ESSENTIAL DRUGS: A guide for Health workers

ESSENTIAL DRUGS

A guide for Health workers

P. Okereke

© Okereke P. 2007

+2348055318800

Published by Noble publishers (A div. of Noble resources Ltd.)

1^st print 2003

2^nd print 2007 with amendments

Second edition 2007

COPYRIGHT RESERVED

No part of this publication may be reproduced in any for, electronic, mechanical, photocopying, recording or otherwise without the written permission of the publishers.

ISBN 978-2994-70-7

Second print by

Re-opec (Nig) Ltd.

9, st. John street/Modebe Avenue

Onitsha

+2348055523019

Preface

There are many drugs in the market today but only few of them are essential. The essential drugs according to World Health Organization are those drugs that satisfy the health care need of the majority of the population. One of the essential elements of Primary Health Care is “provision of essential drugs” and drugs makes health care credible because they have the ability to cure and prevent diseases, relieve symptoms and control any abnormal condition of the body. So many of drugs are in circulation in the drug market today and as such, problem of selecting the appropriate drug for a particular illness has been a hindrance to health practitioners. The introduction of essential drugs by the World Health Organization has helped to alleviate this problem.

Therefore the purpose of this book is not to make suggestions, create additional or separate list of essential drugs apart from the already existing list of the essential drugs of World Health Organization/Nigeria. Rather it is aimed at giving essential information (indication, mode of action, side effects, contraindications, route of administration, dosage schedule, safety precautions and examples of popular brand products that contains the required generic preparations) on rational used of drugs.

Finally all doses recommended in this book are for adults except where otherwise stated.

---Author

1. Anaesthetics and preoperative drugs 7

2. Analgesics,Antipyretics and NSAIDs 10

Narcotic 10

Non narcotic 12

NSAIDs 13

3. Anti allergics and antianaphylaxis 18

Antihistamines 18

Antianaphylactic 21

4. Antidotes 24

Specific 24

Nonspecific 24

5. anticonvulsants/antiepileptic 28

6. Antiinfective 32

Antihelmintics 32

Antifilariais 34

Antischistosomal 36

Antibacterial 37

Anti TBL 60

Antifungal 63

Antiviral 67

Antigiardiasis and antiamoebic 71

Anti malaria 72

7. Hormones and endocrine drugs 80

Corticosteroids 80

Androgen 82

Oestrogen 83

Progestogens 84

Contraceptives 85

Pituitary drugs 87

Anti diabetics 90

8. Antiparkinsonism 93

9. Drug affecting the blood 94

Antianaemia 94

Plasma substitute 97

Anti coagulants 97

10. Cardiovascular drugs 100

Anti anginal 100

Anti arrhythmic 102

Anti hypertensive 103

Cardiac glycosides 108

11. Dermatological drug 109

Antiinfective 109

Anti-inflammatory and antipruritic 110

Fungicides 112

Scabicides and pediculicides 114

12. Ophthalmic drugs 116

Antiifective 116

Anti-inflammatory/antiallergic 118

13. Antiseptic and Disinfectants 120

14. Diuretics 123

15. Gastrointestinal drugs 126

Antacids/antiulcer drugs 126

Anti emetic 129

Antispasmodic/smooth muscle relaxant 133

Purgative 134

Anti diarrhea 137

Antihaemorrhoid 138

16. Immunological 140

Sera and immunoglobulins 140

Vaccine 142

17. muscle relaxant 145

Myasthenia gravis 146

18. Oxytocics 148

19. Psychotherapeutic drugs 150

Hypnotics and sedatives 150

Anti psychotic 153

20. Respiratory drugs 158

Anti asthmatic 158

Antitussive and expectorants 159

21. Vitamins and minerals 162

22. Electrolytes 169

23. Ear, Nose and Throat drugs 172

Antiifective 172

Anti-inflammatory 173

Nose 174

Mouth and throat 176

2. ANALGESICS, ANTIPYRETICS AND NSAIDS

Analgesics (Painkillers) are a class of drugs used to relieve pain. The pain relief induced by analgesics occurs either by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals, without producing anaesthesia or loss of consciousness. There are basically two kinds of analgesics: non-narcotics and narcotics.
Non-narcotics - Non narcotic analgesics are effective in relieving mild to moderate pains and are further classified into two: i. anti pyretic and ii. Non steroidal anti-inflammatory agents

Narcotics - Narcotic analgesic alleviates severe pains and is capable of producing sedation even at moderate doses.

It is not fully understood how painkillers work. Damaged or inflamed body tissues produce various chemicals which send signals through the nervous system to the brain. The brain produces the sensation of pain. Different painkillers act at different points in this process. For example, NSAIDS may act at the point of injury, whereas others act on the nerves or brain.

I. Narcotic analgesics

DIHYDROCODEINE

30 mg (tartrate)/tab; 500 mg/ml amp.

A less potent narcotic analgesic used to relieve moderately severe pain; normal dose is 30 to 60 mg every six hours is for adults. This medication may cause dependence, especially if it has been used regularly for an extended time or if it has been used in high doses. In such cases, withdrawal reactions (e.g., runny nose, watery eyes, and restlessness) may occur if you suddenly stop this drug. To prevent withdrawal reactions when stopping extended, regular treatment with this drug, gradually reduce the dosage

Synonym: DF 118

MORPHINE

10 mg, 15 mg (sulphate or hydrochloride)/ amp, and 10mg (sulphate)/tab.

Is a powerful opiate derivative and is mostly suitable for severe continuous pain of visceral or soft tissue origin especially where other narcotic analgesic have failed. It is better to start therapy with oral dose of 2.5 to 5 mg every four hours. Dose may be titrated by 50 to 100% to control pain for full 24 hours. Morphine causes respiratory depression but does not alter blood pressure just like other opiate analgesic. Constipation with morphine is severe therefore it may be administered together with laxatives and antiemetic if vomiting occur. Contraindications include respiratory depression, obstructive airway disease, 24 hours pre and post operation, pregnancy, head injury, lactation and coma. S/E: tolerance, dependence, constipation, nausea, vomiting, drowsiness, urticaria. Morphine may be given in a dose of 10 to 20 mg either by s.c, i.m, or i.v injection.

PETHIDINE

50 mg/tab; 50 mg/ml (HCl)

Pethidine hydrochloride is an effective analgesic that can be used in place of morphine for the relieve of most severe types of pain. The analgesic action of pethidine hydrochloride is sometimes accompanied by euphoria; its duration of action may last for 2-5 hours. The dose varies with the purpose, age and route of administration. For relieve of pain in most medical and surgical condition, a dose of 100 mg i.m, orally or slow i.v injection. In severe pain, a dose of 150 mg may be required; up to 50 mg may be given as a single slow intravenous dose. Pethidine reduces the severity of labour pain, but does not alter contraction. A dose of 100 mg intramuscular is used for this purpose. S/P: Pethidine may cause respiratory depression

PETHILORFAN

Inj., pethidine 50mg (HCl) plus Levallorphan

0.625mg (tatrate) in 1 or 2ml ampoule

A nice combination of pethidine hydrochloride and levallorphan tartrate. The actions of pethidine are as enumerated above. Levallorphan prevents respiratory depression due to pethidine and other narcotic analgesic. Therefore pethilorfan exhibit all the analgesic actions of pethidine but does not cause respiratory depression in healthy patient as do ordinary pethidine. It is a good substitute for pethidine for safety reasons. Pethilorphan does not relieve respiratory depression caused by other medical condition.

ii. Non narcotic analgesics

ACETYLSALICYLIC ACID

300 mg/tab; 500 mg/cap

Acetylsalicylic acid has analgesic, anti-pyretic and anti-inflammatory action. It is one of the essential drugs because of its low toxicity, cheapness and ready availability. It is indicated in less severe pains like headache, neuralgia, gout, neuritis, rheumatic joint pains, myalgias, cold, toothache and feverish conditions. Acetylsalicylic acid acts on the hypothalamus and inhibits prostaglandin that is responsible for production of inflammation, fever and pains. Dose: 0.3-1g in divided doses for analgesic and antipyretic, 0.5-1g every 4 hours in chronic rheumatism. All by oral administration. It is contraindicated in gastric lesion, and asthma. Side effects include dyspepsia, haematemesis and melaena.

Brand name: Aspirin

PARACETAMOL

500 mg, 125 mg/tab. or cap. 125 mg/5 ml syrup or susp.

Paracetamol has analgesic action, but no anti-inflammatory effect. It is a good substitute to patients sensitive to acetylsalicylic acid. Its hepatotoxic effect is irreversible. This effect is always due to overdose. Paracetamol is used to relieve pain in conditions like Toothache, Pain During Periods, Pain associated with Arthritis, Backache, Muscle Pain, Fever, Pain, Head Pain. Migraine Headache, rheumatism and neuralgia. Do not take this medication for fever for more than 3 days. For adults, do not take this product for pain for more than 10 days (5 days in children) Pain medications work best if they are used as the first signs of pain occur. If you wait until the symptoms have worsened, the medication may not work as well. . Paracetamol causes less gastric irritation than acetylsalicylic acid and is more preferred in elderly patient. The adult dose is 0.5 to 1g every three or four hour. Children aged 3-7: 250 mg, 7-12 years: 500 mg

Popular brand name: panadol,

Non steroidal anti-inflammatory drugs

(NSAIDs) and drugs used for gout

INDOMETHACIN

25 mg/cap

This is a non-steroidal anti-inflammatory drug. It has analgesic, antipyretic and anti-inflammatory effect and is therefore used in the treatment of musculoskeletal disorders such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, dysmenorrhoea and lumbago. A dose of 25-50 mg b.i.d or t.i.d is advised with meals. Higher doses can produce such effects like headache, nausea, vomiting, epigastric discomfort and gastric lesion. Indomethacin is contraindicated in patient with history peptic ulcer disease and asthma.

Brand name: Indocid

DIFLUNISAL

250 mg/tab

Diflunisal has about 8 to 12 hours duration of action without antipyretic effect but anti inflammatory and analgesic effect. Its major area of action is inflammatory conditions and pains like osteoarthritis, rheumatoid arthritis and pains and associated symptoms of dysmenorrhoea. The usual therapeutic dose in patients with osteo or rheumatoid arthritis is between 500 mg to 1g daily in one or two divided doses. In painful conditions like dysmenorrhoea, initial dose of 1g followed by 500 mg b.i.d is recommended. It is contraindicated in asthmatic attack, patients allergic to salicylates or other NSAIDs, gastric intestinal ulcer. Adverse effects are gastrointestinal pains, dyspepsia, nausea, tinnitus. S/P: ulcerative patients, patients receiving anticoagulant, liver diseases. Diflunisal is mostly available in tablets and should not be administered together with indomethacin.

