: max. dose of 7 mg/kg/dose (up to 500 mg); do not repeat within 2 hr.
Anaesthetic lubricant:
- Available as 2% and 4% cream, spray, lotion, ointment, gel
- Apply moderate amount of 2% jelly for endotracheal intubation, urinary catheterization, endoscopy (Do not exceed 4.5 mg/kg/12 hours in children <10 years and 600 mg/12 hours in older children). For skin cuts and sunburns, apply topically 3-4 times a day.

Side effects: Numbness of tongue, Lightheadenes, Visual and auditory disturbance, Muscular twitching, Unconsciousness, Convulsion, Coma, Respiratory arrest

Notes: For cardiac arrest, amiodarone is the preferred agent over lidocaine; lidocaine may be used only when amiodarone is not available.

Linezolid

Tab 200, 400, 800| Inj 25mg| Syp 5m/200mg, 5ml/400mg

Indication: Vancomycin-resistant Enterococcus faecium (VRE), VRSA infections, Multidrug resistant tuberculosis (MDR TB)

Dose:

Infants and Children:
- IV or PO; 10 mg/kg/dose q 8-12 hrly
MDR TB:
- 15 mg/kg once daily if <12 kg and 12 mg/kg if
- >12-23 kg thereafter 10 mg/kg once daily PO

Side effects: Diarrhea, vomiting, headache, nausea, anemia, thrombocytopenia, rash, hypertension, pseudomembranous colitis

Magnesium Sulfate (MgS04)

Inj 500mg/ml (50%)

Indication: Treatment of hypomagnesemia, hypertension, seizures associated with acute
nephritis in children, adjunctive therapy in bronchodilation, severe wheezing

Dose: (All doses expressed in magnesium sulfate salt)

Hypomagnesemia:
- 25-50 mg/kg/dose q 8 hr in neonates and q 6hr in children for 3-4 doses (Max: 2000 mg).
Seizures and hypertension:
- 20-100mg/kg/dose q 4-6 hr as required
Bronchodilator:
- 25 mg/kg/dose as single dose IV over 20 min (Max: 2000 mg).

Side effects: Dilute to 50-200 mg/ml for IV use and infuse over 2-4 hr. Use with caution in digitalized and renal impairment patient. Hypotension, hypermagnesemia, GI disturbances, CNS depression, repiratory paralysis

Metronidazole

Tab 200mg, 400mg| Syp 5ml/200mg, 5ml/100mg |Inj
100ml/ 500mg

Indication:Amoebiasis, Giardiasis, Mesentric adenitis, appendicitis

Dose:

Infant and child: 10-15mg/kg/dose TDS
Amoebiasis:
- PO: 35-50 mg/kg/day divided q 8 hr for 10 days.
- Other parasites: PO: 15-30 mg/kg/day divided q 8hr.
Anaerobic infection: PO, IV: 30 mg/kg/day divided q 6 hr (Max: 4g/day).

Side effects:Nausea, vomiting, diarrhea, loss of appetite, metallic taste in mouth. May cause metallic taste, nausea. Administer IV slowly over 1/2-1 hr.

Mefenamic Acid (Meftal P)

5ml/100mg

Indication: MSK Pain, Menstural pain, Fever, RA, Pain with inflammation

Dose:

10mgkg/dose Q8H
≥14 years:
- Initial 500 mg orally once, then 250 mg PO every 6 hours as needed usually not more
  than 7 days in pain and not more than 3 days in primary dysmenorrhea

Side effects: Dizziness, dyspepsia, elevated ALT/AST, fluid retention, ecchymosis, tinnitus, headache, somnolence, rash, peripheral edema, photosensitivity

Milrinone

Inj 10mg/10ml

Indication: Pulmonary hypertension, CCF

Dose:

0.75 mcg/kg/min for 3 hours followed by 0.2 mcg/kg/min (Neonate)
50mcg/kgIV bolus followed by infusion of 0,25- 0.75mcg/kg/min (Child)

Side effects: Hypokalemia, chest pain, pain and swelling at injection site, dizziness

Morphine (IV)

Inj 10mg/ml

Indication: Sedation, pain relief; relieves dyspnea of left ventricular failure and pulmonary edema; preanesthetic medication, Cynotic spell

Dose:

Neonates:
- IV, IM, SC:
  - - Continuous infusion: 0.01-0.02 mg/ kg/hr
      (i.e. 0.01-0.02 ml/ kg/hr)
    - Intermittent dose: 0.1-0.2 mg/kg 2-4
      hourly = 0.1-0.2ml/kg 2-4 hourly
- Infants and children
  - IV, IM, SC: 0.1-0.2 mg/kg/dose q 2-4 hr (Max: 15mg/dose); PO: 0.2-0.5 mg/kg/dose q 4-6 hr.
- > 12 yr:
  - 3-4 mg; may be repeated after 5 min as required.
- Administer IV over 15-30 min at a final concentration of 0.5-5 mg/ml.

Side effects: Respiratory depression, drowsiness

Midazolam

Inj 1mg/ml

Indication: Used for sedation during surgical procedures, and for treating seizures. Continuous IV for sedation of intubated and mechanically ventilated patients

Dose:

Neonate:
- For intermittent dosing:
  - Take 1 ml of Midazolam (1mg/ml) and add 9ml NS (0.1mg/ml)
  - Dose: 0.1-0.2mg/kg 2-4 hourly = 0.1-0.2ml/kg 2-4 hourly
- For continuous infusion:
  - Take 1 ml of Midazolam (1mg/ml) and add 9ml NS (0.1mg/ml)
  - Take 1 ml of above solution (0.1mg/ml) and add 9ml NS (0.01mg/ml)
  - Infusion dose: 0.01-0.02mg/kg/hour =0.01-0.02ml/kg/hr
- Infants > 2 mth and children
  - Status epilepticus: Loading dose: 0.15 mg/kg followed by continuous infusion of 1 mcg/kg/minute.
  - Sedation: 0.05 – 0.2 mg/kg loading dose; may be repeated after 1-2 hr if required or continuous infusion of 1-2 mcg/kg/min

Side effects: Drowsiness, dizziness, loss of balance,nausea.

Multivitamin

Indication: Used to treat or prevent vitamin deficiency due to poor diet, certain illnesses.

Dose:

Neonate:
- Drop 0.5ml PO OD
3-11 years: 5ml/day PO OD x 10-15 Days
>11 years: 1 tab/day PO OD x 10-15 Days

Mupirocin

Ointment 2%

Indication: Impetigo, folliculitis, Furunculosis, minor wounds, used intranasal to eradicate S. aureus carriers

Dose:

LA TDS x 10 days

Side effects: Burning and stinging pain, itching, rash,nausea, headache, erythema, dry skin, tenderness, swelling, contact dermatitis, and increased exudate.

Meropenem

Inj 500mg, 1000mg

Indication: Active against both gram-positive and gram-negative aerobic and anaerobic pathogens including S. aureus, S. pneumoniae, H. influenzae, N. meningitidis, E. coli, Klebsiella

Dose:

Newborn:
- 20mg/kg/dose TDS Children
Urinary tract Infection, soft tissue infection and skin infections:
- 10 mg/kg/dose IV every 8 hours. Max: 500mg/dose.
Pneumonia, peritonitis, neutropenia, septicemia:
- 20 mg/kg/dose every 8 hours. Max: 1 gm/dose
Meningitis and life threatening infections:
- 40 mg/kg IV every 8 hours. Max: 2 gm/dose

Metoclopromide/ Perinorm

Tab 10mg| Syp 5mg/5ml | Inj 5mg/ml

Indication: Gastroesophageal reflux, prevention of nausea and vomiting due to various causes, symptomatic treatment of diabetic gastric stasis

Dose:

GE reflux:
- PO, IV, IM: 0.4-0.8 mg/kg/day divided q 6-8 hr (Max. dose: 0.8 mg/kg/24 hr or 10 mg/dose)
Postoperative nausea and vomiting:
- IV: 0.1-0.2 mg/kg/ dose
Vomiting:
- PO, IV: 1-2 mg/kg/ dose q 2-4 hr as required

Side effects:: : Contraindicated in GI obstruction, past history of seizures. Causes extrapyramidal reactions and these can be prevented and treated with diphenhydramineg

Methylprednisolone

Inj 40mg, 80mg/ml | Tab 2,4,8,16 mg

Indication: Anti-inflammatory or immunosuppressant use in Connective tissue disorder, vasculitis, graft rejection, demyelinating disorder, status asthmaticus

Dose:

Anti-inflammatory or immunosuppressant:
- PO; IM, IV: 0.5-2 mg/kg/day in divided doses.
Pulse therapy:
- 15- 30 mg/kg/dose given slowly once daily for 3 days.
Status asthmaticus:
- IV: Loading dose of 2 mg/kg/dose then 0.5-1mg/kg/dose q 6 hr
- Oral:
  - Child ≤ 12 yr: 1–2 mg/kg/24 hr ÷ Q12–24 hr (max. dose: 60 mg/24 hr) × 3–10 days
  - Child > 12 yr and adult: 40–60 mg/24 hr ÷Q12–24 hr × 3–10 days
Acute spinal cord injury:
- IV; 30 mg/kg over 15 min followed 45 min later by continuous infusion of 5 mg/ kg/hr. for one day

Side effects: increased blood pressure, edema, cardiac enlargement precipitating in congestive heart failure, potassium loss leading to hypocalcemic alkalosis

Nappy Soft cream

Ingredient: Zinc Oxide

Indication:Diaper rash, Anal excoriation

Dose: LA TDS X 5 days

Nitrofurantoin

Tab 50mg,100mg |Syp 25mg/5ml

Indication:Prevention and treatment of UTI, VUR

Dose:

Not prescribed below 1 month
UTI treatment:
- 1 month-12 years: 5-7 mg/kg/day orally, in 4 divided doses for 7 days. Max: 400 mg/day.
UTI prophylaxis:
- 1-2 mg/kg/dose at bedtime or in 2 divided doses. Max: 100 mg/24 hours.

Side effects: Nausea, vomiting, loss of appetite, headache

Notes: Anuria, oliguria, or significant impairment of renal function are contraindications.

Neopeptine

Drop /Syp

Indication: Used for the symptomatic relief of flatulence, abdominal distension, belching, and other symptoms associated with gas.

Dose:

<2 years: 2.5ml BD x 5-7 days
>2 years: 5ml BD x 5-7 days

Side effects: Throat irritation, itching, rashes, difficulty in breathing

Neosporin (Neomycin and Polymyxin B)

Ointment and powder

Indication: Umbilical granuloma

Dose:

LA TDS X 5 days

NS bolus

Indication: Shock

Dose:

Neonate:
- 10ml/kg/dose over 20 minutes
Child
- 20ml/kg/dose over 20 minutes

Ofloxacin

Ear drop 0.3%| Eye drop 0.3% | Syp 50mg/5ml | Inj 2mg/ml

Indication: UTI, Typhoid, Diarrhea. Drop is used in otitis externa, corneal ulcer, ASOM, CSOM

Dose:

Neonate:
- PO: 10 mg/kg/dose BD (Max: 20mg/kg/dose)
- IV: 10mg/kg/dose BD (Max: 10mg/kg/dose)
Drops (0.3%)
- Bacterial conjunctivitis, Corneal ulcer:
  - >1 year: Day 1 and 2 put 1-2 drops in
    affected eye every 2-4 hours. From day 3-7,
    put 1-2 drops, every 6 hours until clinical
    cure.
Otitis media:
- 1-12 years: 5 drops in affected ear twice daily.
- >12 years: 10 drops in affected ear twice daily.

Notes: Give for 1 week for acute otitis media with tympanostomy tubes and for 2 weeks for chronic suppurative otitis media with perforated tympanic membrane

Ondansetron/Ondem

Inj 2mg/ml| Tab 4mg | Syp 5ml/ 2mg

Indication: Nausea and vomiting

Dose: 0.1-0.2mg/kg/dose

PO:
- < 4 yr: 1-3 mg
- 4-11 yr: 4 mg
- >11 yr, 8 mg q 8 hrly
IV
- 0.15-0.45 mg/kg/dose q 8 hr.
For IV dilute to 1 mg/ml and be given over 15
minutes

Side effects: Headache, dizziness, drowsiness,
constipation.