Brand name: Dolobid

DICLOFENAC

25 mg and 100 mg per tab.

Inflammatory and degenerative form of rheumatism, acute musculoskeletal disorders, acute gout, post traumatic and post operative inflammation and pain; painful conditions of the ear, nose and throat; renal and biliary colic, dysmenorrhoea and inflammatory infections. Adult dose of 75 to 150mg daily is recommended orally or intramuscularly with food. It is contraindicated in peptic ulcer disease, asthma and pregnancy. Side effects involved are nausea, vomiting, dyspepsia, rashes, gastrointestinal pain, headache, dizziness.

Brand name: Voltaren

IBUPROFEN

200 and 400 mg per tab/cap

A non-steroidal anti-inflammatory agent indicated in the treatment of muscular and soft tissue pains, rheumatoid arthritis, osteoarthritis, analgesic and anti-inflammatory conditions. Initial dose of 1.2g daily in divided doses and maintenance dose of 600 mg daily also in divided doses. Toxic effects: gastrointestinal upset or haemorrhage skin rash. Contraindications: history of or active peptic ulcer.

Synonym: Brufen, Motrin

KETOPROFEN

500, 100 and 200 mg per cap; 100 mg/2ml amp.

Ketoprofen controls symptoms for a period of 24 hours with a central analgesic activity for a powerful pain relief. Its main area of action is rheumatological disorders, ankylosing spodylitis, acute gout, acute painful musculoskeletal conditions, cervical spondylitis, acute gout and postoperative pains. 100-200 mg daily single daily dose with food. Route of administration could either be by mouth or deep intramuscular injection. Contraindications: pregnancy, patients allergic to NSAIDs, bronchial asthma, active peptic ulcer, dyspepsia and renal dysfunction.

Synonyms: Orudis, Oruvil

NAPROXEN

250 mg, 500 mg per tab.

Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout, acute musculoskeletal disorders, dysmenorrhoea, and other painful and inflammatory conditions. 500-1000 mg daily in two divided doses at twelve hourly intervals or as a single daily dose depending on clinical reasons. S/E: skin rash, GI intolerance, headache tinnitus and vertigo. S/P: elderly, history or active gastrointestinal lesions, renal or hepatic impairment, and heart failure. C/I: NSAIDs induced allergy, active peptic ulcer, pregnancy, lactation and children.

PIROXICAM

10 and 20 mg/tab and cap. 10 mg/ml amp.

A non steroid anti-inflammatory agent for the management of osteoarthritis, rheumatoid arthritis ankylosing spondylitis, gout, muscle and skeletal disorders, dysmenorrhoea, post traumatic and post operative pains and inflammatory conditions. A standard dose of 20 mg daily as single dose for three days is advised. In acute state give 40 mg daily for 2 days then 20 mg daily for 5-12 days. In the case of gout, initial dose of 40 mg as a single dose then 40 mg daily in single or divided doses for next 4 to 6 days. Children below 15 kg: 5 mg/kg; 16-25kg: 10 mg/kg; 26-45 kg: 15 mg/kg; over 46 kg: as for adult, all as single daily dose. It is contraindicated in history of or active peptic ulcer, patient sensitive to NSAIDs, pregnancy, lactation and asthma. S/E: GI disturbance, oedema, injection site reactions, tinnitus.

Synonym: Feldene

ALLOPURINOL

100 mg/tab

Inhibit xanthine oxidase enzyme that produces uric acid. For this reason, it is useful in the treatment of gout. Initiation of therapy may be accompanied by an increase of acute gout attacks, therefore colchicines or an anti-inflammatory drug should be given concurrently when initiating therapy. Allopurinol reduces the production of uric acid by inhibiting xanthine oxidase. So allopurinol prevents the production and deposition of uric acid as sodium urate crystal in the joint, tendon sheets, and organs which in turn causes gout. It is also used in the management of calcium oxalate renal stones when fluid and dietary measures have failed. However allopurinol should only be used in chronic gout. It is on record that allopurinol should not be used in acute gout as it exacerbate and prolong symptoms. Adult dose is 100-200mg daily in mild conditions. Larger doses should be administered in divided doses of not more than 300mg/day in divided doses. C/I: aspirin, acute gout; S/P: pregnancy elderly, renal or hepatic dysfunction; S/E: Nausea and acute gout, Skin reactions (withdraw if occur). NOTE: NSAIDs should be used in the treatment of acute gout Brand name: Zyloric

6. ANTI-INFECTIVE

Anthelmintics

NICLOSAMIDE

500 mg/tab chewable

Adults and children over 8 years: 2g in two divided doses. Children 2-8 years: 1g and under 2years: 500 mg all in two divided doses. Niclosamide is a taenicide, which is active against most tapeworms, including the beef tapeworm (Taenia saginata), pork tapeworm (Taenia solium), fish tapeworm (Diphyllo bothrium latum) and dwarf tapeworm (Hymenolepis nana). Niclosamide is administered in tablets, which must be chewed thoroughly before swallowing and washed down with a little water. Fasting or purging is not necessary but patient should abstain from solid food on the evening before treatment. The next morning a dose of 1g is given on an empty stomach followed one hour later by another dose of 1g. A meal may be taken 2 hours thereafter. Side effects include gastrointestinal upset, light-headedness and occasionally pruritus. S/P: avoid alcohol during therapy, It is contraindicated in pregnancy.

Brand name: Yomesan.

PIPERAZINE

500 mg/tab (adipate or citrate); 5g/ sachet;

500 mg/5ml elixir or syrup

Piperazine causes flaccid paralysis in roundworm and threadworm, which helps in expulsion of the worm by peristalsis. It is effective against roundworms and threadworms only in which all stages of the parasite in the gut are affected though little or no effect on larvae in the tissues. The dose for adults is 4g. Children should be given 40 mg/kg body weight, maximum of 4g all as single dose. If patient is constipated, then a purgative may be necessary to expel the worm before the effect of the drug wears off. In case of heavy roundworm infestations, piperazine should be given in divided dose as described below.

For elimination of thread worm, adults and children over 12 years should receive 1g twice daily for 7 days; 7-12 years: 500 mg thrice daily, 4-6 years: 500 mg twice daily, 2-3 years old: 250 mg twice daily. Infants aged 9 months to 24 months: 250 mg twice daily. All for a period of 7 days. It is contraindicated in pregnancy.

Brand names: Antepar, Padrax.

ALBENDAZOLE

200 mg/tab; 100 mg/5ml

A brand spectrum anthehmintics used in the treatment of thread worm, whipworm, roundworm, hookworm, and tape worm infestation. Adults and children above 2 years 400 mg orally at once. Not recommended for pregnant mothers and children below 2 years of age.

Brand name: Zentel

LEVAMISOL

40 mg/tab; 40 mg/ml

Active against ascaris lumbricoides, ancylostoma duodenale, Nectar americanus, enterobius vermicularis, Trichuris trchiura, Strongyloides stercoralis. Adults: 120 mg; 6-12 years: 80 mg; 1-5 years: 40 mg; 6-11 months: 20 mg all as a single oral dose. C/I: pregnancy

Brand name: Ketrax

PYRANTEL

125 mg/tab; 125 mg/5 ml syrup

Effective against the following parasites. Enterobus vermicularis (Pinworm); Ascaris lumbricoides (roundworm) Ancylostoma duodenale (hookworm), Necator americanus (hookworm), Trichostrogylus spp (theadworm). Adults 500- 750 mg: 6-12 years: 375 mg; 3-5 years 250 mg; 1-2 years: 125 mg all as a single dose

Brand name: Combantrin

MEBENDAZOLE

100 mg/tab; 100 mg/5ml susp.

Slowly immobilises and kills parasitic worms probably by inhibiting their micro-tubular transport systems. It is a highly effective broad spectrum anthelmintic indicated for the treatment of nematode infestations including roundworms, whipworms, threadworms and hookworms. It is poorly absorbed and has less systemic effects. Except minor gastrointestinal pain or loss stool which may be due to high dose, mebendazole has no other side effect. Adults and children: 100 mg trice daily for three consecutive days.

Brand name: Vermox

Antifilarials

DIETHYLCARBAMAZINE

50 mg/tab (citrate)

Diethylcarbamazine citrate is very effective in the treatment of filariasis, particularly when due to Wucheraria bancrofti or Loa Loa. It has been of value in the early stage of elephantiasis and tropical oesinophilia. Diethylcarbamazine eliminate the microfilariae rapidly from the blood stream. Its action upon the adult worm is doubtful as they may persist for several months of therapy. Local reactions sometimes appear at the sites, which commonly harbour adult worms. In Loaiasis, both microfilaria and adult worm are killed. Diethylcarbamazine is administered by mouth as tablets, In filariasis a suitable course of treatment is 1 mg/kg daily in single dose for 2 days. Then 6 mg per kg in single or divided daily dose for 21 to 28 days. For mass treatment in endemic areas, 6 mg per kilogram body weight weekly for six weeks is effective.

They major side effect is allergic reactions due to release of foreign proteins in the tissues by the death of larvae or adult worms, Others are fever, tender swelling, muscular pains skin rashes. Such allergic reactions are especially prominent in onchocerciasis. In allergic patient, give anti histamine at least 10 minutes orally before diethylcarbamazine. It is unwise to use diethylcarbamazine in the treatment of onchocerciasis because the allergic reaction may involve the eyes. To control reactions, use corticosteroids or antihistamines and withdraw therapy.

Brand name: Banocid, Hetrazan

IVERMECTIN

6mg/tab

Onchocerciasis is the major indication of this drug. This drug is so effective in such that it’s dose need not be repeated before one year. It is also effective in the eradication of roundworm, but anthelmintics have been proved to be more effective. The dose of Ivermectin depends on body weight, 65-84 kg: 12 mg per annum; 45-64 kg: 9 mg/annum; 26-44kg: 6mg/ annum. 15-25 kg: 3 mg/annum. Children below 5 years of age, pregnancy and lactating mother are at risk.

Brand name: Mictizan

SURAMIN

1 g/vial

Suramine is effective in the treatment of onchocerciasis, filariasis and trypanosomiasis. In onchocerciasis and filariasis, It is very effective in clearing adult filariae, but has no direct action on the microfilariae. Since diethylcarbamazine is effective on the larvae, The two drugs may be used simultaneously to eliminate both adults and microfilariae. In the treatment of trypanosomiasis due to T. gambiense and T. rhodesiense but as it does not penetrate the cerebrospinal fluid it is ineffective in the advanced stage when the CNS is affected. It is administered intravenously. To test patient’s tolerance, give 500 mg iv start. Followed by 1g iv after 24 to 48 hours if well tolerated. Repeat weekly for 5 weeks. The urine should be tested before each dose. If protein is present, reduce dose or administration delayed. Side effects include shock; vomiting, oedema, pruritus and urticaria are some of the immediate reactions. Reaction within 24 hours: paraesthesia, hyperaesthesia of the hands and feet, photophobia and peripheral neuritis. Kidney damage, which is signified by proteinuria, is the later reaction. It is contraindicated in renal or adrenal insufficiency.

Antischistosomal

PRAZIQUANTEL

600 mg/tab

Treatment of all infections due to schistosomes and other liver and lung flukes. Dose for schistosmiasis:40 mg/kg as a single dose or 20 mg/kg twice daily for one day. Flukes: 25 mg/kg thrice daily for 2days.

Brand name: Biltricide

OXAMNIQUINE 250 mg/cap is effective against schistosoma mansoni especially where prazequantel fails. Dose: 15 mg/kg as a single dose.

METRIFONATE 100 mg/tab, is used against infections due to schistosoma haematobium only

Antibacterial

Antibiotics are chemical substances used in treating infectious diseases caused by pathogenic bacteria. Many are derived from substances, which are formed in nature. Major groups of antibiotics include the penicillins, the cephalosporins, the tetracyclines and the macrolides (drugs related to erythromycin). Antibiotic therapy is based on clear clinical and bacteriological diagnosis. Antimicrobial should be administered to patients in full therapeutic dose and at regular intervals for at least five days. Once treatment has been started, the prescribed course should be completed, even when cure seems to have taken place. Failure to finish the course may increase the chances of bacterial resistance to further treatment with the drug.

The intervals may be six, eight or twelve hourly or daily depending on the type of antibiotic. Every antibiotic has its own mode of action. The potency of antibiotic in individual depends on the competence of the immune system. Some antibiotics are very active on wide range of bacteria (broad spectrum) while others are effective against limited number or microbes (narrow spectrum). Abuse of antibiotic has resulted in a number of consequences like drug resistance among others. Prophylactic use of antibiotic is very necessary in some clinical cases. Antibiotics are not effective in the treatment of viral infections but patient with viral infection may if necessary be placed on antibiotic cover to prevent secondary infection. It can also be used to reduce the incidence of infection following surgery.

Allergic reaction is another adverse effect of antibiotic. Their reaction ranges from skin rash to anaphylaxis. Pre-treatment with antihistamine and steroid may be necessary to avoid such reaction. Reading of drug label is very necessary as most of the precautions are stated on it. Any antibiotics that produce reaction should be terminated at once. Antibiotic dosages are according to the maker’s instruction. The use of antibiotics is very rampant in this country and should be discouraged. Some antibiotics may reduce the effectiveness of oral contraceptives.

Erythromycin interacts with a number of drugs including: aminophylline, theophylline, anticoagulants, anti-arrhythmics and some antihistamines. Tetracyclines should not be taken with dairy products or antacids. If a patient on antibiotic therapy develops profuse, watery, foul smelling diarrhoea, pseudo membranous colitis should be suspected, therefore treatment should be discontinued immediately and a course of metronidazole considered.

AMOXYCILLIN

250mg/cap; 250mg/5ml susp; 250mg and 250mg/vial

Amoxycillin is a broad-spectrum antibiotics belonging to the penicillin family. The body absorbs it rapidly. Amoxycillin penetrate all systems even bronchial secretions more readily than ampicillin. It’s action against gram-positive and gram-negative bacteria is due to its ability to inhibit bacterial cell wall synthesis thereby exposing the cytoplasmic membrane to hazardous condition and possible rupture due to osmotic pressure. The major indications of amoxycillin are infections of: gastrointestinal tract, genitourinary tract, respiratory tract, meningitis, ENT, dental abscess, skin and soft tissue, typhoid and paratyphoid. Dose of 250-500mg three times daily either orally or intramuscularly, may be increased in severe cases or 500mg-1g intravenously every four to six hours. Total daily dose should not exceed 6g or 100mg/kg/day. In children, doses of 125 to 250 mg three times based on 35-100mg/kg/day. When intravenous administration is required a dose of 100mg/kg/day in divided doses every six hours is recommended. The action of beta lactamase however may render this drug inactive. Side effects recorded include occasional rashes and GI disturbance.

Brand name: Amoxil

AMOXYCILLIN plus CLAVULANIC ACID

Tab or cap, 250mg amoxycillin (trihydrate) plus

125 mg clavulanic acid (potassium salt); oral susp,

125mg amoxy. Plus 62.5mg clavul. acid Vial for inj.

500mg amoxy. Plus100mg clavul. Acid. All as

trihydrate plus potassium salt respectively

Since amoxycillin cannot be used for penicillinase producing organisms like staphylococcus _Spp, klebsiella or pseudomonas aeruginosa infections because they produce beta-lactamase which inhibit the action of amoxycilin. Clavulanic acid, been a beta lactamase inhibitor when combined with amoxycillin (as in some proprietary brands like augmentinâ) enhances the action of amoxycillin to perforate bacterial cell wall except pseudomonas aeruginosa. It’s main indication is as that of amoxycilin. Oral dose: 375mg-750mg t.i.d before meal for 14 days. Maximum daily oral dose for adults is 3g. In severe cases 1.2g intravenously six or eight hourly. Children 1-12years: 25-50mg/kg/day oral suspension three times daily or 30mg/kg six or eight hourly. Never exceed 14days therapy.

Brand name: Augmentine

AMPICILLIN

250mg and 500mg/cap; 125mg/

5ml susp; 250 and 500mg in vial

Ampicillin resembles benzylpenicillin in its action against gram-positive organisms including streptococcus faecalis, streptococcus pneumoniae, haemolytic streptococci and gram-negative bacteria especially Escherichia coli, proteus mirabilis and enterococci resistant to benzyl penicillin. It is particularly used for the prophylaxis and treatment of infections of the respiratory tract such as chronic bronchitis, pneumonia and bronchietasis and infections caused by Haemophilus influenza. Genitourinary tract infection, soft tissues and skin infection, pyelonephritis. Ampicillin is excreted in high concentration in the bile and as such it is therefore used in the treatment of infection of the biliary and intestinal tract caused by E. coli and shigellae. It is also of use for intraperitoneal dialysis to prevent bacterial peritonitis. The usual dose for an adult is 250 to 500mg q.i.d orally or parenterally. In gonorrhoea, 2g of ampicillin plus 1g probenecid is needed parenterally. Children less than 2years: 62.5-125mg every six hours. Side effects: occasional pruritis, rash, urticaria, oesinophilia, fever, diarrhoea. Supra infections of the gastrointestinal tract with klebsiella, pseudomonas and candida have been reported. C/I: patients sensitive to penicillin and penicillinase producing organisms. In urinary tract infection, the simultaneous administration of probenecid is contraindicated since it may decrease the urinary concentration of ampicillin.

Proprietary name: Penbritin

AMPICILLIN plus CLOXACILLIN

250mg/cap; 125mg/5ml susp;

ampicillin 60mg + cloxacillin 30mg/0.6ml in

neonatal drops; inj., ampicillin 50mg +cloxacillin 25mg/vial i.e.250mg of each (sodium salts) in vial

Ampicillin plus cloxacillin is a broad-spectrum formulation composed by two synthetic penicillin (ampicillin trihydrate and cloxacillin sodium). Ampicillin is advisable in infections due to gram-positive bacteria insensitive towards penicillin. Cloxacillin is efficacious against infection caused by penicillinase producing strains. Both compounds are acid stable and are well absorbed, producing good serum and urine concentrations in-patient with normal renal function higher and more prolonged levels may be achieved by the concurrent administration of probenecid. Indications: infection of the- respiratory tract, pelvic, ENT, urinary tract, gastrointestinal tract, skin and soft tissues, endocarditis, septicaemia and orthopaedic infections, prophylaxis in major surgery, infections in premature bodies and neonates. Normal adult dose of 500mg to 1g is recommended orally, IM/iv four to six hourly depending on severity. Children: 1month to 2years: ¼ adult dose; 2-10years: ½ adult dose or 50 to 100mg/kg in divided dose every 6hours. Neonates: 75mg 8hourly parenterally. S/E: mild nausea, diarrhoea, urticarial, erythematous, it is contraindicated in penicillin hypersensitivity patient. S/P: milk and sodium bicarbonate delay absorption and is useful in case of overdose.

Brand name: Ampiclox

BENZATHINE- BENZYLPENICILLIN

0.72g (1.2 million units) and 1.44g (2.4 mu)

of benzylpenicilin in vial

Benzathine penicillin is a long acting penicillin is used in the treatment of infections due to micro-organisms highly susceptible to penicillin especially syphilis and other treponema infections and streptococcal infection. Adult dose of 1.2mu every 4-7days by deep intramuscular injection only. In primary or secondary syphilis 2.4 million units (1.2mu each buttock) as a single dose. A single dose gives an effective concentration of penicillin in the blood for one week or longer. S/E: pain and tenderness on the site of injection, anaphylactic reaction is common.

Brand: Retarpen

BENZYL PENICILLIN

0.6g (1 million units) and 3.0g (5mu)

sodium or potassium salt/vial

Benzyl penicillin is used in the treatment of a variety of infection including that of the wounds, tendon sheets, fracture, abscesses, boil, carbuncles, acute tonsillitis, pneumococcal pneumonia, rheumatic fever, acute osteomyelitis, otitis media, mastoiditis, meningococcal infections, gonorrhoea and syphilis. If possible cultural identification and sensitivity test should be carried out before treatment. It is wise to start with initial dose sufficient enough to achieve bactericidal concentration in the blood as rapidly as possible in order to prevent the emergence of resistant strains. 1-2mu (600mg-1200mg) i.m/i.v in two to four divided daily doses for adults is recommended. Children below 7days old: 50mg/kg/day in two divided doses; 1-4 weeks: 75mg/kg/day in three divided doses; 1month to 12 years: 100mg/kg/day in four divided doses. In meningitis, adults: 14.4g daily in divided doses; below 7days: 100mg/kg/day in two divided doses; 1-4 weeks old, 150 mg/kg in three divided doses. Above 12 years: as for adult. All by either intramuscular or by intravenous injection.