Paracetamol (Oral, IV, Per Rectal)

Drop PCM (1ml/150mg), Syp PCM (5ml/125mg, 120mg ),
Suppositary 125mg, 250mg, 500mg

Indication: Fever, Pain

Dose:

PO/IV/ Per Rectal: 10-15mg/kg/dose TDS/QID
< 1yr: Give Drop (Wt/10) ml PO TDS
>1 yr: Give Syp (Wt/2) ml PO TDS

Side effects: Liver injury, Anaphylaxis, renal tubular necrosis

PIPTAZ (Piperacillin Tazobactum)

Inj 4.5gm, 2.25gm

Indication: Pseudomonas, Klebsiella

Dose:

Newborn:
- 50-100 mg/kg/dose (piperacillin component) IV BD or TDS
Children:
- 100 mg/kg/dose (piperacillin component) IV 3 times daily. Max: 4 g/dose piperacillin and 4.5g/dose piperacillin tazobactam

Side effects: Nausea, vomiting, diarrhea, skin rash,injection site reactions

Phenobarbitone (Oral, IV)

Tab 15, 30, 60 mg

Indication: Epilepsy, Neonatal seizure, status epilepticus, Hyperbilirubinemia, Jitteriness

Dose:

Neonate:
- Loading dose:
  - 20 mg/kg over 15 – 20 min
- Maintenance dose:
  - 2.5mg/kg/dose Q 12 H (first dose given 12 hours after loading)
Infants:
- 5-6 mg/kg/24 hours oral or IV in 2 divided doses or as single daily dose.
1-5 years:
- 6 -8 mg/kg/24 hours oral or IV in 2 divided doses or as single daily dose.
6-12 years:
- 4-6 mg/kg/24 hours in 2 divided doses or as single daily dose.
>12 years:
- 1-3 mg/kg/24 hours oral or IV in 2 divided doses or as single daily dose.
Hyperbilirubinemia (off-label):
- Neonates: 5 mg/kg/day oral/IV as a single dose or twice daily. Not widely used as phototherapy usually suffices.

Side effects:Drowsiness, dizziness, excitation, nausea,headache

Phenytoin (IV)

Syp 25mg/ml | Inj 50mg

Indication: Epilepsy, Status Epilepticus, Nerupathic pain

Dose:

Status epilepticus:
- Loading : 20mg/kg/dose (1st), 10mg/kg/dose (2nd, 3rd)
- Maintenance – 5mg/kg/day BD
Antiepileptic:
- Loading doses:
  - Neonates: 5 mg/kg/day PO in 2 divided dose.
  - 6 months-16 years: 5 mg/kg/day PO in 2-3 divided doses.
- Maintenance doses:
  - 6 months-4 years: 8-10 mg/kg/day PO in divided doses 2-3 times daily.
  - 4-17 years: 7.5-9 mg/kg/day PO in divided doses 2-3 times daily.
  - 7-10 years: 7-8 mg/kg/day PO in divided doses 2-3 times daily.
  - 10-16 years: 6-7 mg/kg/day PO in divided doses 2-3 times daily.

Side effects: Gum hypertrophy, hirsutism, osteomalacia,coarse facies

Notes: IV injections should be followed by NS flushes to avoid local irritation of the vein.

Pralidoxime

Inj 500mg

Indication: Write

Dose:

IM, IV:
- 25-50 mg/kg as 5% solution over 15-20 min. The dose may be repeated after 1-2 hr and then at 10-12 hr interval if cholinergic crisis recur
<12 yrs:
- 25mg/kg over 30 min and continues infusion 10mg/kg/ hour in children
>12 yrs:
- 1-2 g IV infusion over 30 min

Side effects: Headache, dizziness, drowsiness, seizure, visual disturbances, tachycardia, hyperventilation, muscle weakness, nausea, hypertension, pain at injection
site

Prednisolone (Oral, IV)

Tab 2.5, 5, 10, 20, 40 mg

Indication: Severe Asthma, Croup, Nephroticsyndrome, connective tissue disorder, IBD, infantile spasm

Dose:

2mg/kg/day stat then 1mg/kg/day
Acute asthma:
- Oral: 1 mg/kg/day as a single daily or 2 divided doses for 3-5 days (If steroid is used for wheezing)
Nephrotic syndrome:
- Oral: Initially 4 weeks: 60 mg/m²/day or 2mg/kg/day; Max: 80 mg/day; orally in 3 divided doses until proteinuria is absent for 3 consecutive days. Next 4 weeks: 40 mg/m² or 1.5 mg/kg oral every other day; Maximum dose: 60 mg/day.
- Maintenance doses (for frequent relapses):0.5-1 mg/kg/dose orally every other day for a period of 3-6 months.

Side effects: Congestive heart failure, hypertension, hypokalemia, cardiac enlargement, edema, and hypokalemic alkalosis.

Propofol (IV)

Inj 10mg/ml

Indication: Sedative, Hypnotic, Anaesthesia

Dose:

1-3 mg/kg loading dose then 1mg/kg/hr
For induction of anaesthesia:
- 3-16 years: 2.5-3.5 mg/kg IV perfusion over 20-30 seconds (older children may require lower doses as compared to younger ones).
Maintenance of anesthesia:
- 2 months-16 years: 0.125-0.3 mg/kg/min IV; after 30 mins, decrease the infusion rate if clinical signs of light anesthesia are absent; older children may require lower doses compared to ≤5 years.
Sedation prior to procedure:
- 1-18 years: 1 mg/kg IV loading dose and then 0.5 mg/kg IV.

Side effects:Respiratory acidosis and depression

Potassium Chloride (15% w/v)

Inj 15 % – 2mEq (approx. ) or 150mg / ml , Syp 15ml / 1.5 gm (
20 mEq approx.)

Indication:Hypokalemia

Dose:

Hypokalemia: PO, IV: 2-5 mEq/kg/day in divided doses.
Potassium supplementation: Oral 0.5-2 mEq/kg 2 times daily

Side effects: Hyperkalemia. Upper and lower GI obstruction, bleeding, ulceration and perforation. The most common adverse reactions to oral potassium salts
are nausea, vomiting, flatulence, abdominal pain/discomfort, diarrhea.

Notes: IV doses should be added to maintenance fluids and PO doses should be diluted to 8 times in water. Rapid administration may cause arrhythmias and cardiac arrest, hypotension. Injectable should only be given in patient with adequate urine flow

Qudrajel (Ointment)

Contain Chlorhexidine 1%, Metronidazole 1%, Lignocaine 2%

Indication: Apthous ulcer

Dose:

LA TDS x 3 days

Side effects:Skin irritation.

Ranitidine

Syp 5ml/75mg | Tab 150mg | Inj 2ml/50mg

Indication: APD, Gastritis, Gastric ulcer, Hyperacidity, GERD
Dose:

Dose:

IV: 10mg/kg/day BD ;Maximum: 50 mg/dose or 300 mg/day.

Side effects: Hypersensitivity reactions, including urticaria, angioneurotic edema, fever, bronchospasm, hypotension and anaphylaxis have been reported.

Salbutamol (Oral, IV, Nebu, MDI)

Syp 2mg/5ml (Beta 2) | Respule 2.5ml/ 2.5mg | MDI
100mcg/dose

Indication: Severe bronchospasm, Hyperkalemia

Dose:

PO – 0.1-0.4mg/kg/dose TDS
- Neonates: 0.1-0.3 mg/kg/dose q 6-8 hr.
- Children
  - < 6 yr: 0.1-0.2 mg/kg/dose TDS
  - 6-12 yr: 2 mg/dose TDS or QID
  - >12 yr: 2-4 mg TDS or QID
MDI -100 mcg/puff TDS
- 2 puff PO TDS x 5 days then sos
Nebulization:
- Neonates; 0.1-0.5 mg/kg/dose or q 2-6 hr
- Children; 0.15-2.5 mg/dose or q 4-6 hr (Min:2.5 mg).
- <2yrs: 0.2-0.6 mg/kg/day every 4-6 hours, >2 years: 0.6-2.5mg every 4-8 hourly)

Side effects:Tachycardia, Hyperglycemia

Sodium Bicarbonate (7.5%)

1meq/ml

Indication: Metabolic acidosis, life-threatening hyperkalemia, correction of acid base imbalance in cardiac arrest

Dose: 0.5 to 2 meq/kg/day in 3-4 divided doses

For correction of metabolic acidosis:
- Dose calculation:
  - - HCO3 needed (mEq) = HCO3 deficit (mEq/L) x (0.3 x body weight in kg) OR HCO3 needed (mEq) = 0.4 x body weight in kg x (desired bicarbonate-actual bicarbonate) (Assume desired bicarbonate as 24 meq)
  - Administer half the calculated dose over 4 hours and re-assess. Dilution: Can be diluted in NS, 5% Dextrose, 10% Dextrose or WFI. For peripheral infusion, dilute at least 1:10; for central line infusion, dilute in at least 1:5

Side effects: Frequent urination, mood changes, muscle pain, irregular heartbeat.

Notes: Contraindicated in hypocalcemia, hypernatremia, inadequate ventilation. May cause cerebral hemorrhage, metabolic alkalosis, hypernatremia, hypokalemia hypocalcemia, pulmonary edema. For IV use dilute in equal volume of sterile water.

Surfactant

inj 4ml, 8ml

Indication: Prophylaxis and treatment of RDS in premature neonates

Dose:

Prophylactic therapy:
- 4ml/kg/dose intratracheally as soon as possible; up to 4 doses can be given at 6 hr interval during the first 48 hr of life.
Rescue therapy:
- 4ml/kg/dose intratracheally, immediately following the diagnosis of RDS. May repeat 4 dose as needed at 6 hr interval.

Side effects: May cause bradycardia, pallor, hypotension, apnea, pulmonary air leak

Notes: Avoid suctioning of ETT for at least 1 hour.

Secnidazole (Oral)

Syp 10ml/500mg | Tab 500mg, 1000mg

Indication: Intestinal amoebiasis, Giardiasis

Dose:

30mg/kg/dose

Side effects: Stomach pain, diarrhea, dry mouth, a
metallic taste in the mouth

Sildenafil

Tab 25, 50, 100mg

Indication: Pulmonary hypertension

Dose:

Initially 250-500mcg/kg q4-8h. Adjust according to response and maximum dose 2mg/kg q6h

Side effects: Hot flushes, Headaches, Vomiting

Tobramycin

Eye drop 0.3% w/v

Indication:Conjuncitivitis

Dose:

1 Drop LA TDS x 7 days

Thyroxine

Tab 12.5, 25, 50, 75, 100mcg

Indication: Hypothyroidism

Dose:

1–3 mo:
- 10–15 mcg/kg/dose once daily. If patient is at risk for developing cardiac failure, start with lower dose of 25 mcg/24 hr, and if patient has very low T4 (<5 mcg/dL), use higher dose of 12–17 mcg/kg/24 hr.
3–6 mo: 8–10 mcg/kg/dose once daily
6–12 mo: 6–8 mcg/kg/dose once daily
1–5 yr: 5–6 mcg/kg/dose once daily
6–12 yr: 4–5 mcg/kg/dose once daily
>12 yr:
- Incomplete growth and prepuberty:
  - 2–3 mcg/kg/dose once daily
- Complete growth and puberty:
  - 1.7 mcg/kg/dose once daily

Side effects: Iatrogenic hyperthyroidism, partial hair loss. With excessive dose: tachycardia, sweating, cramps, excitability, headache, palpitations, cardiac arrhythmias, and diarrhea

Notes: Start with lower dose and increase every 4-6 weeks if risk for cardiac failure; adjust dose based on Thyroid function tests. Give oral form on empty stomach.

Vitamin A

Chewable tablets 1 Tab/ 50,000 IU

Indication: Measles, Vitamin A deficiency

Dose:

Prophylaxis in patient at risk (malnutrition, severe infection, recurrent diarrhea, pneumonia).
- <1 yr; 100,000 units
- > 1 yr; 200,000 units given PO q 4-6 mth.
Children with Measles:
- Oral or IM: 50,000 units once daily for 2 days; administer a third dose 2-4 weeks later if clinical manifestations of vitamin deficiency are present.
Xerophthalmia
- Oral
- <6 months:
  - Initially, 50,000 units daily for 2 days; repeat with 50,000 units at least 2 weeks later (total of 3 doses).
- 6-12 months of age:
  - Initially, 100,000 units daily for 2 days, then 100,000 units at least 2 weeks later (total of 3 doses)
- >12 months of age:
  - Initially, 200,000 units daily for 2 days, then 200,000 units at least 2 weeks later (total of 3 doses).