Brand names: Crystalline penicillin

CEFOTAXIME

500mg and 1g in vials (sodium salt)

Broad spectrum antibiotics employed in severe cases of infections of the kidneys, respiratory tracts, reproductive organs, urinary tract, meningitis, septicaemia, endocarditis, bones, joint, skin and soft tissues. It act by inhibiting bacterial cell wall synthesis, thereby exposing it’s cytoplasmic membrane for possible rupture under osmotic pressure. Following rupture of the membrane, leakage of the cytoplasm ensure and the organism shrink and die. Cefotaxime is the longest acting cephalosporins which belongs to the third generation cephalosporins. Normal adult dose is 1g intramuscularly or intravenously every 12hours. In severe cases, up to 12g in three or four divided daily doses is required. Neonates: 50mg/kg/day; others, 100-150mg/kg daily. Both in 2 to 4 divided doses. Do not exceed 200mg/kg/day. S/E: include pains at injection site, candidosis, GI upset, haemolytic anaemia, rise in liver enzymes S/P: penicillin sensitive patient, severe renal failure, pregnancy and lactation.

Brand name: Claforan

CEFTAZIDIME

0.5,1,2g vial

A broad spectrum and cell wall inhibitor belonging to the cephalosporins. It is very effective in respiratory tract infection, ear-nose-throat infection, gastrointestinal tract, genitourinary systems, skin and soft tissue, septicaemia, meningitis and other systemic infections of bacterial origin and infections in immunocompromised patients. Adults: 1-6g in two or three divided doses IV or deep IM , below 2months: 25-60 mg/kg/day in 2 divided doses: 2 months-1year: 25-50mg/kg in two daily doses. Over 1year: 30-100mg/kg in 2-3 divided doses daily. S/E and S/P are as for cefotaxime.

Brand name: Fortum

CEFTRIAXONE

250, 500, 1 and 2g powder/vial

Ceftriaxone has a prolonged half life of about 8hours and has been proved to be effective against a wide range of serious infections when administered either once or twice per day. It is indicated for the treatment of pneumonia, septicaemia, meningitis, bone, skin and soft tissue infection and preoperative prophylaxis. The bactericidal activity of ceftriaxone results fro inhibition of cell wall synthesis. It is remarkably effective against gonorrhoea for which a single dose of 250mg is curative. Adult dose is usually 1g daily by deep intramuscular injection or by slow intravenous injection. For severe infection infections, 2-4g as a single dose every 24hours is recommended. Children: usually 20-50mg/kg/day by i.m. or slow i.v. injection but in severe infection the dose may be increased to maximum of 80mg/kg/day and maximum of 50mg/kg in neonate. Children dose of over 50mg/kg is administered by slow i.v. infusion over at least 30minutes. S/P: severe renal and hepatic impirement. C/I: pregnancy.

Brand names: Rocephine, medaxonum, oframax.

CEFUROXIME

125, 250, & 500mg/tab; 250 &750mg/vial

This second-generation cephalosporin is obtainable both in perenteral and oral preparation (as zinacef^â and Zinnat^ârespectively). It is of much value in cases of respiratory tract, UTI, ENT, skin and soft tissue, bone and joint infection, gonorrhoea, meningitis, and other serious infection pending bacteriology, prophylaxis against infection in surgical procedures. Oral administration: Adults, most infection and bronchitis, usually 250mg b.i.d. after meal. Severe infection and pneumonia, 500mg b.i.d. In gonorrhoea, 1g as single dose. UTI, 125mg twice daily but in pyelonephritis, 250mg twice daily is recommended. Children: under 3months, not recommended, 3months to 2years: 125mg twice daily; over 2years 250mg b.i.d. All by mouth. Parenteral administration: 750mg thrice daily by i.m or i.v injection. In severe infections, 1.5g intravenously three or four times daily. Children: 30 –100mg/kg body weight/day in divided doses. S/P: hepatic or renal impairment, pregnancy, lactation. This drug is contraindicated in hepatic disease. S/E: allergic reaction, GI upset, photosensitivity, jaundice.

Brand names: Zinnacef, Zinnat.

IMIPENEM + CILASTATIN

Powder for injection 250mg (as monohydrate) + 250mg (as sodium salt); 500mg (as monohydrate) + 500mg (as sodium salt) in vial.

Imipanem – cilastatin has proved to be effective in treating a wide range of life-threatening hospital based infection including febrile neuropenic patient, lower respiratory tract, itra-abdominal, genitor-urinary, gynaecological, bone and joint, skin ans soft tissue infections ans septicaemia due to suspected or proven multidrug resistant. Adults:usually 250mg-1g by i.v. infusion 6-8hourly depending on the severity of the infection or 500-750mg by deep i.m. injection 12hourly depending on the type and severity of infection; maximum of 1.5g daily. In gonococcal urethritis or cervicitis, 500mg as a single dose. Children not recommended. s/p: penicillin hypersensitivity, GI disease particularly colitis, CNS disorders, renal dysfunction, pregnancy and lactation. S/E: nausea, vomiting, diarrhoea, colitis, blood dyscrasias, increased liver enzymes and urea, CNS disturbances and convulsion. However, resistance has been seen in P. aeruginosa during treatment.

Brand name: Primaxin

AZITHROMYCIN

250mg, 500mg cap; 200mg/5ml susp.

Azithromycin is a macroloides and has all the properties of erythromycin. Its indication is also the same with erythromycin and other macrolides but has the advantage of short course therapy in several situations. WHO has listed it for single dose treatment for genital C. trachomatis and of trachoma. It is superior to erythromycin because of its enhanced activity with a half life of 36-50 hours. Serum concentrations are extremely low but tissue concentrations including intracellular uptake are relatively high. Adults: 2tablets once daily for 3days taken at least 1hour before or 2hours after food. Genital infections, 4 as a single dose. Under 3years (up to 15kg), 10mg/kg susp; 3-7years, 5ml; 8-11yrs, 7.5ml; 14-2-14 years, 10ml. all as a single daily dose for 3days, taken at least 1hour before or 2hrs after food. C/I : liver diseases. S/P: pregnancy, lactation, hepatic or renal impirement. Int. ergot derivatives, antacids, digoxin, warfarin and cyclosporin.

Brand name: Zithromax

CHLORAMPHENICOL

250mg/cap; 125 mg/5ml susp (palmitate);

1g (sodium succinate) in vial

Chloramphenicol is a broad spectrum antibiotic with bacteriostatic and bactericidal activity. It inhibit protein synthesis by interfering with the transfer of amino acids from soluble RNA to ribosome .It is highly effective against all species of rickettsia, Salmonella typhi and paratyphi, Haemophilus influenza, Bordetella Pertussis as well as Escherichia coli, shigella and proteus species, Pseudomonas spp; It is the antibiotic of first choice in typhoid and paratyphoid fevers. It’s use for other gastrointestinal and urinary tract infections should be reserved for those organisms such as; klebsiella spp, Proteus vulgaris, and Pseudomonas aeruginosa resistant to other chemotherapautic agents. Chloramphenicol is also of value for the local treatment of a variety of eye, ear and skin infections due to sensitive organisms. Chloramphenicol Palmitate is administered by mouth as aqueous suspension. It is hydrolysed to chloranphenicol in the GI tract. Chloramphenicol Sodium Succinate is very soluble in water and is therefore absorbed more rapidly when given parentrally.

Adults: 500mg orally three or four times per day, for 5 days, 6-12yrs: 250mg capsule three times daily. Injection; 1g every 6 or 8 hours, for adult, and 100mg/kg/day for children in divided doses at interval of 6 or 8 hours. S/E: Chloramphenicol causes severe depression of bone marrow activity leading to aplastic anaemia, agranulocytosis, thrombocytopenia. Less serious side effects include dryness of the mouth, nausea, vomiting and diarrhoea, supra fungal infection. C/I: anaemic patient, pregnancy, and newborn infants

Brand names: Chlorocide, Chloromycetin, Paraxin

CIPROFLOXACIN

250 and 500mg/tab (HCl); 2mg/ml (lactate)

In 50 and 100ml vials

Ciprofloxacin is a bacterial nucleic acid synthesis inhibitor. Nucleic acid is the enzyme responsible for maintaining the structure of bacterial DNA. It is rapidly bactericidal for susceptible bacteria. Ciprofloxacin is suitable for treating infections caused by ciprofloxacin sensitive pathogens like: gastrointestinal tract infection, including typhoid and paratyphoid fever, respiratory tract infection, except pneumonia caused by streptococcus; skin and soft tissue infection, bone and joint infections, ENT, urinary tract infection except prostatitis, urethritis and cervicitis gonorrhoea, Adult dose is 250 to 500mg twice daily for 7-14 days in mild to moderate infections. In severe cases 750mg twice daily for 7-14 days is prescribed. Therapy exceeding two weeks duration may be required for severe complicated infections. Required dose should be taken 2hours after meals with plenty of water. Ciprofloxacin is a quinolone derivative. Co-administration of ciprofloxacin with magnesium-aluminium antacid decreases ciprofloxacin absorption. It is not recommended for children except where benefit outweigh the risk

Brand name: Ciproxin, Ciproflox

CO-TRIMOXAZOLE

Tab, 400 mg sulphamethoxazole plus 80 mg trimethoprim,

and 100 mg sulphamethoxazole plus 20 mg trimethoprim

Susp, 200 mg sulphamethoxazole plus 40 mg trimethoprim/5ml.

Contains Trimethoprim and Sulphamethoxazole in the fixed ratio of 1:5. Co-trimoxazole is a folic acid synthesis inhibitor with bactericidal properties. It’s antibacterial effect covers a wide range of gram-positive and gram-negative organisms like streptococci, staphylococci, Pneumococci, Haemophilus influenza, Neisseria, E- coli, Proteus mirabilis, Proteus vulgaris, Bordetella, Salmonella, Shigella, vibro cholera. Cotrimoxazole is indicated in respiratory tract infection, acute and chronic bronchitis, pneumonia, pharyngitis, tonsillitis, sinusitis, otitis media, UTI, cystitis, urethritis, prostatitis, typhoid and paratyphoid fever, bacillary dysentery, cholera, abscesses and infected wounds, pyoderma, furuncles, skin and soft tissues infection. Adults: 960 mg every 12hours for a minimum of 5days, uncomplicated gonorrhoea 2.4g 12hourly for 1 day. Children: less than 1 year: 60 mg, 1-2 years: 120 mg, 3-5 years: 240 mg, 6-12 years: 480 mg, all twice daily for a minimum of 5 days. S/E: stevens-johnson’s syndromes. C/I: first trimester, hepatic or renal insufficiency, premature and new-born infants

Brand names: Bactrim, Rancotrim, Septrin

DOXYCYCLIN

100 mg/cap

Doxycyclin is a protase inhibitor belonging to the tetracycline family and is the most potent in this group. It is highly effective in the treatment of all bacterial sexual transmitted disease, pelvic inflammatory disease, Ear-nose and throat infection, urinary tract infection, gastrointestinal tract infection, respiratory tract infection, pneumonia, soft tissues and skin infection and ophthalmic infections. Dose of 200 mg initially then 100-200 mg daily all with food. In gonorrhoea, 300 mg at once repeat after one hour or 100mg twice daily for 7days. Doxycycline is highly contraindicated in children, pregnant and lactating mother because it gives permanent dental discoloration. Precaution should be taken in patients with hepatic impairment. Do not administer together with antacids, barbiturates, carbamazepine, phentoin and mineral supplements. Side effects include GI disturbance, oesophagitis, photosensitivity, fungi super infections.

Brand name: Vibramycin,

ERYTHROMYCIN

Cap and Tab, enteric/film coated,250mg

(stearate or ethylsuccinate) injection powder

500mg (lactobionate) in vial

Erythromycin is a broad spectrum antibiotics with bacteriostatic and bactericidal activities depending on it’s concentration. In order to prevent erythromycin resistant strain, many authorities have decided that the use of this antibiotics be restricted to the treatment of patient sensitive to penicillin who tolerate erythromycin well and of infections due to penicillin resistant strain of bacteria. Erythromycin is indicated for the treatment of acute streptococcal infections, lobar pneumonia and other pneumococal infections and infections due to Haemophilus influenza, staphylococcal enteritis. It may be useful in amoebiasis and has been used often in combination with other antibiotics.

Erythromycin is a protein synthesis inhibitor belonging to the group of macrolides. The acid of the gastric juice following oral administration slowly destroys it. Effective therapeutic amount is present in the blood for about 6 hours. It crosses the placenta and enters into foetal circulation and also the blood brains barrier unless the meninges are inflamed. It is excreted mainly in the bile and in urine to a lesser extent. For moderately severe infections in adults, a dose of 250 mg every 6 hours, for severe infections 500 mg may be given. Children up to 1 year: 80 mg; 1-5 years: 120 mg; 6-12 years: 200-250 mg every six hours or 25 to 30 mg/kg/day. To avoid destruction by gastric juice, erythromycin is usually given as enteric-coated tablets, preferably on an empty stomach as its absorption is delayed by the presence of food. Erythromycin may be given by injection i.m. or i.v informs of one of its more soluble salts like lactobionate. Injection should be given to patient who are unable to tolerate oral medication or when it is necessary to produce a high blood concentration. Oral medication should replace parenteral administration as soon as practicable.

Brand name: Erythrocin, Erythroped

FORTIFIED PROCAINE PENICILLI

Inj. Powder, in vials: 0.4 million units

Containing 0.3 mu (300 mg) of procaine penicillin

and 0.1 million units (60mg) of benzyl penicillin and

4.0 mu containing 3.0 mu (3g) of procaine penicillin

and 1.0 mu (600mg) of benzylenicillin.

Procaine penicillin is administered by injection into the gluteal muscle from where penicillin is slowly liberated. After an intramuscular injection of 300,000 to 600,000 units effective concentrations of penicillin are found in the blood of most subjects for a period of 12 to 24 hours. Fortified procaine penicillin has the same indication and anti microbial action with benzylpenicillin. Fortified procaine penicillin is measured in units. Every 4.0 million units vial powder contains 3.0 million unit’s (3g) of procaine penicillin and 1.0 million units (600mg) of benzyl penicillin.

Doses: infants 0-5 months: 75,000 I.U; 6-11 months: 150,000I.U; 1-5 years:300,000 I.U; 6-12: years: 450,000 I.U; Adults: 600,000 I.U all as intramuscular daily injection. Fortified procaine penicillin should be given with caution as severe anaphylactic shock has been reported several times from professionals even when skin sensitivity test shows no reaction. It should not have a direct contact with circulating blood since the smallest drop into the vessel may trigger fatal anaphylactic reaction.

Brand name: Hostacillin

GENTAMICIN

10mg/ml and 40mg/ml (sulphate)

Gentamicin belongs to the family of aminoglycosides. It is a broad-spectrum antibiotic with bacterial activity against many strains of Escherichia coli, Pseudomonas, klebsiella, proteus and staphylococcus. It is also useful in severe burns, wounds, genitourinary tract infection, gastrointestinal tract infection, respiratory infection and septicaemia. Intramuscular administration of gentamicin sulphate results in peak serum level about 30 minutes after administration, detectable serum level persists for 8-12 hours. Rate of excretion through urine is about 78-81% in 24 hours. There is a synergism between penicillin and gentamicin. Gentamicin inhibits the synthesis of bacterial protein. It is poorly absorbed from the gastrointestinal tract but rapidly absorbed after intramuscular injection. Peak serum level being reached in half to one hour and effective concentrations being still present 4 hours after injection. Adults: 80 mg IM two to three times daily for 7-10 days. Children: 3 to 5mg/kg body weight daily in two or three equally divided doses. May be increased adequately for IM injection or IV infusion in severe systematic infection caused by strong toxic pathogens. S/E: ototoxicity and nephrontoxicity. C/I: hepatic and renal function disorder, neonates and pregnant mothers except in life threatening situations.

Brand names: Genticin, Garamycin

LINCOMYCIN

500mg/cap; 250mg/5ml syrup; 150mg/ml (phos.) ampoule

Lincomycin is abroad spectrum bacteriostatic agent with a range of action similar to that of erythromycin. It is active against streptococcus pyogenes, streptococcus pneumoniae, staphylococcus aureus, coryne-bacterium diphtheriae and bacillus anthracis, including septicaemia, cellulitis, bacteria endocarditis, osteomylitis, pneumonia, erysipelas, otitis media, sinusitis, pharyngitis and tonsillitis. It is less active than erythromycin against Neisseria gonorrhoea, Neisseria meningitidis and haemophilus influenzae. Escherichia coli, klebsiella spp, proteus spp, pseudomonas aeruginosa, shigella spp, and salmonella spp are resistant to lincomycin. It is rapidly absorbed from the intestine and excreted in urine and bile. It crosses the placenta barrier. Diffusion into the cerebrospinal fluid is poor. Dose by mouth: adults, 500mg 3 or 4 times daily between meals. Children, 30 to 60 mg/kg/day in 3 or 4 equal divided doses. By intramuscular injection: 600mg to 1.2g two times daily for adults. Children, 10 to 20mg/kg daily in 2doses. By intravenous infusion: adults, 600 mg every 8 to 12 hours, Children: 10 to 20mg/kg in two or three divided doses. For infusion, the dose should be dissolved in about 250 ml of 5% dextrose water or sodium chloride injection and infused over 30 minutes. S/P: neonates check liver function and blood regularly with prolonged use. C/I: pre-existing monilial infections.

Brand name: Lincocin

NEOMYCIN

500mg/tablet; 100mg/5ml susp

. Neomycin is used in lotions and ointments for tropical application in the treatment of infections of the skin and eyes due to staphylococci and other susceptible organisms, including impetigo, sycosis barbae, infected wounds, burns and ulcers, conjunctivitis, blepheritis and styes. To avoid the development of resistant strains, It may be used in combination with bacitracin and to prevent inflammation, hydrocortisone acetate may be added. Neomycin sulphate is poorly absorbed from the gastrointestinal tract and as such it is administered orally as an intestinal antiseptic to suppress the normal bacterial flora of the intestinal tract before surgical operations on the large intestine and anus. It is also employed for the treatment of infective diarrhoea caused by Escherichia coli, Proteus vulgaris, Salmonellae and other susceptible organisms. For pre-operative use, 1g of neomycin is given orally every 4 hours for a total of 6 doses. For the treatment of intestinal infections, including infantile diarrhoea, a total daily dose of 30 to 50mg/kg body weight may be given in 3 or 4 orally divided doses. Prolonged oral administration of neomycin sulphate (4 to 10g daily for up to 10 months) for suppression of the intestinal flora has been recommended in hepatic failure. Parenteral neomycin is seldom administered because of possible damage to the kidney and the 8^th cranial nerve. This drug is contraindicated in renal or auditory impairment. Side effects involved are kidney damage, partial or permanent deafness

METRONIDAZOLE

Inj. 500mg/ 100ml

Metronidazole is a nitroimidazole derivative; it is bactericidal to anaerobic organisms. Metronidazole tablets have been discussed under antiflagellate and amoebicide. Therefore this section will discourse parenteral metronidazole. Metronidazole infusion is effective and mostly employed in severe anaerobic organisms like: Clostridium specie, Endolimax nana, Entameba histolytica, Fusobacterium vincentii, Gardnerella vaginalis, Giardialamblia, Peptococcus, Peptostreptococcus and trichomonas vaginalis. After the bacterial up take of metronidazole, the drug produces unstable metabolite inside the bacteria DNA thereby inhibiting its nucleic acid synthesis. It is excreted in urine. It’s half life is about 6-12 hours. So metronidazole injection is used for treatment and prophylaxis of infections caused by anaerobic bacteria. Therapeutically, metronidazole is generally used in the treatment of Abdominal and pelvic sepsis, urogenital tract infection, cerebral abscess, pulmonary abscess, dermatological infections, intestinal and hepatic amoebiasis, post operative infections and Vincent’s angina (purulent gingivitis). It may be combined with penicillin, aminogycosides or cephalosporin in the treatment of polymicrobial infection but should be administered separately. For amoebiasis: 500-750mg thrice daily for 5 to 7 days. In anaerobic infections: 15mg/kg initially then 7.5mg/kg every 6 hours for at least 7 days. Preoperative prophylaxis: 15mg/kg one hour before surgery and 7.5mg/kg at 6 hours and again at 12 hours after surgery. Infants and children: 7.5mg/kg 8 hourly for 5 to 7 days. Side effects recorded include vomiting, anorexia, abdominal discomfort, dry mouth, dry vulva and vagina, vertigo, insomnia. S/P: pregnancy, CNS disorder, hepatic impairment.

Brand name: Flagyl injection

NITROFURANTOIN

50 and 100mg per tab

Nitrofurantoin is a synthetic nitrofuran that acts by interfering with bacterial DNA. It is a broad spectrum antibacterial used for the treatment of urinary tract infections, prophylaxis in genitourinary surgery and instrumentation. It is given by mouth usually in daily dose of 50 to 150 mg four times daily for adults, children up to I year: 15mg every 6hours; 1-5years: 25mg; 6-12years: 50mg every 6hours all for a duration of 7days. It is given during or immediately after meal. It can be used during pregnancy except at term. Nitrofurantoin occasionally causes nausea, vomiting, and skin sensitisation and renal failure. It is contraindicated in patient with severe oliguria, anuria or severe renal damage.

Brand name: Furadantin, Furan.