Vitamin K

inj (Phytonadione) 10mg/1ml

Indication: Newborn to prevent Hemorrhagic disease of newborn, Vitamin K deficiency prophylaxis, Hepatic failure, Antidote to warfarin

Dose:

Prophylactic dose
- 1mg for term infants, 0.5mg for preterm infants
Therapeutic dose – 5-10mg/dose
Warfarin poisoning: 5-10 mg IM or IV
- < 2 Kg:
  - Oral 1 mg,, IM/IV 0.5mg
- >2kg:
  - Oral 2 mg, IM/IV 1mg

Side effects: Pain, swelling, or irritation where the injection was given

Tus Q –Dx (Dextromethorphan)

Indication: Used to temporarily relieve cough caused by minor throat and bronchial irritation

Dose:

1-2mg/kg/day, up to a maximum of 60mg/day

Side effects: Dizziness, lightheadedness, drowsiness, nervousness, restlessness, nausea, vomiting, stomach pain

Tranexamic Acid

Inj 500mg , Tab 250mg, 500mg , 1gm

Indication: Bleeding after surgery or injury, Heavy menstrual bleed

Dose:

10mg/kg/dose TDS

Side effects: Nausea, vomiting, diarrhea, and allergic
reactions

Ursodeoxycholic Acid

Syp 5ml/125mg

Indication: Cholestasis, Liver disease due to cystic fibrosis

Dose:

0 to 30 mg/kg/day, given orally in two or three divided doses

Side effects: Exacerbation of pre-existing psoriasis, rash, urticaria, dry skin, sweating, hair thinning, biliary pain, cholecystitis, constipation, stomatitis, flatulence

Notes: It is contraindicated in calcified cholesterol stones, gallstones > 15 mm, hepatic impairment, biliary obstruction

Vecuronium

inj 10mg

Indication: Anaesthesia, Ventilation

Dose:

Neonate:
- Initial: 0.1 mg/kg/dose IV
- Maintenance: 0.03–0.15 mg/kg/dose IV every 1–2 hr as required
Infants (>7 wk–1 yr):
- Initial: 0.08–0.1 mg/kg/dose IV
- Maintenance: 0.05–0.1 mg/kg/dose IV Q1 hr as required ; may administer via continuous infusion at 0.06–0.09 mg/kg/hr IV
>1 yr–adult
- Initial: 0.08–0.1 mg/kg/dose IV
- Maintenance: 0.05–0.1 mg/kg/dose IV every 1 hr as required; may administer via continuous infusion at 0.09–0.15 mg/kg/hr IV

Zinc (Oral, Ointment)

Tab Zinc 10mg, 20mg | Syp 5ml/20mg

Indication: AGE, Acrodermatitis enteropathica

Dose:

Acute Gastroenteritis
- < 6 months:
  - 10mg PO OD x 14 days
- > 6 months:
  - 20mg PO OD x 14 days
Deficiency
- PO: 0.5-1 mg/kg/day in 2-3 divided doses
Acrodermatitis enteropathica
- 6 mg/kg/day

Side effects: Nausea, vomiting, stomach upset, diarrhea, metallic taste in the mouth

Notes: Tell the caretaker to dissolve the tablet in expressed breastmilk, ORS, or clean water before giving to child. Common effect is vomiting so stop it once child start vomiting and you can continue after vomiting stop

Refrences:

THE HARRIET LANE HANDBOOK |TWENTY-FIRST EDITION
BNF for children 2022-2023

Asystole/ Bradycardia
- Neonate : IV, Intratracheal:
  - 0.01-0.03 mg/kg every 3-5 min as needed (0.1-0.3 ml/kg of 1: 10,000 solution)
- Infants and Children:
  - IV- 0.01 mg/kg (0.1 ml/kg of 1:10,000 solution). Max: 1 mg (10ml), may be repeated every 3-5 min as needed.
  - Intratrachea (ET)- 0.1 mg/kg (0.1 ml/kg of 1:1000 solution) repeat every 3-5 minutes
Bronchodilator
- Subcutaneous- 0.01 ml/kg/dose ( 1:1000 solution) (max. single dose 0.5 mL)
  - Repeat Q15 min × 3–4 doses (Also use in angioedema, urticaria, anaphylactic shock)
- Nebulization (Post extubation, Anaphylaxis,Croup):
  - Croup:
    - 0.5ml/kg per dose (max 5ml) of 1:1000 over 15 minutes (can be repeated every 15-20 mintues upto 3 to 4 dose. Cardiac monitoring required
      - Max. doses: ≤4 yr: 2.5 mL/dose; >4 yr: 5 mL/dose
    - Racemic epinephrine 2.25%: 0.5 mL/dose diluted to 3 mL with NS via a nebulizer over 15 min Q3–4 hr
  - Neonate (Post extubation):
    - Epinephrine (1:1000) 1ml= 0.1ml of racemic epinephrine
    - 0.25-0.5ml of racemic epinephrine solution diluted with NS to a total volume of 3 ml given by nebulizer over 15
      minutes.
Hypersensitivity
- IM: 0.01 mg/kg per dose (max 0.5mg per dose) of 1:1000 solution (Repeat after 15-20 minutes)

Side effects: Increased heart rate, nervousness, sweating, pallor, headache

Notes: Racemic epinephrine is mixture of the R- and L- forms (isomers) of epinephrine. It is more potent at reducing laryngeal edema.

Adrenaline and Noradrenaline (IV Infusion)

Indication: Hypotension, Shock

Dose:

0.1-1mcg/kg/min
- (Wt in Kg x 0.6)mg in 25ml NS or 5% Dextrose
  - 1ml/hr- 0.4mcg/kg/min
Wt in Kg x 0.6)mg in 50ml NS or 5% Dextrose
- 1ml/hr- 0.2mcg/kg/min

Side effects: Increased heart rate, hypertension, anxiety

Albendazole

Tab 200, 400 mg | Syp 10ml/ 400mg

Indication: Helminthic infections, Neurocysticercosis

Dose:

Not recommended for <1 yr
For 1-2 Years:
- Give 200mg PO HS (Single Dose)
For >2 Years:
- Give 400mg PO HS (Single Dose)
Neurocysticercosis:
- 15 mg/kg/day in 2 divided doses for 28 days (Max: 800 mg/day)

Side effects: Nausea, headache, dizziness

Adenosine

Inj 6mg/2ml

Indication: ·Paroxysmal supraventricular tachycardia (PSVT)

Dose:

Neonate:
- 0.05mg/kg/dose rapid IV push followed by NS flush. If not effective by 1-2 minutes, increase dose by 0.05mg/kg/dose every 1-2 minutes to maximum single dose of 0.25mg/kg until termination of SVT.
Child:
- 0.1–0.2 mg/kg (initial max. dose: 6 mg) by rapid IV push over 1–2 seconds; may increase dose by 0.05-mg/kg increments every 2 min to a max. of 0.25 mg/kg (up to 12 mg), or until termination of SVT. Max. subsequent single dose: 12 mg.
>50kg or Adult
- 6 mg rapid IV push over 1–2 seconds; if no response after 1–2 min, give 12-mg rapid IV push. May repeat a second 12-mg dose after 1–2 min if required. Max. single dose: 12 mg

Albumin (5%, 20%, 25%)

Indication: Hypoalbuminemia, Hypovolemia, Hypoprotenemia, Burns, Acute liver failure

Dose:

Use 5% Albumin in neonate
Hypoalbuminemia: 0.5-1gm/kg/dose given over 4 hours. Repeat every 1-2 days
Hypovolemia: 0.5g/kg/dose infuse over >60 min. Rapid infusion over 10-20 min in hypovolemic shock.
Max: 1 g/kg/day in neonates and 6 g/kg/day in
children

Side effects: Fluid overload, hypersensitivity reactions, hypertension

Aminophylline

Inj 25mg/ml

Indication: : Asthma, Apnea of prematurity, Bradypnea

Dose:

Acute bronchospasm (Asthma/Reactive airway
disease)
- IV:
  - Loading dose of 6 mg/kg diluted to 1 mg/ml and infuse over 30 min followed by 0.6-1.5 mg/kg/hr as continuous infusion, if already on oral therapy, omit loading dose.
- PO:
  - 15-20 mg/kg/day divided every 4 to 6 hours
  - Ensure there is no history of administration of theophylline in the past 24 hours.
Apnea of prematurity
- Loading dose: 5–6 mg/kg IV over 30 minutes
- Maintenance dose: 1–2 mg/kg/dose 8 hourly (After 12 hours of loading dose)
- Continuous infusion: 0.2mg/kg/hr

Side effects: : Seizures, tachyarrhythmias, feeding intolerance in neonates, gastroesophageal reflux, vomiting, CNS irritability

Notes: : With hold dose if heart rate greater than 180 beats/min

Amikacin

Inj 100mg/2ml | 250mg/2ml | 500mg/2ml

Indication: Gram-negative bacilli (E. coli, Klebsiella, Proteus, Enterobacter, Serratia, Pseudomonas, Mycobacterium tuberculosis and Atypical mycobacteria)

Dose:

Neonates (IV, IM):
- 15mg/kg/dose OD
Infants and children:
- 15mg/kg/day OD
Anti tubercular dose:
- 15-30 mg/kg/day (Max dose: 1 g)

Side effects: Nephrotoxicity, ototoxicity

Notes: Hold the drugs when if there is AKI (Raise cretinine level) or give the renal dose.

Amoxicillin

Syp- 5ml/125mg | Drop- 1ml/100mg | Cap- 500mg | DT250mg

Indication: LRTI, Pneumonia, Otitis Media, Sinusitis, Enteric fever

Dose: (PO)

Neonates:
- 20-30 mg/kg/day BD
- Infants and Children:
  - 50-80 mg/kg/day TDS or BD
    - Max: 2-3g/24 hr
- Tonsillitis/pharyngitis (S. pyogenes):
  - 50 mg/kg/24 hr TDS or BD PO × 7 days
    - Max. dose: 1 g/24 hr
- Enteric fever:
  - 100 mg/kg/day for 14 days

Side effects: Diarrhea, rash, hypersensitivity reactions

Notes: Common side effects of Amoxicillin is diarrhea. If diarrhea occur, stop the medicine and give Syp Bifilac and send the Stool R/M/E.

Amoxyclav (Amoxicillin- Clavulanic Acid)

Cap- 625mg (500mg +125mg)|DT- 375mg (250mg
+125mg)|Syp- 5ml (200mg+28.5mg)

Indication: Tonsillitis, LRTI, Pneumonia (Same as amoxicillin in addition β-lactamase producing M. catarrhalis, H. influenzae, Niesseria and S. aureus, Klebsiella)

Dose: ( Based on Amoxicillin component)

1-3 months:
- 30 mg/kg/day PO BD
>3 months and children:
- 50-80 mg/kg/day PO TDS
IV-100mg/kg/day TDS for 7-14 day

Side effects: Diarrhea, rash, hypersensitivity reactions

Ampicillin

Inj 100mg, 250mg, 500mg | Cap 250mg, 500mg | Syp
5ml/125mg

Indication: EONNS, Sepsis, Meningitis (Active against Streptococci, Pneumococci, Enterococci, some strains of H. influenzae, Salmonella, Shigella, E. coli and Klebsiella)

Dose:

Neonate:
- 100mg/kg/dose BD
Infants and Children:
- IV: 100-200 mg/kg/day QID
- PO: 50–100 mg/kg/day QID (Max dose: 4 g/24
  hr)
Sepsis: 200mg/kg/day TDS
Meningitis: 300mg/kg/day TDS

Side effects: Diarrhea, rash, hypersensitivity reactions

Ampiclox

Syp- 5ml/125mg, 5ml/250mg | Drop- 1ml/100mg | Capsule250mg, 500mg | DT-125mg, 250mg | IV- 500mg, 1gm

Indication: EONNS, Pneumonia, Bronchiolitis, LRTI

Dose:

IV
- Neonate:
- 200mg/kg/day BD
- Infant and children:
- 200mg/kg/day QID (Max-4gm)
PO
- 100mg/kg/day QID

Side effects: Diarrhea, rash, hypersensitivity reactions

Antacid

5ml/ 200mg (AlOH) + 200mg (MgOH) + 25mg (Simethicone)

Indication: Acid reflux, Peptic ulcer disease, bloating

Dose:

5 to 15 ml PO TDS
(Weight/2 ) ml BD/ TDS

Side effects: Constipation, diarrhea, nausea It is usually taken prior to your food almost 30 to 45 minutes before.