NORFLOXACIN

400mg/tablet

Norfloxacin is bactericidal; it belongs to the quinolone family which act by inhibiting the enzyme responsible for interfering with the DNA strands during bacterial replication. It is active principally against gram-negative organisms, particularly of use in both upper and lower/complicated and uncomplicated acute and chronic urinary tract infection. Adults: cystitis, 400mg b.i.d. for three days; complicated UTI, 400mg daily for 7-10days; chronic UTI, 400mg twice daily for up to 3months, all doses are to be taken with water at least one hour before food or two hours after meal. It is contraindicated in pregnancy, lactation, children and adolescents. Special precaution to be taken in epileptic patient. Side effects: nausea, headache, dizziness, rashes, abdominal discomfort, anorexia, insomnia, anxiety, convulsion, Steven’s Johnson syndrome, haemolytic anaemia, hepatitis, photo sensitivity, vaginal candidiasis. Discontinue treatment if side effects occur.

Brand name: Utinor

OFLOXACIN

200mg, tab and cap; 100mg/50ml

and 200mg/100ml ,inj

A nucleic acid inhibitor of valuable in the treatment of lower respiratory tract infection, skin and soft tissue infections, urethral and cervical gonorrhoea, non gonococcal urethritis, cervicitis and septicaemia. Adults dose: 200-400mg once daily by mouth. In severe state, 400-800mg daily orally in two divided doses for a period of 5-10days or 200-800mg daily by slow intravenous infusion over 30minutes for 7-10days depending on type and severity of infection. Contraindications: history of epilepsy, pregnancy, lactation, children and adolescents. Side effects and safety precaution are as for norfloxacin.

Brand name: Tarivid

OXYTETRACYCLINE

250mg, tab and cap

A protase inhibitor with a wide spectrum anti-microbial activity used in the treatment of a large number of infections including anthrax, brucellosis, pneumonia, whooping cough, rickettsial fever, urinary tract infection, klebsiella spp, escherichia coli, and Pseudomonas aeruginosa. It is also of value in certain stages of syphilis, in yaws and in gonorrhoea including acute gonococcocal ophthalmia, vaginitis due to trichomonas vaginalis. Dose by mouth is 1-2g daily in equal divided doses. S/E: Permanent dental discoloration in children, nausea, diarrhoea, over growth of resistant organisms, sore mouth, redness and thrush due to candida albicans overgrowth. Over growth of pseudomonas spp and proteus spp in the intestine causes diarrhoea, over growth of candida albicans in the bowel causes pruritus ani. It is contraindicated in infants, premature babies, pregnancy and lactation. It should not be given together with milk, antacids, oral contraceptives and mineral supplements.

Brand name: Terramycin.

PHENOXYMETHYL PENICILLIN

250mg (potassium) tab; 250mg/5ml, susp.

Has a range of anti-microbial activity similar to that of benzyl penicillin. It is inactivated by penicillinase. Phenoxymethyl penicillin is absorbed rapidly from the gastrointestinal tract. It is useful in the treatment of infections caused by susceptible staphylococci, streptococci, gonococci and pneumonococci. It should only be administered for mild infection caused by the above-mentioned organisms. If no improvement is noted within 2 or 3days, consider injection or other stronger oral antibiotics, caution should be observed in its administration to penicillin sensitive person and those with bronchial asthma or other symptoms of allergy. Allergic shock has been rarely reported after oral administration of phenoxymethyl penicillin. Adults: 250-500mg; 6-12years: 125-250mg; less than 6years: 50-75mg, to be taken three or four times daily.

Brand name: Penicillin V

PHTHALYSULPHATHIAZOLE

500mg, tab

Phthalysulphathiazole is sparingly absorbed from the gastrointestinal tract. The small amount that is absorbed is rapidly eliminated in the urine. It is effective in a dosage of 5-10g daily in divided doses for a period of seven days. In the pre-operative preparation and postoperative control and treatment of infection in patients undergoing operations in the large bowel. It reduces the number of Escherichia coli, Clostridium welchii and streptococci in the intestine and thus lowers the risk of peritonitis and abscess formation. It is effective in the treatment of bacillary dysentery and inflammatory disease of the intestinal tract. In children, the dosage varies from 50mg/kg body weight to 250mg/kg. S/E: overgrowth of candida spp. Suppresses the synthesis of vitamin B and K in the small intestine and when it is given over a long period of time, these vitamins should be administered concurrently.

Brand name: Thalazole

SPECTINOMYCIN

2g (HCl) , vial

Spectinomycin is active against few gram positive and gram-negative organisms particularly of the following species: brucella, klebsiella, proteus and pseudomonas. It is not known to have any advantage over any other generally used antibiotic. It is administered by intramuscular injection usually in a dose of 2g as a single dose for male and 4g for female. It is contraindicated in pregnancy and neonates.

Brand names: Togamycin, Trobicin

SULPHONAMIDES

Sulphonamide is a familial name comprising many essential and non-essential antibiotics. The essential ones that will be discoursed under this group include: sulphadiazine, sulphamerazine, sulphathiazole and sulphadimidine. They exert an effective bacteriostatic against wide range of organisms although they have been superseded in many diseases by other antibiotics. The choice of sulphonamides should be based on thorough bacteriological and clinical diagnosis. They are effective in the treatment of bacillary dysentery, meningitis, haemophilus influenzae, urinary tract infection due to escherichia coli and gram positive cocci except enterococci, proteus infection, mixed sulphonamides (sulphadiazine 185mg plus sulphamerazine 130mg plus sulphathiazole 185mg per tablet as in Sulphatriad^â) are formulated to minimise the renal toxicity caused by precipitation of crystals of free sulphonamide in the ureters and tubules. The constituent drugs of the mixture can co-exist in solution in water or urine without affecting the solubility of each other and each acts as if it were present alone. Therefore, a large total amount of sulphonamide can be present in the urine without precipitations than would be possible if only one were present. The mixture has no advantage over sulphadimidine. The pharmacological and therapeutic properties of mixed sulphonamides are similar to those of the individual sulphonamide. Administration is usually by mouth either as tablets or as a liquid suspension. The usual initial dose for adult is 3 to 4g followed by 1g every 4hours; 1-3 years: ¹/₃ of adult dose; 4-10 years: ½ of adult dose; 11-15 years: ²/₃ of adult dose. C/I: hypersensitivity to the drugs, Renal diseases, jaundice, infants within one week of full term birth or within one month of premature birth because of the danger of causing mental deficiency.

Brand name: Sulphatriad

SULPHADIMIDINE

500mg, tab; 500mg/5ml susp

Sulphadimidine rarely cause serious toxic effects, nausea and vomiting seldom occur and do not usually interfere with the continuation of treatment. It has the general uses of the sulphonamides as described above. It is rapidly absorbed in gastrointestinal tract. Sulphadimidine is firmly band to plasma proteins and is therefore excreted slowly. It crosses the blood brain barrier less easily than the constituent of the mixtures mentioned above. In general, it is the sulphonamide of choice in pneumococcal and streptococcal infections and in Escherichia coli infections of the urinary tract but it is usually less effective than the mixed sulphonamide in meningeal infections. It is administered by mouth in an initial dose of up to 3g with a subsequent dosage of 1g every 4 hours or 1.5g every six hours. For UTI, the dose is 2g initially followed by 0.5 –1g every 6 or 8hours. Infants and children of 1-3 years: ¹/₃ of the adult dose; 4 to 10yreas: ½ of the adult dose; 11 to 15years: ²/₃ of adult dose.

SULTAMICILLIN

Tab, 147mg, sulbactam + 220mg ampicillin;

susp., 98mg sulbactam+147mg ampicillin/5ml

Sultamicillin is a combination of sulbactam and ampicillin. Since ampicillin is inactivated by penicillinase producing micro-organism. Sultamicillin, which is a good beta lactamase inhibitor when combined with ampicillin (as in Unasynâ) extends its spectrum to cover all streptococci, H. influenza, and most gram-negative coliforms except pseudomonas aeruginosa. It’s anti-microbial action is the same as that of ampicillin. Dose, adults and children over 30kg: 375-750mg orally twice daily for 5-14days. Children 25-50mg/kg/day in two divided doses. In gonorrhoea 2.25g as a single oral dose combined with 1g probenecid

Brand name: Unasyn

STREPTOMYCIN SULPHATE

1g and 5g (sulphate) in vial

The major use of streptomycin is in the treatment of tuberculosis in combination with other drugs. It is of a particular value in the treatment of tuberculous meningitis and military tuberculosis, in pulmonary tuberculosis, it is effective in the early stage or when the disease is progressing rapidly and less effective in chronic tuberculosis. Tuberculosis of the larynx, trachea, bronchi, pharynx, genitourinary system and tuberculous ulcers all respond very well to streptomycin. Since streptomycin and penicillin are both bactericidal and synergistic, they are sometimes used together in the treatment of certain bacterial infection like sub-acute bacterial endocarditis caused by streptococcus mitis or streptococcus faecalis, peritonitis due to mixed streptococcal and clostridial infections. After intramuscular injection, maximum concentration in the blood is reduced in 1 to 2hours and the therapeutic serum level may persist for 6-8hours or longer and significant amount may still be present after 24 hours. Maximum concentration in the blood is achieved within few minutes of intravenous injection but declines more rapidly than after intramuscular injection. As much as 70% of a parenterally administered dose is excreted in the urine in 24hours and significant amount of the remainder in the bile. It does not cross the blood brain barrier in normal condition but passes the placenta barrier. In general, streptomycin is a narrow spectrum antibiotics with bacteriostatic and bactericidal activities. It belongs to the family of aminoglycoside. Dose of 1g daily by intramuscular injection for adult over 50kg; 21-50kg: 0.75g; less than 21kg: 20mg/kg. In active tuberculosis it should be given daily for two months together with other anti tuberculosis agents such as Rifampicin 600mg; Isoniazid 300mg; Pyrazinamide 2g, all as single daily doses for a period of 2months. Side effect include vertigo, headache, lassitude, pain and irritation at injection site. More serious effect is the selective toxication on the 8^th cranial nerve and consists of vertigo, tinnitus, and permanent deafness. Kidney and liver damage may be due to higher doses. Medical professionals should handle this drug with care to prevent skin sensitisation, which may lead to dermatitis. C/I: hepatic or renal impairment, ear damage.

Anti TBL

Drugs used in the treatment of leprosy should never be used except in combination. Combination therapy is essential to prevent the emergence of drug resistance. Colour coded blister packs (MDT blister packs) containing standard two drug (paucibacillary leprosy) or three drug (multibacillary leprosy) combinations for adult and childhood leprosy should be used. MDT blister packs can be supplied free of charge through WHO.

DAPSONE

50 and 100mg/tab

This medication is used to treat a certain type of skin disorder (dermatitis herpetiformis). It is also used with other drugs to treat Hansen's disease. Dapsone is a bacteriostatic agent which inhibit folic acid synthesis in mycobacterium laprae. Dapsone belongs to a class of drugs known as sulfones. It works by decreasing swelling (inflammation) and stopping the growth of bacteria. Dose: 13 years and above, 1^st month: 25 to 50 mg weekly; 2^nd month: 50-100mg weekly to maximum of 100-300mg weekly. 6 to 12years, 1^st month: 10-25 mg weekly; 2^nd month: 25-50mg weekly to a maximum of 50-100mg weekly. Do not give in severe anaemia, give folate supplements if patient is pregnant. Side effects include blood disorders, rashes, gastrointestinal upset, headache, hepatitis and psychosis.

Brand name: DDS

CLOFAZIMINE

50 and 100mg/cap

Clofazimine inhibit the growth of myco-bacterium laprae especially where other drugs are ineffective. It also possesses anti-inflammatory properties and is suitable for treating leprosy reactions. Adults: 300mg as a single dose, then 50-100mg daily for 28days. S/E: dry and discoloured skin, secretions, pruritus, eye problem, anorexia, headache, tiredness.

ISONIAZID

100 and 300mg/tab

The action of Isoniazid is bactericidal against M. tuberculosis. 3years and above: 300mg daily; 1-2years: 200mg/day; 6-11months: 150mg daily, all for over a period of six months. Side effects: hepatitis, insomnia, muscle twitching, restlessness.

Trade name: INH

PYRAZINAMIDE

500mg/tab

This medication is used with other anti-tuberculosis medications to treat active tuberculosis (TB) infection (TB involving the Lungs, Active Tuberculosis, TB Meningitis). Pyrazinamide belongs to a class of drugs known as antibiotics that are active against tuberculosis. Patients weighing 20kg and below: 30mg/kg daily; 21-30kg: 1g daily; 31-50kg: 1.5g daily; Over 50kg: 2g daily ,all for a period of two months. Over dose may cause hepatitis

RIFAMPICIN

150 and 300mg/cap or tab

Indicated for the treatment of mycobacterium tuberculosis also useful in mycobacterium laprae. It is effective when administered daily by mouth for a period of two months. 20kg and below: 10mg/kg; 21-30kg: 300mg; 31-50kg: 450mg; Over 50kg: 600mg . Rifampicin changes the colour of urine and body secretion to orange. Hepatitis and jaundice are the side effect which mostly occur with high doses.

ETHAMBUTOL

100-500mg/tab (HCl)

Effective when combined with other anti tuberculosis agents. It helps to prevent the emergence of resistance strains. Adult: 400mg daily, Children: 15mg/kg/day, all for a period of 6months. Overdose may cause eye problems.

Brand name: Myambutol

Reserve second-line drugs for the treatment of multidrug-resistant tuberculosis (MDR-TB) should be used in specialized centres adhering to WHO standards for TB control. They include ciprofloxacin tablet, levofloxacin, kanamycin and ofloxacin.

STREPTOMYCIN SULPHATE

See section on antibiotics page…78.

Systemic anti-fungal agents

AMPHOTERICIN B

50mg/vial

Amphotericin B is a broad spectrum anti-fungal agent but because of it’s toxicity, it should be reserved for the treatment of severe infections due to fungi susceptible to it. It should be administered in hospital under close supervision. It is highly effective in the treatment of deep seated mycotic infections, amphotericin B is ineffective against bacteria and viruses but is effective against leishmaniasis. Generalised systemic moniliasis may be favourably influenced by amphotericin B. Usual dose is 0.1mg per kg body weight by slow intravenous infusion over a period of 3 to 6hours initially; then up to 1mg per kg daily for 4 to 8weeks. It may also be given by intra-articular injection using the dose of 0.015 to 0.25mg per kg every 2 to 4 days to 1mg per kg daily. Lotion that contains amphotericin B are applied locally in the treatment of intertrigo, napkin rash and onychomycosis. The lotion should be well rubbed into the affected area 2 to 4 times daily for a period of 1or 2weeks. Amphotericin B irritates the venous endothelium and may cause pain and thrombophlebitis at the injection site. Hypokalaemia occurs frequently after intrathecal injection, pain in the back and leg, impaired vision and retention of urine have occurred. Headache, vomiting, nausea, chills, fever, malaise, body pains, sweating, flushing, anorexia, diarrhoea, GI cramps, anaemia, skin rash, hypotension, blurred vision and convulsion has also been reported following intravenous injection.

Brand name: Fungizone

FLUCONAZOLE

50 and 150 mg/cap; inj. 2mg/ml in 0.9%NaCl

Is used to treat candidal infections at all mucosal sites, including systemic candidosis Thrush, Candidiasis, fungal Infection of the Oropharynx, Yeast Infection of Vagina and Vulva, Urinary Tract Infection due to Candida Albicans Fungus, Candida Fungus Infection of Mouth, Skin, Nails or Vagina, Candidiasis Yeast Infection that Spreads Throughout Body, TPrevention of Disseminated Candidiasis, Fungal Infection of the Esophagus, Fluconazole Oral may also be used to treat: Skin Infection marked by Ulcers - Cutaneous Leishmaniasis, Ringworm, Athlete's Foot, Treatment for Prevention of Vulvovaginal Yeast Infection. This medication is an azole antifungal. It works by stopping the growth of fungus that causes the infection Dose for systemic candidosis: 400mg at once then 200mg daily. Vaginosis or balanitis: 150mg as a single dose. Mucosal candidosis: 50-100mg daily for two weeks. Brand name: Diflucan

CLOTRIMAZOLE

Oint, Cream, 1%. spray, aerosol, 1%,

Dusting powder, 1%. Pessaries., 100mg, 200mg

Clotrimazole is a broad spectrum antimycotic with fungicidal action for local application, it has a reliable action on dermatophytes, yeast and other fungi skin infection. It is indicated in all forms of dermatomycoses due to dermatophytes, all dermatomycoses due to moulds and other fungi infections, leucorrhoea, vaginitis due to fungi (candida _spp/trichomonas) and other clotrimazole sensitive bacteria. Interdigital, paronychias and skin fold mycosis. Apply thinly 2-3 times daily to infected sites and rub in. To prevent relapse in fungal infection of the feet, treatment should continue for about 2weeks beyond the disappearance of all signs of the disease. Wash and dry the affected parts thoroughly before application. In case of vaginoses, one pessaries is to be inserted deeply into the vagina once daily preferably at bedtime or 2 applicators charge of cream to be applied deeply into the vagina in the evening on 3 consecutive days.

Brand name: Canesteen

GRISEOFULVIN

125 and 500mg/tab; 125mg/5ml susp

Griseofulvin is administered by mouth in the treatment of a variety of fungus infection of the skin, nail and hair especially where tropical therapy has failed or is inappropriate. For superficial forms of ringworm, treatment needs to be continued for 3 to 6 weeks, and for nail infection it may need to be continued for up to 12months. Griseofulvin is absorbed from the gastrointestinal tract following administration and is deposited in the deep layer of the skin, the keratin of the nails and hair thus preventing fungal invasion of newly formed cells. It is destroyed by the liver and excreted via urine and faeces.

Adults: 0.5 to 1g daily in divided doses. Children, up to 1year: 62.5 mg twice daily; 1-5years: 62.5mg thrice daily; 6-12years: 125mg twice or thrice daily. S/E: usually consist of headache, skin rashes allergic reaction and angioneurotic oedema, GI disturbance, dermatitis, It also enhances the effect of alcohol.

Brand name: Fulcin

KETOCONAZOLE

200mg/tab; 100mg/5ml susp

Ketoconazole inhibits fungal cell wall thereby causing leakage of cellular constituents. It is used in the treatment of fungal infections of various origin such as: systemic mycoses, serious chronic mucocutaneous candidosis and serious mycoses of the gastrointestinal tract, mouth and vagina not responsive to other therapy, culturally determined dermatophyte infections not responding to treatment, infection of the skin, hair and nails induced by dermatophytes and /or yeast, prophylaxis of mycoses in patient with reduced immune response. Adults: 200-400mg once daily by mouth with meals. Continue treatment at least one week after symptoms have cleared. Children: 3mg/kg daily orally. It is contraindicated in liver diseases. S/E: teratogenicity, liver toxicity, headache, rashes, GI upsets, hypersensitivity reactions. Special precautions: don’t administer together with antacid, anticoagulant, rifampicin, phenytoin, steroid, anti-colinergics

Brand name: Nizoral.

MICONAZOLE

250mg/tab

This medication is used to treat skin infections caused by fungus (e.g., athletes foot, ringworm). Miconazole tincture reduces the itching, peeling, and burning that may occur with these skin infections. This medication is an azole antifungal. It works by stopping the growth of fungus that causes the infection, Fungal Infection of the Skin with Yellow Patches, Skin Infection due to a Candida Yeast. Vulvo-vaginal candidiasis, super infections due to gram positive bacteria, balanitis. Insert one pessary high in the vagina at night as a single dose for seven consecutive nights

Brand name: Gynodaktarin.

NYSTATIN

500,000units/tab; 100,000units/ml susp

Nystatin is used for the local treatment of moniliasis especially that caused by candida albicans, including thrush, intestinal and vulvovaginal and cutaneous moniliasis and monilial paronychia. It may be combined with broad-spectrum antibiotics as a prophylactic measure against over growth of candida. This is to prevent development of microbial resistance to nystatin. Nystatin is poorly absorbed from the gastrointestinal tract and is excreted in the faeces. It is not absorbed through the skin, or mucous membranes when applied topically. For anal or vaginal infections, suppositories or pessaries containing 100,000 units may be inserted twice daily for 7days. For cutaneous lesions, ointments containing 100,000units per gram may be applied, and for lesion of the mouth, suspension of a similar strength may be used. The use of nystatin to treat systemic fungal infection has been disappointing. Adult dose is 500,000 units orally every 8hours. Children up to 5years: 100,000units orally every 6hours. 6-12years: 500,000 twice daily. S/E: mild nausea and vomiting, diarrhoea.

Brand name: Mycostatin, Nystan

Anti-viral drugs

Antiherpes

ACYCLOVIR

Tab., 200 and 400mg; susp, 200mg/5ml.,

inj., 250mg sodium salt/vial., cream, 5%

Acyclovir is a viral DNA inhibitor. It exerts its antiviral action by becoming phosphorlated via viral enzyme called thymidinekinase. The triphosphate form of the drug then acts as an inhibitory substrate for viral DNA polymerase enzymes and thereby preventing viral replication without affecting normal cellular activities. Acyclovir is a narrow spectrum antiviral agent, It is indicated for the treatment of infections due to herpes simplex, herpes zoster and vericella. Herpes simplex skin infection may be treated with topical preparations (cream) but oral treatment is required for varicella zoster and mucocutaneous herpes simplex infections.