Anti-Tubercular

Always add pyridoxine to prevent peripheral neuropathy
Dose: 10mg PO OD x 6 months

Atropine

Inj 0.4mg/ml, 0.6mg/ml, 1mg/ml

Indication: Bradycardia, OP Poisoning

Dose:

OP Poisoning:
- IV- 0.05-0.1 mg/kg every 5-10 minutes until sign of atropinization. Start Atropine Infusion as (20% of atropinization dose (ml)/hr)
- OR,
  - <12 years: 0.05mg/kg IV
  - > 12 yrs: 1-2 mg/dose IV
Sinus bradycardia:
- Neonate:
  - 0.01–0.03 mg/kg/dose IV/IM every 10–15 min when required up to a total maximum of 0.04 mg/kg. (Administer IV over 1 min)
- Child:
  - 0.02 mg/kg/dose IV Q5 min × 2–3 doses when required
  - Max. single dose: 0.5 mg in children, 1 mg in adolescents
  - Max total dose: 1 mg children, 2 mg adolescents
Bronchospasm
- Inhalation- 0.03-0.05 mg/kg/ dose 3-4 times/day (Max: 2.5 mg/dose) in 2.5ml NS every 6-8 hours via nebulizer

Side effects: Dry mouth, blurred vision, tachycardia

Azithromycin

Syp- 5ml/100mg, 5ml/200mg| Tab- 100mg, 250mg, 500mg|
Inj 500mg

Indication: URTI, Typhoid fever, Scrub Typhus, LRTI, Pneumonia, Pertusis

Dose: 10-20 mg/kg/day PO OD for 5 fays (Max: 500 mg/day)

Pharyngitis/Tonsilitis (2-15 yrs)
- 12 mg/kg/24 hr PO once daily × 5 days (max.
  dose:500 mg/24 hr
Typhoid: 20 mg/kg/day PO OD x 7 days
Intravenous: 10-20mg/kg/day OD

Side effects: : Nausea, vomiting, diarrhea, abdominal pain

Betamethasone

Ointment 0.1% W/W

Indication: : Phimosis

Dose: 0.1% LA BD x 15 days

Side effects: Fibrosis

Notes: Tell parents to apply ointmen to forskin after cleaning it. Then, retract the foreskin for about 1 minute. Tell them not to leave the foreskin retracted as it might cause paraphimosis.

Bifilac (Pre and Probiotic granules)

5ml/Lactic acid bacillus, Streptococcus fecalis, Colistridiumbutyricum, Bacillus mesentricus

Indication: : Diarrhea, Irritable bowel syndrome, Gut flora imbalance

Dose:

<2yr- 2.5ml BD;
>2yr- 5ml BD x 5 days
Or
<10kg: 2.5ml PO BD x 5days
>10kg: 5ml PO BD x 5 days

Side effects:Bloating, gas, upset stomach

Brica-BM (Pediatric)

(Bromhexine Hcl 4 mg + terbutaline sulphate 1.5 mg )/ 5ml

Indication: Productive cough, Asthma

Dose:

<3 year: 2.5ml TID
3-6 year: 2.5-5ml TID
7-15 year:5-10ml TID

Side effects: GI side effects, headache, dizziness, sweating, skin rashes, tremor, headache, nervousness, restlessness, transient hypoglycaemia, dizziness, drowsiness, insomnia, dry mouth

Budecort MDI

200mcg Budesonide/dose

Indication: Asthma, Reactive Airway Disease

Dose:

200mcg 1 puff BD
Max: 1mg/day

Side effects: Throat irritation, cough, hoarse voice, oral candidiasis (Tell patient to rinse mouth after each use either use water or give breastfeeding )

Buscopan (Hyoscine Butyl Bromide)

Inj 20mg/ml | Tab 10mg , 20mg

Indication: Abdominal colic, Renal colic

Dose:

Oral:
- 5-12 Years: 10mg/dose PO TDS x 2 days then
  SOS
- 12-18 years: 20mg/dose PO TDS
IV:
- < 6 years: 5mg/dose TDS
- 6-12 years: 5-10 mg/dose TDS
- >12 years: 20mg/dose TDS

Side effects: Dry mouth, dizziness, blurred vision, constipation

Caffeine Citrate

Inj 20mg/ml

Indication: Idiopathic apnea of prematurity

Dose:

Loading dose:
- 20 mg/kg IV over 30 mintues
Maintenance dose:
- Give after 24 hours of loading dose
- 5 -10 mg/kg/day caffeine base OD IV (Given
  over 10 minutes)

Calcium gluconate

Inj 100 mg/mL (10%)

Indication: Hypocalcemia

Dose:

Hypocalcaemia
- Loading:
  - 1-2ml/kg (100-200mg/kg) of calcium gluconate 10% as a single dose IV over 5-10 minutes (Slowly not >10ml)
- Maintenance:
  - 2-8ml/kg/day (200-800mg/kg/day) IV infusion over 24 hours
- Cardiac arrest and hyperkalemia :
  - 100 mg/kg/dose IV over 10 minutes

Side effects: Hypotension, bradycardia, arrhythmias, hypercalcemia, hypophosphatemia.

Calvit

Syp 10ml/ 200IU (Vitamin D3)+ 400mg (Calcium
Phosphate) | Tab Calvit

Indication:Calcium Deficiency, Growing pain

Dose: (Based on Calcium Phosphate)

PO: 75 mg/kg/day PO BD x 10-15 days
> 12 Year
- Tab Calvit 1 tab PO OD TDS x 10-15 days

Side effects: Constipation, Nausea

Calamine Lotion

Calamine 15%, Zinc Oxide 5%, Menthol 0.5%

Indication: Topical anti-pruritic, Skin soothing and
protective

Dose: Applied to affected area three times daily for
up to 5-10 days.

Side effects: Mild itching, tingling, or irritation

Notes: Should not be applied in open wound or broken
skin

Candid Mouth paint

Clotrimazole 1% w/v

Indication: Oral Candidiasis

Dose: LA TDS x 5days

Side effects: Mouth Irritation

Cefixime

Syp: 5ml/50mg, 5ml/100mg | DT: 50mg, 100mg, 200mg,
400mg

Indication: : UTI, Diarrhea, Enteric Fever, Mesentric
adenitis

Dose:

10-20mg/kg/day BD
Enteric fever: 20mg/kg/day x 14 days
Adolescent: 200mg PO BD x 7 days

Side effects: Pseudomembranous colitis, Nausea, Diarrhea, Abdominal Pain, Headache

Carbamazepine

Syp 100mg/5ml| Tab 200mg, 400mg

Indication: Prophylaxis of generalized tonic-clonic, partial, mixed partial or generalized seizures, Trigeminal neuralgia or diabetic neuropathy, Bipolar disorders; myotonic muscular dystrophy

Dose:

< 6 years
- Initial: 10–20 mg/kg/24 hr PO ÷ BID-TID (QID for suspension)
- Increment: Q5–7 days up to max. dose of 35 mg/kg/24 hr PO
6-13 years
- Initial: 10 mg/kg/24 hr PO ÷ BID up to max. dose: 100 mg/dose BID
- Increment: 100 mg/24 hr at 1 wk intervals (÷ TIDQID) until desired response is obtained.
- Maintenance: 20–30 mg/kg/24 hr PO ÷ BID-QID; usual maintenance dose is 400–800 mg/24 hr; max. dose: 1000 mg/24 hr.
- >12 years
  - Initial: 200 mg PO BID Increment: 200 mg/24 hr at 1 wk intervals (÷ BID-QID) until desired response is obtained. Maintenance: 800–1200 mg/24 hr PO ÷ BID-QID
  - Max dose:
    - 12–15 yr: 1000 mg/24 hr
    - >15 yr: 1200 mg/24 hr

Side effects: Exacerbation of seizure, sedation

Cefotaxime

Inj 500mg, 1gm, 2gm, 10gm

Dose:

Neonates (0-4 weeks)
- < 7 days:
  - < 2kg: 50mg/kg/dose BD
  - > 2kg: 50mg/kg/dose TDS
- > 7days:
  - <1.2 kg: 50mg/kg/dose BD
  - 1.2-2kg: 50mg/kg/dose TDS
  - >2kg: 50mg/kg/dose QID
- Infant and children
  - <12 years or <50 kg:
    - 100-200 mg/kg/day IV/IM in 6-8 hourly divided doses for 7-14 days.
    - For severe infections, meningitis use the dose of 200 mg/kg/day.
  - >12 years or >50 kg:
    - 1-2 g /doseIV/IM every 8 hours for 7-14 days. For severe infections, meningitis use the dose of 2 g/day. (Max: dose: 12 g/day)

Side effects: Diarrhea, Rash, Nausea, Injection site inflammation, hypersensitivity (rash, pruritus, fever, urticaria and anaphylaxis), pseudomembranous colitis

Cefpodoxime

Syp: 5ml/50mg, 5ml/100mg | Drop: 1ml/100mg | Tab:
100mg, 200mg | DT: 50mg

Indication:Pharyngititis or tonsilitis, Acute maxillary sinusitis, skin and skin structure infections, UTIs, ASOM

Dose: 10mg/kg/day/BD x 5- 10 days

Side effects: Nausea, allergic reaction

Ceftriaxone

Inj 250mg, 500mg, 1gm, 2gm

Indication: Meningitis, Typhoid, Pneumonia, Otitis media, Pyelonephritis, Septicemia, UTI

Dose: : IV

Infants and children:
- Mild to moderate infection: 50-75 mg/kg/day every 12 hourly (Max dose: 2gm/24hr)
- Meningitis and typhoid fever: 100mg/kg/day every 12 hourly (Max dose: 2gm/dose)
- Ceftriaxone: 75-100 mg/kg/day BD
Adolescent: 1–2 g/dose Q12–24 hr IV/IM; max. dose: 2 g/dose and 4 g/24 hr

Side effects: Injection site inflammation, rash, pruritus, fever, eosinophilia, urticaria, anaphylaxis

Cefuroxime

Inj 750mg, 1.5mg | Tab 125mg,250mg, 500mg| Syp 125,
250mg/5ml

Indication: Bone and joint infection, sepsis, URTI, UTI, Otitis media, acute bacterial sinusitis, Impetigo

Dose:

IV/IM
- Neonate <7 days: 100 mg/kg/day divided 12 hourly IV
  - >7 days: 150 mg/kg IV/IM divided 8 hourly.
- > 3 mo
  - Mild/moderate infection: 75–100 mg/kg/24 hr ÷ Q8 hr; max. dose: 1500 mg/dose
  - Severe infection: 100–200 mg/kg/24 hr ÷ Q6–8 hr; max. dose: 1500 mg/dose
PO
- 3 months-12 years: 20-30mg/kg/day BD for 10
  days (Max: 1g/day)
- >13 yrs: Tab: 250 mg BD

Side effects: Pseudomembranous colitis, nausea and vomiting, diarrhea, rash, urticaria, angioedema, pruritus, false positive urine glucose test, positive direct Coombs tests

Cetirizine

Tab 5mg, 10mg | Syp 5mg/ml

Indication:Allergic rhinitis, Urticaria

Dose:

6 month- 2 year: 2.5mg PO OD (Max: 5mg/24hr)
2-5 year: 2.5-5mg PO OD or BD
>6 year– adult : 5-10 mg PO once daily

Side effects: Headache, pharyngitis, GI symptoms, dry mouth, and sedation

Notes: Generally not recommended for treating URIs in infants. No proven benefits in infants and young children with URIs.

Charcoal (Activated)

Indication: To prevent absorption of any orally ingested poison

Dose:

Infants: 1 g/kg/dose orally, repeat every 4-6 hours.
Children: 1-2 g/kg/dose or 25-50 g/dose orally; repeat every 4-6 hours.
Adolescents: 5-10 times the estimated weight ofthe drug/chemical ingested (or 50-100 g dose); repeat every 4-6 hours

Side effects: Vomiting, constipation, black stools, intestinal obstruction

Ciprofloxacin

Tab: 250mg, 500mg, 750mg | DT: 250mg| Syp 5ml/125mg,
250mg |Ointment 0.3% w/w | Ear/Eye Drop 0.3% +
(Dexamethasone 0.1%)

Indication: Pyelonephritis, Pneumonia, Typhoid, Appendicitis, Gastroenteritis, Cholera, conjunctivitis, ASOM, Otitis externa

Dose:

Oral:
- 30-40 mg/kg/day PO divided into 12 hourly doses (Maximum: 500 mg/dose) for 10-21 days.
IV:
- 20-30 mg/kg/day IV in 8-12 hourly divided doses (Maximum: 1.2 g/day) for 10-21 days
Conjunctivitis:
- Ointment LA HS x 5 days
Acute otitis externa (≥1 yr and adult):
- 0.25 mL to affected ear(s) BID × 7 days
ASOM with tympanostomy tubes or acute otitis
externa (≥6 mo and adult):
- 4 drops to affected ear(s) BID × 7 days

Side effects: Arthralgia, pseudomembranous colitis, erythema nodosum, Stevens-Johnson syndrome, reversible haematological disorders.

Notes: Use with caution in patients with seizures and renal problems

Clindamycin

Inj 150mg/ml, 300, 600mg

Indication: Active against aerobic gram-positiveStaphylococci and Streptococci and anaerobc bacteria such as Fusobacterium, Bacteroids and Actinomyces

Dose:

<7 days
- <2kg: 5mg/kg/dose IV BD
- > 2kg: 5mg/kg/dose IV TDS
>7 days
- <1.2kg: 5mg/kg/dose IV BD
- 1.2-2kg: 5mg/kg/dose IV TDS
- >2kg: 5-10mg/kg/dose TDS or QID
Child and adolescent:
- PO: 10–40 mg/kg/24 hr ÷ Q6–8 hr; max. dose: 1.8 g/24 hr
- IM/IV: 25–40 mg/kg/24 hr ÷ Q6–8 hr; max. dose: 2.7 g/24 hr

Cotrimoxazole (TMP-SMX)

Syp 5ml/ Trimethoprim-40mg and Sulphamethoxazole200mg

Indication: : UTI prophylaxis, Bacillary dysentery, Otitis media

Dose:

<2 months: Contraindicated.
Mild to Moderate Infections:
>2 months
- IV -8-10 mg TMP/kg/day in 2 divided doses.
- PO- 15-20 mg TMP/kg/day in 4 divided doses.
  - Max: 320 mg/day trimethoprim and 1.6 g/day of sulfamethoxazole.
Prophylaxis:
- 150 mg TMP/m²/day PO in 2 divided doses /hr for 3 days/week on consecutive or alternate days
- Or, 2 mg TMP/kg/dose PO every day, or 5 mgTMP/kg/dose two times weekly

Colistin (Colistimethate)

Inj 1, 2 Million I/U

Indication: : MDR gram negative infection,
Pseudomonas lung infection in cystic fibrosis

Dose:

Neonates, Infants and Child (<60kg)
- 25,000 units/kg/dose every 8 hour
- Dilution for IV infusion: Dilute in NS to
  concentration of 40,000units/ml and infuse
  over 30 min
- Dilution for slow IV injection: Dilute in NS to
  concentration of 90,000units/ml

Side effects: : Dizziness, paresthesia, tingling sensation,neurotoxicity, nephrotoxicity, acute respiratory failure

Cyclopam (Dicyclomine)

Drop (1ml/10mg) | Syp (5ml/10mg) | Inj 1ml/10mg

Indication:Infantile colic, renal colic

Dose: (PO)

Infants >6 months:
- 5 mg 3-4 times a day; Max: 20 mg/day orally.
Children:
- 10 mg 3-4 times a day; Max: 40 mg/day orally.
To be taken half to one hour before meals.

Side effects: Dry mouth, thirst and dizziness, tachycardia, decreased sweating, blurred vision.

Dobutamine

Inj 250mg/vial

Indication: Hypotension persisting after adequate fluid volume replacement, cardiac failure, septicemia

Dose: 5-20 mcg/kg/min

2.5-15 mcg/kg/minute as continuous infusion and titrate to response (Max: 20 microgram/kg/min in newborn and 40 mcg/kg/minute in children)

Dopamine and Dobutamine (Infusion)

Indication: Used to support blood pressure in conditions like septic shock or heart failure

Dose:

(wt in kg x 6)mg in 25ml 5% dextrose or NS
- 1ml/hr for 4mcg/kg/min or at 4ml/hr for 16mcg/kg/min
(wt in kg x 6)mg in 50ml 5% dextrose or NS
- 1ml/hr for 2mcg/kg/min or at 4ml/hr for 8mcg/kg/min.

Side effects: Increased heart rate, hypertension, palpitations, chest pain.

Dexamethasone (Dexona)

Inj 4mg, 8mg| Tab 0.5mg

Indication: BPD, Cerebral edema, meningitis, Croup, Raise ICP, Inflammation, Spinal cord compression

Dose:

Airway Edema:
- 0.25-0.5mg/kg/dose once IV given 4 hours before extubtion. May repeat q8h for a total of 4 dose
Croup:
- 0.6 mg/kg/dose orally/IM/IV, Max: 16 mg
Asthma exacerbation:
- 0.6 mg/kg/dose (max. 16 mg/dose) PO/IV/IM Q24 hr × 1 or 2 doses; use beyond 2 days increases risk for metabolic adverse effects
Inflammation:
- 0.08-0.3 mg/kg/day orally/IV/IM in 2-4 divided doses.
Meningitis:
- 0.15mg/kg/dose IV in 4 divided doses for 2-4 days 10-20 minutes prior or simultaneously with antibiotics.
Cerebral Edema:
- 1-2 mg/kg/dose IV/IM stat; Maintained on 1-1.5 mg/kg/day IV/IM in 4-6 divided doses; Max: 16 mg/day.
Spinal Cord Compression:
- 2 mg/kg/day in in 4 divided doses

Side effects:: Hypertension, Insomnia, mood changes, increased appetite, weight gain.

Dextrose

5%, 10%, 25%

Indication: Hypoglycemia, Hyperkalemia

Dose:

Hypoglycemia:
- Neonates:
  - 2 ml/kg/ dose of 10% solution) followed by 4-6 mg/kg/min infusion
- Infants and children:
  - 0.5-1 g/kg/dose (2-4 ml/kg/dose of 25% solution) Or 5ml/kg/dose of 10% Dextrose
Hyperkalemia:
- 0.5-1 g/kg of 25% or 50% solution combined with 1 unit of regular insulin for q 5 g dextrose, to be infused over 2 hr

Diazepam

Inj 5mg,10mg| Tab 2mg, 5mg, 10mg |Rectal gel

Indication: Status epilepticus, skeletal muscle relaxant in tetanus, general anxiety, febrile seizures, preoperative sedation

Dose:

Status epilepticus:
- Per rectal (Rectal Gel):
  - 2-6 years: 0.5 mg/kg/dose repeat after 4-12 hours as per requirement.
  - 6-12 years: 0.3 mg/kg/dose, repeat after 4-12 hours as per requirement.
  - Above 12 years: 0.2 mg/kg/dose repeat after 4-12 hours as per requirement.
- Intravenous:
  - Neonate: 0.3–0.75 mg/kg/dose IV Q15–30 min × 2–3 doses; max. total dose: 2 mg
  - 6 months-5 years: 0.2–0.5 mg/kg/dose IV Q15–30 min; max. total dose: <5 yr: 5 mg; ≥5 yr: 10 mg. May repeat dosing in 2–4 hr, as needed.
  - Above 5 years: 1 mg slow intravenous infusion every 2-5 minutes; Max: 10 mg: can be repeated after 2-4 hours if needed.
- Sedative/muscle relaxant
  - IM or IV: 0.04–0.2 mg/kg/dose Q2–4 hr; max. dose: 0.6 mg/kg within an 8-hr period.
  - PO: 0.12–0.8 mg/kg/24 hr ÷ Q6–8 hr

Side effects: : Respiratroy depression (Rapid IV push), apnea, hypotension

Domperidone

Tab 10mg| Syp (5ml/5mg)| Drop (1ml/10mg)

Indication : Nausea and vomiting, reflux esophagitis, dyspepsia

Dose: : (PO)

1 month-12 years:
- 0.2-0.4 mg/kg/dose 3-4 times a day before food.
12-18 years:
- 10-20 mg 3-4 times a day

Contraindicated in GI obstruction or perforations. May increase prolactin secretion leading to gynecomastia in males and galactorrhea in females

Doxycycline

Cap 100mg | Inj 100mg/ml

Indication:Rickettsial fevers, Scrub typhus, malaria, cholera

Dose:

<8 years:
- Not recommended due to tooth discoloration and enamel hypoplasia (However, AAP recommends doxycycline as the drug of choice for rickettsial disease regardless of age)
>8 years:
- Bacterial infections, severe acne vulgaris,Rickettsial fever, Malarial fever:
- < 45kg:
  - 2.2 mg/kg/dose PO/IV 12 hourly 7-10 days (Max dose: 100 mg/dose). In malaria: Use along with quinine.
- > 45kg:
  - 100mg/dose BD PO IV

Side effects: Tooth discoloration in children <8 years, hypersensitivity reaction, photosensitivity, skin reaction, pericarditis, hepatitis

Enalapril

Tab 2.5mg, 5mg, 10mg | Inj 2.5mg/2ml

Indication:Hypertension, Hypertensive crisis, CCF, Proteinuria

Dose:

Hypertension:
- Use in children above 1 month of age.
- Oral:
  - 0.1-0.5 mg/kg/day PO OD or in 2 divided doses. Max: 40 mg/day. Adjust according to blood pressure.
IV:
- 0.01-0.02 mg/kg/day in two divided doses.
Hypertensive crisis:
- 0.05-0.1 mg/kg given as an intravenous injection.

Side effects: Neutropenia, agranulocytosis, anemia, thrombocytopenia, pancytopenia, rash, pruritus, arthralgia, fever, eosinophilia, hypotension, angioedema, cough

Ezevac Enema (30ml)

Glycerin 15% w/v , Sodium chloride 15% w/v , Purified water

Indication: impacted stool, constipation

Dose:

2.5 ml/Kg
2–4yrs: 15ml
5–11yrs: 30ml

Side effects: Upset stomach, Stomach cramps, Gas, Diarrhea, Burning, Rectal irritation.

Flucloxacillin

Inj 500mg, 1000mg | Syp 5ml/125mg | Cap 250mg, 500mg

Indication: Used to treat infections caused by penicillin-resistant Staphylococcus species.

Dose:

Oral –
- Adult: 250 mg 4 times daily. Dose may be doubled in severe infections.
- Child: <2 yr 62.5 mg 4 times daily; 2-10 yr 125 mg 4 times daily.
IV:
- Adult: 0.25-1 g 6 hrly, via slow inj over 3-4 min, or by infusion. Dose may be doubled in severe infections.
- Child: <2 yr Quarter of the adult dose; 2-10 yr Half of the adult dose.

Side effects:Rash, nausea, vomiting, diarrhea

Ferofolic (Iron)

Drop 1ml/20mg | Syp 5ml/220mg (elemental iron)

Indication:Used to prevent or treat iron and folic acid deficiencies

Dose:

PO
- Prophylaxis:
  - <2yrs: 1-2 mg/kg/day of elemental iron (Max: 15 mg/day).
  - >2yrs: 2 mg/kg/day of elemental iron (Max 30 mg/day).
- Deficiency: 4 -6 mg/kg/day of elemental iron OD/BD (Max: 15mg elemental Fe/24hr)

Side effects: GI irritation, nausea, diarrhea, dark stools, constipation, urine discoloration, teeth staining.

Fentanyl

Inj 50mcg/ml

Indication: Sedation, pain relief, preoperative medication, adjunct to anesthesia

Dose:

Neonates and infants
- Intermittent doses: 1-4 mcg/ kg/dose; may be
  repeated every 2-4 h r (For Sedation)
- Continuous infusion: 1-5 mcg/kg/hr.
1-12 yr
- Pain:
  - IM, IV: 1-3 mcg/ kg/dose; may be repeated
    after 30 minutes; continuous infusion: 1-5
    mcg/kg/hr
> 12 yr
- Pain: IM, IV: 0.5-1 mcg/kg/dose; may be
  repeated after ½ to 1 hour.
Anesthesia: IM, IV: 2-50 mcg/kg

Side effects: respiratory depression, hypotension, chest wall or jaw muscle rigidity (if given without muscle relaxants)

Contraindicated: Rraised ICP, severe respiratory depression, hepatic or renal problems

Notes: For IV administer slowly over 5-10 minutes. Rapid IV infusion may cause skeletal muscle rigidity, impaired ventilation, apnea, laryngospasm

Fexofenadine

Syp 5m/30mg | Tab 60, 120, 180

Indication:Cough, urticarial, allergic rhinitis

Dose:

6mo-2yrs: 15mg BD
2-12 yrs: 30mg BD
>12 yrs: 60mg BD or 180mg OD

Or,

<5kg- 2.5ml
5-10kg- 5ml
10-20kg- 7.5ml
>20kg – 10ml.

Side effects: Insomnia, dizziness, flatulence, diarrhea, abdominal pain, dyspepsia, vomiting, epistaxis, throat irritation, nervousness, appetite increase, agitation, nightmares, dry mouth

Notes: Medication as a single agent may be administered with or without food. Do not administer antacids with or within 2 hr. of fexofenadine dose.

Fusidic Acid

Cream 2%

Indication:Staphylococcal skin infections

Dose: LA TDS x 5 days

Side effects: Skin irritation, rash, itching

Glycopyrrolate

Inj 0.2mg/ml

Indication: Pre-anesthetic medication, Drooling, Control of Secretions, Neuromuscular Blockade reversal

Dose: 0.01mg/kg/dose TDS

Control of Secretions:
- 0.004-0.01 mg/kg IM/IV every 6 hours.
- 0.04-0.1 mg/kg orally every 6 hours.
Drooling:
- Under 3 years: Safety and efficacy not
  established.
- 3-16 years:
  - 0.02 mg/kg orally every 8 hours initially
    and can be increased by 0.02 mg/kg every
    5-7 days if needed; Max: 0.1 mg/kg every 8

Side effects: : Urinary hesitancy and retention, cycloplegia, xerostomia, blurred vision and photophobia

Hydrocortisone

Inj 100mg, 200mg| Tab 20mg

Indication: Acute asthma, Anaphylaxis, Arthritis, Adrenal insufficiency, Toxic shock, anti-inflammatory or immunosuppressive

Dose:

Neonate
- Hypoglycaemia (If hypoglycaemia persists
  despite GIR >12mg/kg/min): 2.5mg/kg q12h for
  24 to 48 hours
- Vasopressor-resistant hypotension:
  - Day 1 (Initial dose): 1mg/kg/dose q8h x 3 doses
  - Day 2 : 0.5mg/kg/dose IV q12 h x 2 doses
  - Day 3: 0.25 mg/kg/dose IV q12h x 2 doses
  - Day 4: 0.125 mg/kg/dose IV x 1 dose
    - If BP improves and other vasopressors have been weaned off, treatment may stop after 24 hours.
Anaphylaxis and acute asthma
- Loading: 5mg/kg/dose (Max: 250mg)
- Maintenance: 2mg/kg/dose TDS
Inflammation (<12 years):
- 2.5-10 mg/kg/day given as 3-4 divided oral
  doses or 1-5 mg/kg/day either
  intramuscularly or intravenously once or
  twice a day.

Side effects:Weight gain, high blood pressure, muscle weakness, mood and behavior changes

Flexon (Ibuprofen +Paracetamol)

Syp 5ml/100mg+ 125mg

Indication: : Used for relieving pain, reducing inflammation, and lowering fever

Dose:

10-15 mg/kg/dose
Fever:
- (Weight/ 2) ml TDS x 3 days then SOS

Side effects: Nausea, vomiting, constipation, diarrhea,gas, heartburn.

Insulin (Regular Human Insulin)

nj 40IU, 100IU

Indication: Treatment of insulin dependent diabetes mellitus, hyperkalemia, diabetic ketoacidosis.

Dose:

Only regular insulin can be given IV or IM.
Neonates:
- Regular insulin 0.01-0.2 unit/kg/hr (Usual Starting dose: 0.05 units/kg/hr) continuous infusion or 0.1-0.2 unit/kg q 6-12 hr SC.
For continuous infusion
- Dilution: Take 0.1ml of Insulin (=4 units) + 3.9ml WFI = 1 unit/ml then take 2 ml insulin (1 unit/ml) + 18ml WFI = 0.1unit/ml
- Flow rate (ml/hr) = [dose (units/kg/hr) x weight (kg)] / concentration (units/ml)
- Start insulin if glucose level remains >250mg despite efforts to reduce GIR
- Check glucose level every 30 minutes
- If glucose remains >180 mg/dl, titrate in increments of 0.01units/kg/hr
- If hypoglycaemia occurs, discontinue insulin and give 10% Dextrose 2ml/kg IV
Children:
- 0.5-1 unit/kg/day in divided doses SC, adjust dose as per blood glucose level.
Diabetic ketoacidosis:
- IV; Loading dose of 0.1 unit/kg followed by maintenance continuous infusion of 0.1 unit/ kg/hr, adjust as per blood glucose level.
Hyperkalemia:
- (Treat with IV calcium and sodium bicarbonate before giving insulin). Add 1 unit of regular insulin in 5 gm of dextrose solution, infuse at a rate of 0.5- 1 gm/kg over 30 min followed by 0.1 unit/kg SC or IV.

Ipratropium bromide (Nebulization)

Nebulization Solution: 500mcg/2ml

Indication: : Recurrent wheezing, severe respiratory distress , Asthma, RAD

Dose:

< 12 years: 250mcg (1ml)
> 12 years: 500mcg (2ml).
Can be given every 20 minutes for 3 dose followed by PRN
Give every 6 hourly and gradually taper

Side effects: Dry mouth, cough, dizziness, nausea.

Ivermectin (PO)

Tab 3mg, 6mg, 12mg

Indication: Tropical pulmonary eosinophilia, Filariasis, pediculosis, scabies

Dose:

200 microgram/kg/dose taken orally as one dose; can be repeated in 3-12 months
Scabies: Prescribe only when weight is >15Kg

Side effects: : Abdominal pain, asthenia, fatigue, myalgia, diarrhea, anorexia, nausea, constipation, vomiting, vertigo

Ketamine

Inj 100mg/ml

Indication: Anesthesia induction and maintenance, Analgesia

Dose:

Only to be given to children who are 3 months or older.
0.5-1.5 mg/kg IV. May give 0.5-1 mg/kg IV after 10 mins after initial dose. Max: 2 mg/kg

Side effects:Hypo-hypertension, tachy-bradycardia, respiratory depression, apnea

Ketorolac (Oral, IV)

Inj 30mg/ml | Tab 10mg

Indication: Moderate to severe acute pain

Dose:

Under 2 years: Safety and efficacy not established.
IV/IM
- 2-16 years:
  - 0.5 mg/kg IM/IV every 6 hourly for 5 days. Max: 15 mg/day.
>16 years but
- <50 kg: 15 mg IV/IM every 6 hourly. Max: 60 mg/day.
- >50 kg: 30 mg IV/IM every 6 hourly. Max: 120 mg/day.
Oral:
In children >16 years
>50 kg or more:
- 20 mg orally once followed by 10 mg every 4 to 6 hours. Maximum dose: 40 mg/day.
<50 kg:
- 10 mg orally once followed by 10 mg every 4 to 6 hours. Maximum dose: 40 mg/day.

Lactulose

Syp 15ml/10mg

Indication:Constipation, Hepatic encephalopathy

Dose:

Constipation:
- 1.5–3 mL/kg/24 hr PO ÷ BID; max. dose: 60
  mL/24 hr
Hepatic Encephalopathy:
- For infants:
  - Use 2.5-10 ml/day (corresponds to 1.7-6.67g/day) orally in divided doses and adjusted to ensure passing 2-3 soft stools per day.
- For children and adolescents:
  - 40–90 mL/24 hr PO ÷ TID–QID

Notes: : Target in hepatic encephalopathy is to produce 2-3 soft stools/day. Do not give to patient who are undergoing electrocautery procedure.

Lorazepam

Inj 2,4mg/ml

Indication: : Status epilepticus, anxiolytic, sedation

Dose:

Status epilepticus
- Neonate, infant, child, and adolescent: 0.05–0.1 mg/kg/dose IV over 2–5 min. May repeat dose in 10–15 min. Max. dose: 4 mg/dose.
Anxiolytic and sedation
- Infant and child: 0.05 mg/kg/dose Q4–8 hr PO/IV; max. dose: 2 mg/dose. May also give IM for preprocedure sedation.

Lasix (Furosemide)

Inj 10mg/ml

Indication:Edema, CCF, Hypertension

Dose:

0.5-2 mg/kg/day IV/IM/Oral in 1-3 doses, maximum of 2 mg/kg/day in neonates and 6 mg/kg in infants and older children.
Continuous infusion: 0.05 mg/kg/hr. and titrate to response.

Side effects: Dizziness, lightheadedness, dehydration,electrolyte imbalance, hypotension, dizziness, fluid and electrolyte imbalance, ischemic hepatitis.

Levetiracetam

Syp: 5ml/500mg| Inj 100mg/ml

Indication:Epilepsy. Adjunctive therapy in partial, myoclonic and tonic-clonic serizure

Dose:

Loading – 60 mg/kg IV over 10 min [or no more than 3 mg/kg/min] (Max dose: 4500 mg),
repeat 2-3 times of seizure persist
Maintenance – Start 20mg/kg/day till 60mg/kg/day BD

Side effects: Drowsiness, dizziness, unusual tiredness, weakness.

Levocetirizine (L-CTZ)

Syp 5ml/2.5mg

Indication:Allergic rhinitis, urticaria

Dose:

6 month- 2 year: 2.5mg PO OD (Max: 5mg/24hr)
2-5 year: 2.5-5mg PO OD or BD
>6 year- adult : 5-10 mg PO once daily

Side effects: Somnolence, fatigue, asthenia, urinary retention, nasopharyngitis, xerostomia, fever, diarrhea, vomiting, cough, pharyngitis, otitis media, epistaxis

Lidocaine/Xylocaine

Inj 1%, 2%, 4% | Gel 2%

Indication: Local anesthetic, relief of pain in postherpetic neuralgia, ventricular arrhythmias

Dose:

Antiarrhythmic:
- Start with bolus of 0.5-1 mg/kg /dose IV/ET Max: 100 mg. Continuous infusion: 20-50
  mcg/kg/min IV. Monitor ECG simultaneously.
Local anaesthetic-Local infiltration:
- Without epinephrine: max. dose of 4.5 mg/kg/dose (up to 300 mg); do not repeat within 2 hr.
- With epinephrine: max. dose of 7 mg/kg/dose (up to 500 mg); do not repeat within 2 hr.
Anaesthetic lubricant:
- Available as 2% and 4% cream, spray, lotion, ointment, gel
- Apply moderate amount of 2% jelly for endotracheal intubation, urinary catheterization, endoscopy (Do not exceed 4.5 mg/kg/12 hours in children <10 years and 600 mg/12 hours in older children). For skin cuts and sunburns, apply topically 3-4 times a day.

Side effects: Numbness of tongue, Lightheadenes, Visual and auditory disturbance, Muscular twitching, Unconsciousness, Convulsion, Coma, Respiratory arrest

Notes: For cardiac arrest, amiodarone is the preferred agent over lidocaine; lidocaine may be used only when amiodarone is not available.

Linezolid

Tab 200, 400, 800| Inj 25mg| Syp 5m/200mg, 5ml/400mg

Indication: Vancomycin-resistant Enterococcus faecium (VRE), VRSA infections, Multidrug resistant tuberculosis (MDR TB)

Dose:

Infants and Children:
- IV or PO; 10 mg/kg/dose q 8-12 hrly
MDR TB:
- 15 mg/kg once daily if <12 kg and 12 mg/kg if
- >12-23 kg thereafter 10 mg/kg once daily PO

Side effects: Diarrhea, vomiting, headache, nausea, anemia, thrombocytopenia, rash, hypertension, pseudomembranous colitis

Magnesium Sulfate (MgS04)

Inj 500mg/ml (50%)

Indication: Treatment of hypomagnesemia, hypertension, seizures associated with acute
nephritis in children, adjunctive therapy in bronchodilation, severe wheezing

Dose: (All doses expressed in magnesium sulfate salt)

Hypomagnesemia:
- 25-50 mg/kg/dose q 8 hr in neonates and q 6hr in children for 3-4 doses (Max: 2000 mg).
Seizures and hypertension:
- 20-100mg/kg/dose q 4-6 hr as required
Bronchodilator:
- 25 mg/kg/dose as single dose IV over 20 min (Max: 2000 mg).

Metronidazole

Tab 200mg, 400mg| Syp 5ml/200mg, 5ml/100mg |Inj
100ml/ 500mg

Indication:Amoebiasis, Giardiasis, Mesentric adenitis, appendicitis

Dose:

Infant and child: 10-15mg/kg/dose TDS
Amoebiasis:
- PO: 35-50 mg/kg/day divided q 8 hr for 10 days.
- Other parasites: PO: 15-30 mg/kg/day divided q 8hr.
Anaerobic infection: PO, IV: 30 mg/kg/day divided q 6 hr (Max: 4g/day).

Side effects:Nausea, vomiting, diarrhea, loss of appetite, metallic taste in mouth. May cause metallic taste, nausea. Administer IV slowly over 1/2-1 hr.

Mefenamic Acid (Meftal P)

5ml/100mg

Indication: MSK Pain, Menstural pain, Fever, RA, Pain with inflammation

Dose:

10mgkg/dose Q8H
≥14 years:
- Initial 500 mg orally once, then 250 mg PO every 6 hours as needed usually not more
  than 7 days in pain and not more than 3 days in primary dysmenorrhea

Side effects: Dizziness, dyspepsia, elevated ALT/AST, fluid retention, ecchymosis, tinnitus, headache, somnolence, rash, peripheral edema, photosensitivity

Milrinone

Inj 10mg/10ml

Indication: Pulmonary hypertension, CCF

Dose:

0.75 mcg/kg/min for 3 hours followed by 0.2 mcg/kg/min (Neonate)
50mcg/kgIV bolus followed by infusion of 0,25- 0.75mcg/kg/min (Child)

Side effects: Hypokalemia, chest pain, pain and swelling at injection site, dizziness

Morphine (IV)

Inj 10mg/ml

Indication: Sedation, pain relief; relieves dyspnea of left ventricular failure and pulmonary edema; preanesthetic medication, Cynotic spell

Dose:

Neonates:
- IV, IM, SC:
  - - Continuous infusion: 0.01-0.02 mg/ kg/hr
      (i.e. 0.01-0.02 ml/ kg/hr)
    - Intermittent dose: 0.1-0.2 mg/kg 2-4
      hourly = 0.1-0.2ml/kg 2-4 hourly
- Infants and children
  - IV, IM, SC: 0.1-0.2 mg/kg/dose q 2-4 hr (Max: 15mg/dose); PO: 0.2-0.5 mg/kg/dose q 4-6 hr.
- > 12 yr:
  - 3-4 mg; may be repeated after 5 min as required.
- Administer IV over 15-30 min at a final concentration of 0.5-5 mg/ml.

Side effects: Respiratory depression, drowsiness

Midazolam

Inj 1mg/ml

Indication: Used for sedation during surgical procedures, and for treating seizures. Continuous IV for sedation of intubated and mechanically ventilated patients

Dose:

Neonate:
- For intermittent dosing:
  - Take 1 ml of Midazolam (1mg/ml) and add 9ml NS (0.1mg/ml)
  - Dose: 0.1-0.2mg/kg 2-4 hourly = 0.1-0.2ml/kg 2-4 hourly
- For continuous infusion:
  - Take 1 ml of Midazolam (1mg/ml) and add 9ml NS (0.1mg/ml)
  - Take 1 ml of above solution (0.1mg/ml) and add 9ml NS (0.01mg/ml)
  - Infusion dose: 0.01-0.02mg/kg/hour =0.01-0.02ml/kg/hr
- Infants > 2 mth and children
  - Status epilepticus: Loading dose: 0.15 mg/kg followed by continuous infusion of 1 mcg/kg/minute.
  - Sedation: 0.05 – 0.2 mg/kg loading dose; may be repeated after 1-2 hr if required or continuous infusion of 1-2 mcg/kg/min

Side effects: Drowsiness, dizziness, loss of balance,nausea.

Multivitamin

Indication: Used to treat or prevent vitamin deficiency due to poor diet, certain illnesses.

Dose:

Neonate:
- Drop 0.5ml PO OD
3-11 years: 5ml/day PO OD x 10-15 Days
>11 years: 1 tab/day PO OD x 10-15 Days

Mupirocin

Ointment 2%

Indication: Impetigo, folliculitis, Furunculosis, minor wounds, used intranasal to eradicate S. aureus carriers

Dose:

LA TDS x 10 days

Side effects: Burning and stinging pain, itching, rash,nausea, headache, erythema, dry skin, tenderness, swelling, contact dermatitis, and increased exudate.

Meropenem

Inj 500mg, 1000mg

Indication: Active against both gram-positive and gram-negative aerobic and anaerobic pathogens including S. aureus, S. pneumoniae, H. influenzae, N. meningitidis, E. coli, Klebsiella

Dose:

Newborn:
- 20mg/kg/dose TDS Children
Urinary tract Infection, soft tissue infection and skin infections:
- 10 mg/kg/dose IV every 8 hours. Max: 500mg/dose.
Pneumonia, peritonitis, neutropenia, septicemia:
- 20 mg/kg/dose every 8 hours. Max: 1 gm/dose
Meningitis and life threatening infections:
- 40 mg/kg IV every 8 hours. Max: 2 gm/dose

Metoclopromide/ Perinorm

Tab 10mg| Syp 5mg/5ml | Inj 5mg/ml

Indication: Gastroesophageal reflux, prevention of nausea and vomiting due to various causes, symptomatic treatment of diabetic gastric stasis

Dose:

GE reflux:
- PO, IV, IM: 0.4-0.8 mg/kg/day divided q 6-8 hr (Max. dose: 0.8 mg/kg/24 hr or 10 mg/dose)
Postoperative nausea and vomiting:
- IV: 0.1-0.2 mg/kg/ dose
Vomiting:
- PO, IV: 1-2 mg/kg/ dose q 2-4 hr as required

Side effects:: : Contraindicated in GI obstruction, past history of seizures. Causes extrapyramidal reactions and these can be prevented and treated with diphenhydramineg

Methylprednisolone

Inj 40mg, 80mg/ml | Tab 2,4,8,16 mg

Indication: Anti-inflammatory or immunosuppressant use in Connective tissue disorder, vasculitis, graft rejection, demyelinating disorder, status asthmaticus

Dose:

Anti-inflammatory or immunosuppressant:
- PO; IM, IV: 0.5-2 mg/kg/day in divided doses.
Pulse therapy:
- 15- 30 mg/kg/dose given slowly once daily for 3 days.
Status asthmaticus:
- IV: Loading dose of 2 mg/kg/dose then 0.5-1mg/kg/dose q 6 hr
- Oral:
  - Child ≤ 12 yr: 1–2 mg/kg/24 hr ÷ Q12–24 hr (max. dose: 60 mg/24 hr) × 3–10 days
  - Child > 12 yr and adult: 40–60 mg/24 hr ÷Q12–24 hr × 3–10 days
Acute spinal cord injury:
- IV; 30 mg/kg over 15 min followed 45 min later by continuous infusion of 5 mg/ kg/hr. for one day

Side effects: increased blood pressure, edema, cardiac enlargement precipitating in congestive heart failure, potassium loss leading to hypocalcemic alkalosis

Nappy Soft cream

Ingredient: Zinc Oxide

Indication:Diaper rash, Anal excoriation

Dose: LA TDS X 5 days

Nitrofurantoin

Tab 50mg,100mg |Syp 25mg/5ml

Indication:Prevention and treatment of UTI, VUR

Dose:

Not prescribed below 1 month
UTI treatment:
- 1 month-12 years: 5-7 mg/kg/day orally, in 4 divided doses for 7 days. Max: 400 mg/day.
UTI prophylaxis:
- 1-2 mg/kg/dose at bedtime or in 2 divided doses. Max: 100 mg/24 hours.

Side effects: Nausea, vomiting, loss of appetite, headache

Notes: Anuria, oliguria, or significant impairment of renal function are contraindications.

Neopeptine

Drop /Syp

Indication: Used for the symptomatic relief of flatulence, abdominal distension, belching, and other symptoms associated with gas.

Dose:

<2 years: 2.5ml BD x 5-7 days
>2 years: 5ml BD x 5-7 days

Side effects: Throat irritation, itching, rashes, difficulty in breathing

Neosporin (Neomycin and Polymyxin B)

Ointment and powder

Indication: Umbilical granuloma

Dose:

LA TDS X 5 days

NS bolus

Indication: Shock

Dose:

Neonate:
- 10ml/kg/dose over 20 minutes
Child
- 20ml/kg/dose over 20 minutes

Ofloxacin

Ear drop 0.3%| Eye drop 0.3% | Syp 50mg/5ml | Inj 2mg/ml

Indication: UTI, Typhoid, Diarrhea. Drop is used in otitis externa, corneal ulcer, ASOM, CSOM

Dose:

Neonate:
- PO: 10 mg/kg/dose BD (Max: 20mg/kg/dose)
- IV: 10mg/kg/dose BD (Max: 10mg/kg/dose)
Drops (0.3%)
- Bacterial conjunctivitis, Corneal ulcer:
  - >1 year: Day 1 and 2 put 1-2 drops in
    affected eye every 2-4 hours. From day 3-7,
    put 1-2 drops, every 6 hours until clinical
    cure.
Otitis media:
- 1-12 years: 5 drops in affected ear twice daily.
- >12 years: 10 drops in affected ear twice daily.

Notes: Give for 1 week for acute otitis media with tympanostomy tubes and for 2 weeks for chronic suppurative otitis media with perforated tympanic membrane

Ondansetron/Ondem

Inj 2mg/ml| Tab 4mg | Syp 5ml/ 2mg

Indication: Nausea and vomiting

Dose: 0.1-0.2mg/kg/dose

PO:
- < 4 yr: 1-3 mg
- 4-11 yr: 4 mg
- >11 yr, 8 mg q 8 hrly
IV
- 0.15-0.45 mg/kg/dose q 8 hr.
For IV dilute to 1 mg/ml and be given over 15
minutes

Side effects: Headache, dizziness, drowsiness,
constipation.

Paracetamol (Oral, IV, Per Rectal)

Drop PCM (1ml/150mg), Syp PCM (5ml/125mg, 120mg ),
Suppositary 125mg, 250mg, 500mg

Indication: Fever, Pain

Dose:

PO/IV/ Per Rectal: 10-15mg/kg/dose TDS/QID
< 1yr: Give Drop (Wt/10) ml PO TDS
>1 yr: Give Syp (Wt/2) ml PO TDS

Side effects: Liver injury, Anaphylaxis, renal tubular necrosis

PIPTAZ (Piperacillin Tazobactum)

Inj 4.5gm, 2.25gm

Indication: Pseudomonas, Klebsiella

Dose:

Newborn:
- 50-100 mg/kg/dose (piperacillin component) IV BD or TDS
Children:
- 100 mg/kg/dose (piperacillin component) IV 3 times daily. Max: 4 g/dose piperacillin and 4.5g/dose piperacillin tazobactam

Side effects: Nausea, vomiting, diarrhea, skin rash,injection site reactions

Phenobarbitone (Oral, IV)

Tab 15, 30, 60 mg

Indication: Epilepsy, Neonatal seizure, status epilepticus, Hyperbilirubinemia, Jitteriness

Dose:

Neonate:
- Loading dose:
  - 20 mg/kg over 15 – 20 min
- Maintenance dose:
  - 2.5mg/kg/dose Q 12 H (first dose given 12 hours after loading)
Infants:
- 5-6 mg/kg/24 hours oral or IV in 2 divided doses or as single daily dose.
1-5 years:
- 6 -8 mg/kg/24 hours oral or IV in 2 divided doses or as single daily dose.
6-12 years:
- 4-6 mg/kg/24 hours in 2 divided doses or as single daily dose.
>12 years:
- 1-3 mg/kg/24 hours oral or IV in 2 divided doses or as single daily dose.
Hyperbilirubinemia (off-label):
- Neonates: 5 mg/kg/day oral/IV as a single dose or twice daily. Not widely used as phototherapy usually suffices.

Side effects:Drowsiness, dizziness, excitation, nausea,headache

Phenytoin (IV)

Syp 25mg/ml | Inj 50mg

Indication: Epilepsy, Status Epilepticus, Nerupathic pain

Dose:

Status epilepticus:
- Loading : 20mg/kg/dose (1st), 10mg/kg/dose (2nd, 3rd)
- Maintenance – 5mg/kg/day BD
Antiepileptic:
- Loading doses:
  - Neonates: 5 mg/kg/day PO in 2 divided dose.
  - 6 months-16 years: 5 mg/kg/day PO in 2-3 divided doses.
- Maintenance doses:
  - 6 months-4 years: 8-10 mg/kg/day PO in divided doses 2-3 times daily.
  - 4-17 years: 7.5-9 mg/kg/day PO in divided doses 2-3 times daily.
  - 7-10 years: 7-8 mg/kg/day PO in divided doses 2-3 times daily.
  - 10-16 years: 6-7 mg/kg/day PO in divided doses 2-3 times daily.

Side effects: Gum hypertrophy, hirsutism, osteomalacia,coarse facies

Notes: IV injections should be followed by NS flushes to avoid local irritation of the vein.

Pralidoxime

Inj 500mg

Indication: Write

Dose:

IM, IV:
- 25-50 mg/kg as 5% solution over 15-20 min. The dose may be repeated after 1-2 hr and then at 10-12 hr interval if cholinergic crisis recur
<12 yrs:
- 25mg/kg over 30 min and continues infusion 10mg/kg/ hour in children
>12 yrs:
- 1-2 g IV infusion over 30 min

Side effects: Headache, dizziness, drowsiness, seizure, visual disturbances, tachycardia, hyperventilation, muscle weakness, nausea, hypertension, pain at injection
site

Prednisolone (Oral, IV)

Tab 2.5, 5, 10, 20, 40 mg

Indication: Severe Asthma, Croup, Nephroticsyndrome, connective tissue disorder, IBD, infantile spasm

Dose:

2mg/kg/day stat then 1mg/kg/day
Acute asthma:
- Oral: 1 mg/kg/day as a single daily or 2 divided doses for 3-5 days (If steroid is used for wheezing)
Nephrotic syndrome:
- Oral: Initially 4 weeks: 60 mg/m²/day or 2mg/kg/day; Max: 80 mg/day; orally in 3 divided doses until proteinuria is absent for 3 consecutive days. Next 4 weeks: 40 mg/m² or 1.5 mg/kg oral every other day; Maximum dose: 60 mg/day.
- Maintenance doses (for frequent relapses):0.5-1 mg/kg/dose orally every other day for a period of 3-6 months.

Side effects: Congestive heart failure, hypertension, hypokalemia, cardiac enlargement, edema, and hypokalemic alkalosis.

Propofol (IV)

Inj 10mg/ml

Indication: Sedative, Hypnotic, Anaesthesia

Dose:

1-3 mg/kg loading dose then 1mg/kg/hr
For induction of anaesthesia:
- 3-16 years: 2.5-3.5 mg/kg IV perfusion over 20-30 seconds (older children may require lower doses as compared to younger ones).
Maintenance of anesthesia:
- 2 months-16 years: 0.125-0.3 mg/kg/min IV; after 30 mins, decrease the infusion rate if clinical signs of light anesthesia are absent; older children may require lower doses compared to ≤5 years.
Sedation prior to procedure:
- 1-18 years: 1 mg/kg IV loading dose and then 0.5 mg/kg IV.

Side effects:Respiratory acidosis and depression

Potassium Chloride (15% w/v)

Inj 15 % – 2mEq (approx. ) or 150mg / ml , Syp 15ml / 1.5 gm (
20 mEq approx.)

Indication:Hypokalemia

Dose:

Hypokalemia: PO, IV: 2-5 mEq/kg/day in divided doses.
Potassium supplementation: Oral 0.5-2 mEq/kg 2 times daily

Qudrajel (Ointment)

Contain Chlorhexidine 1%, Metronidazole 1%, Lignocaine 2%

Indication: Apthous ulcer

Dose:

LA TDS x 3 days

Side effects:Skin irritation.

Ranitidine

Syp 5ml/75mg | Tab 150mg | Inj 2ml/50mg

Indication: APD, Gastritis, Gastric ulcer, Hyperacidity, GERD
Dose:

Dose:

IV: 10mg/kg/day BD ;Maximum: 50 mg/dose or 300 mg/day.

Side effects: Hypersensitivity reactions, including urticaria, angioneurotic edema, fever, bronchospasm, hypotension and anaphylaxis have been reported.

Salbutamol (Oral, IV, Nebu, MDI)

Syp 2mg/5ml (Beta 2) | Respule 2.5ml/ 2.5mg | MDI
100mcg/dose

Indication: Severe bronchospasm, Hyperkalemia

Dose:

PO – 0.1-0.4mg/kg/dose TDS
- Neonates: 0.1-0.3 mg/kg/dose q 6-8 hr.
- Children
  - < 6 yr: 0.1-0.2 mg/kg/dose TDS
  - 6-12 yr: 2 mg/dose TDS or QID
  - >12 yr: 2-4 mg TDS or QID
MDI -100 mcg/puff TDS
- 2 puff PO TDS x 5 days then sos
Nebulization:
- Neonates; 0.1-0.5 mg/kg/dose or q 2-6 hr
- Children; 0.15-2.5 mg/dose or q 4-6 hr (Min:2.5 mg).
- <2yrs: 0.2-0.6 mg/kg/day every 4-6 hours, >2 years: 0.6-2.5mg every 4-8 hourly)

Side effects:Tachycardia, Hyperglycemia

Sodium Bicarbonate (7.5%)

1meq/ml

Indication: Metabolic acidosis, life-threatening hyperkalemia, correction of acid base imbalance in cardiac arrest

Dose: 0.5 to 2 meq/kg/day in 3-4 divided doses

For correction of metabolic acidosis:
- Dose calculation:
  - - HCO3 needed (mEq) = HCO3 deficit (mEq/L) x (0.3 x body weight in kg) OR HCO3 needed (mEq) = 0.4 x body weight in kg x (desired bicarbonate-actual bicarbonate) (Assume desired bicarbonate as 24 meq)
  - Administer half the calculated dose over 4 hours and re-assess. Dilution: Can be diluted in NS, 5% Dextrose, 10% Dextrose or WFI. For peripheral infusion, dilute at least 1:10; for central line infusion, dilute in at least 1:5

Side effects: Frequent urination, mood changes, muscle pain, irregular heartbeat.

Surfactant

inj 4ml, 8ml

Indication: Prophylaxis and treatment of RDS in premature neonates

Dose:

Prophylactic therapy:
- 4ml/kg/dose intratracheally as soon as possible; up to 4 doses can be given at 6 hr interval during the first 48 hr of life.
Rescue therapy:
- 4ml/kg/dose intratracheally, immediately following the diagnosis of RDS. May repeat 4 dose as needed at 6 hr interval.

Side effects: May cause bradycardia, pallor, hypotension, apnea, pulmonary air leak

Notes: Avoid suctioning of ETT for at least 1 hour.

Secnidazole (Oral)

Syp 10ml/500mg | Tab 500mg, 1000mg

Indication: Intestinal amoebiasis, Giardiasis

Dose:

30mg/kg/dose

Side effects: Stomach pain, diarrhea, dry mouth, a
metallic taste in the mouth

Sildenafil

Tab 25, 50, 100mg

Indication: Pulmonary hypertension

Dose:

Initially 250-500mcg/kg q4-8h. Adjust according to response and maximum dose 2mg/kg q6h

Side effects: Hot flushes, Headaches, Vomiting

Tobramycin

Eye drop 0.3% w/v

Indication:Conjuncitivitis

Dose:

1 Drop LA TDS x 7 days

Thyroxine

Tab 12.5, 25, 50, 75, 100mcg

Indication: Hypothyroidism

Dose:

1–3 mo:
- 10–15 mcg/kg/dose once daily. If patient is at risk for developing cardiac failure, start with lower dose of 25 mcg/24 hr, and if patient has very low T4 (<5 mcg/dL), use higher dose of 12–17 mcg/kg/24 hr.
3–6 mo: 8–10 mcg/kg/dose once daily
6–12 mo: 6–8 mcg/kg/dose once daily
1–5 yr: 5–6 mcg/kg/dose once daily
6–12 yr: 4–5 mcg/kg/dose once daily
>12 yr:
- Incomplete growth and prepuberty:
  - 2–3 mcg/kg/dose once daily
- Complete growth and puberty:
  - 1.7 mcg/kg/dose once daily

Side effects: Iatrogenic hyperthyroidism, partial hair loss. With excessive dose: tachycardia, sweating, cramps, excitability, headache, palpitations, cardiac arrhythmias, and diarrhea

Notes: Start with lower dose and increase every 4-6 weeks if risk for cardiac failure; adjust dose based on Thyroid function tests. Give oral form on empty stomach.

Vitamin A

Chewable tablets 1 Tab/ 50,000 IU

Indication: Measles, Vitamin A deficiency

Dose:

Prophylaxis in patient at risk (malnutrition, severe infection, recurrent diarrhea, pneumonia).
- <1 yr; 100,000 units
- > 1 yr; 200,000 units given PO q 4-6 mth.
Children with Measles:
- Oral or IM: 50,000 units once daily for 2 days; administer a third dose 2-4 weeks later if clinical manifestations of vitamin deficiency are present.
Xerophthalmia
- Oral
- <6 months:
  - Initially, 50,000 units daily for 2 days; repeat with 50,000 units at least 2 weeks later (total of 3 doses).
- 6-12 months of age:
  - Initially, 100,000 units daily for 2 days, then 100,000 units at least 2 weeks later (total of 3 doses)
- >12 months of age:
  - Initially, 200,000 units daily for 2 days, then 200,000 units at least 2 weeks later (total of 3 doses).

Vitamin K

inj (Phytonadione) 10mg/1ml

Indication: Newborn to prevent Hemorrhagic disease of newborn, Vitamin K deficiency prophylaxis, Hepatic failure, Antidote to warfarin

Dose:

Prophylactic dose
- 1mg for term infants, 0.5mg for preterm infants
Therapeutic dose – 5-10mg/dose
Warfarin poisoning: 5-10 mg IM or IV
- < 2 Kg:
  - Oral 1 mg,, IM/IV 0.5mg
- >2kg:
  - Oral 2 mg, IM/IV 1mg

Side effects: Pain, swelling, or irritation where the injection was given

Tus Q –Dx (Dextromethorphan)

Indication: Used to temporarily relieve cough caused by minor throat and bronchial irritation

Dose:

1-2mg/kg/day, up to a maximum of 60mg/day

Side effects: Dizziness, lightheadedness, drowsiness, nervousness, restlessness, nausea, vomiting, stomach pain

Tranexamic Acid

Inj 500mg , Tab 250mg, 500mg , 1gm

Indication: Bleeding after surgery or injury, Heavy menstrual bleed

Dose:

10mg/kg/dose TDS

Side effects: Nausea, vomiting, diarrhea, and allergic
reactions

Ursodeoxycholic Acid

Syp 5ml/125mg

Indication: Cholestasis, Liver disease due to cystic fibrosis

Dose:

0 to 30 mg/kg/day, given orally in two or three divided doses

Side effects: Exacerbation of pre-existing psoriasis, rash, urticaria, dry skin, sweating, hair thinning, biliary pain, cholecystitis, constipation, stomatitis, flatulence

Notes: It is contraindicated in calcified cholesterol stones, gallstones > 15 mm, hepatic impairment, biliary obstruction

Vecuronium

inj 10mg

Indication: Anaesthesia, Ventilation

Dose:

Neonate:
- Initial: 0.1 mg/kg/dose IV
- Maintenance: 0.03–0.15 mg/kg/dose IV every 1–2 hr as required
Infants (>7 wk–1 yr):
- Initial: 0.08–0.1 mg/kg/dose IV
- Maintenance: 0.05–0.1 mg/kg/dose IV Q1 hr as required ; may administer via continuous infusion at 0.06–0.09 mg/kg/hr IV
>1 yr–adult
- Initial: 0.08–0.1 mg/kg/dose IV
- Maintenance: 0.05–0.1 mg/kg/dose IV every 1 hr as required; may administer via continuous infusion at 0.09–0.15 mg/kg/hr IV

Zinc (Oral, Ointment)

Tab Zinc 10mg, 20mg | Syp 5ml/20mg

Indication: AGE, Acrodermatitis enteropathica

Dose:

Acute Gastroenteritis
- < 6 months:
  - 10mg PO OD x 14 days
- > 6 months:
  - 20mg PO OD x 14 days
Deficiency
- PO: 0.5-1 mg/kg/day in 2-3 divided doses
Acrodermatitis enteropathica
- 6 mg/kg/day

Side effects: Nausea, vomiting, stomach upset, diarrhea, metallic taste in the mouth

Refrences:

THE HARRIET LANE HANDBOOK |TWENTY-FIRST EDITION
BNF for children 2022-2023