Adults: Herpes simplex: treatment, 200mg five times daily at four hourly intervals for 5days. Suppression, 200mg four times daily at 6hourly intervals or 400mg twice daily. When treating immunocompromised patient, 400mg five times daily at 4-hourly intervals are recommended. For prophylactic measure, 200-400mg four times daily at six hourly intervals. Varicella or herpes zoster, 800mg five times daily at 4-hourly intervals for 7days.

Children: varicella: under 2years, 200mg four times daily for 5days; 2-5years; 400mg four times daily for 5days; over 6years, 800mg four times daily for 7days. Herpes simplex: treatment/prophylaxis: under 2years, half adult dose; over 2years same as adults.

Consider intravenous dosing in severe immunocompromed and impaired gut absorption. Adults and children over 12years 5mg/kg slow i.v infusion eight hourly for 5days. Prophylaxis of herpes simplex in immunocompromised patients: 5mg/kg eight hourly for a period at risk. Herpes simplex encephalitis: 10mg/kg eight hourly for 10 days. Side effects include renal impairment, neurological reactions, rashes, headache and fatigue. Safety precautions: renal disorders, pregnancy, maintain adequate hydration.

Brand name: Zovirax

IDOXURIDINE

Sol., 5% in dimethylsuphoxide

Idoxuridine is an antiviral agent, which acts by inhibiting the formation of deoxyribonucleic acid (DNA) of the virus. It is principally used in the treatment of superficial herpes simplex keratitis (dendritic keratitis) of recent origin. Healing usually occurs in 1 or 2 weeks and immediate relapse is prevented by a further 5 to 7 days treatment. In this section, a 5% solution of Idoxuridine is used as a tropical antiviral agent. It is indicated for herpes zoster and herpes simplex infection of the skin. Apply locally four times daily for four days. It is not recommended in children, pregnancy and lactation. Do not apply in open wound as delayed healing has resulted. Side effects that occasionally occur include stinging, pruritus, oedema, inflammation and photophobia.

Brand name: Herpid

Antiretrovirals

Adequate resources and specialist oversight are prerequisites for the introduction of this class of drugs. The antiretroviral drugs do not cure the HIV infection, they only temporarily suppress viral replication and improve symptoms. They have various adverse effects and patients receiving these drugs require careful monitoring by adequately trained health professionals. For these reasons, continued rigorous promotion of measures to prevent new infections is essential and the need for this has not been diminished in any way by the addition of antiretroviral drugs to the Model List of essential drugs. Adequate resources and trained health professionals are a prerequisite for the introduction of this class of drugs. Effective therapy requires commencement of three or four drugs simultaneously, and alternative regimens are necessary to meet specific requirements at start-up, to substitute for first-line regimens in the case of toxicity, or to replace failing regimens. In order to simplify treatment, facilitate storage and distribution, and improve patients’ adherence to the treatment plan, the Committee recommends and endorses the use of fixed-dose combinations and the development of appropriate new fixed-dose combinations. These include modified dosage forms, non-refrigerated formulations and paediatric formulations with assured pharmaceutical quality and interchangeability with the single products as approved by the relevant drug regulatory authority.

Daily dosing of antiretroviral agents for adults

Class/drug	Adult daily dose	Special considerations
Non-nucleoside reverse transcriptase Inhibit the HIV reverse transcriptase enzyme, thereby preventing its DNA synthesis. It is used to delay disease progression in patients with advanced HIV infection.
Delavirdine mesylate 100mg/tab	400mg thrice daily	To be taken at least 1hr apart from didanosine and from antacids
Efavirenz 200mg/cap	600mg once a day	Avoid high fat meal. CNS side effect has been reported. Bed time administration may be useful.
Nevirapine 200mg/tab	200mg twice daily	First 14days of therapy: 200mg once a day
Nucleoside reverse transcriptase inhibitor They are used to delay disease progression in HIV infected patients.
Didanosine 100,125,200 and 250mg/tab	100mg twice daily	Take on empty somach. Avoid alcohol. Above 60kg, dose is 125mg twice daily or 250mg once a day. The 200mg tablet should only be used in the once a day regimen.
Abacavir 300mg/tab	300mg twice daily	Stop if hypersensitivity reactions occur. Don’t restart.
Lamivudine (3TC) 150mg/tab	150mg twice daily
Stavudine (d4T) 15mg, 20, 30 and 40mg/tab	40mg twice daily	Patient weighing <60kg,>
Zalcitabine (ddC) 0.75mg/tab	0.75mg twice daily	Don’t combine with didanosine or magnesium/aluminium containing antacids
Zidovudine (ZDV or AZT) 100, 200mg/cap and 300mg/tab	200mg cap t.i.d or 300mg tab b.i.d
Protease inhibitors Drugs under this category block the action of HIV protease thereby rendering the enzyme incapable of processing the proteins required for production of mature HIV particles. As a result, the spread of HIV from cell to cell is slowed and disease progression is delayed.
Ritonavir is recommended for use in combination with indinavir and saquinavir as a booster, and not as a drug in its own right.
Indinavir (IDV) 200, 300mg/cap (as sulphate)	400mg cap t.i.d	Take 1hr before or 2hrs after a meal. Drink at least 1.5 litres of water daily
Nelfinavir mesylate (NFV) 250mg/tab	750mg t.i.d or 1,250mg b.i.d	Take with a meal
Retonavir 100mg/cap	600mg twice daily	Keep refrigireted and take with a meal. For prolonged use: 300mg b.i.d x2days, 400mg b.i.d (day 3-5), 500mg b.i.d (day 6-13), 600mg b.i.d (day 14+)
Saquinavir (SQV) 200mg/cap	1.2g thrice daily	Take within 2hrs after full meal

Anti giardiasis and antiamoebic

METRONIDAZOL

200mg/tab; 200mg/5ml susp

Metronidazole is useful in the treatment of intestinal and extra-intestinal amoebic infections, trichomonas vaginalis, infection of the genito-urinary tract in males and females, Vincent’s infection of the mouth and gum, giardiasis and entamoeba hystolytica. The dose for adult and children over 10 years is 200mg thrice daily after food for seven days, if there is no response the dose may be increased to 400 mg thrice daily for 7 days. In severe anaerobic infections: 800 mg initially then 400 mg t.i.d. Young children: 300 mg daily in divided doses and 150 mg daily in divided doses for infants. Since metronidazole is transported across the placenta barrier, It is advisable to avoid it during the first trimester and with caution during second and third trimester. S/P: alcohol; S/E: gastrointestinal upset; headache, vertigo, depression and insomnia. S/E: gastrointestinal upset, headache, vertigo, depression and insomnia.

Brand name: Flagyl

TINIDAZOLE

500/tab

Indication: Tinidazole is an anti-infective drug which is used to treat certain types of parasite infections. Severe Intestinal Infection due to Entamoeba Histolytica, Liver Abscess caused by Entamoeba Histolytica, Infection that causes Diarrhea - Giardiasis, Infection caused by Trichomoniasis Protozoa. Adults should receive 2g daily at once for 3 days or 600 mg twice daily for 5 days. Children: 50-60 mg/kg/day as single dose for a period of 3days. C/I: pregnancy, lactation. S/P: alcohol.

Brand name: Fasigyn.

Anti malaria drugs

CHLOROQUINE

Tab/cap 150 mg base; syrup 50 mg base/5ml;

Inj. 40 mg base/ml in 5ml ampoule.

Chloroquine is the most active antimalarial among the 4- aminoquinolines. It is used for the treatment and suppression of malaria. It kills the erythrocytic forms of malaria parasites at all stages of development together with the asexual form of various malaria protozoa. Chloroquine prevents nucleic acid synthesis in actively dividing erythrocytic schizonts and gametocytes of the malarial parasites by intercalating between the stacked base pairs of the DNA double helix. The parasitised erythrocyte selectively accumulates the drug, which accounts for its selective toxicity. Its absorption is rapid and slowly excreted. Doses for chloroquine is commonly expressed in terms of chloroquine base. It has no action on malarial sporozoites or on the tissue forms of P. vivax. The drug has also been of value in the treatment of amoebic liver disease but it has no effect on intestinal amoebiasis. Chloroquine could be administered orally or parenterally. Children dose: 5mg/kg/bodyweight The oral adult dose for treatment of malaria is 600 mg at once daily for 2days, then 300 mg at once on day 3. Or 200 mg IM daily for 3days. In severity, inject 200 mg intramuscularly repeat dose in 12 hours, then oral daily doses as mentioned earlier. In emergency (cerebral malaria) 200mg chloroquine base in 500ml dextrose saline infuse slowly, may be repeated after 8hours if necessary or followed up with either intramuscular injection or oral doses as recommended above

Prophylaxis: 300 mg weekly for adults. Side effects are vertigo, headache, visual disturbance, hypotension, tatchycardia, itching, It is contraindicated in hypoglycaemia, quinine administration.

Brand name: Arelen, Avloclor, Resochine, Nivaquine

HALOFANTRINE

250mg/tab (HCl); 100mg/5ml syrup

Acute treatment of malaria due to single or mixed infections of P. falciparum, P. vivax, P. ovale and P. malaria. It should be administered with meals. Adults, total of six tablets taken in three divided doses at 6hourly intervals, above 40 kg: 500mg six hourly for 3doses; 32-40kg: 375mg six hourly for 3doses; less than 32kg should receive 8mg/kg six hourly for 3doses. C/I: Lactation, pregnancy, unless benefits outweigh risks

Brand name: Halfan

PROGUANIL

100 mg /tab (HCl)

Proguanil is useful for the treatment and prevention of malaria; It is absorbed rapidly when given by mouth and is excreted by the kidney. In Plasmodium vivax, Proguanil kills the asexual parasites in the red blood cells but does not eradicate latent tissue infection, so that a check on malaria may sometimes recur after treatment is stopped. In case of acute malaria, proguanil is not the drug of choice because it does not kill malaria parasites in the red blood cells rather chloroquine or quinine should be used. As prophylaxis, a dose of 100 mg daily is recommended after meal .

Brand name: Paludrin

PYRIMETHAMINE

12.5 and 25 mg/tab

Pyrimethamine is an antimalarial drug, which has condition and use similar to those of proguanil hydrochloride. It affects the nucleo-protein metabolism of the parasites by interference in the folic-folinic acid systems. It does not act on the immature schizonts in the red blood cells and therefore it is not a good remedy for treatment of malaria attack. Chloroquine is a better alternative for this purpose. The chief value of pyrimethamine is in the suppression of malaria attack.

It usually kill the primary exo-eythrocytic parasites and will therefore prevent relapses of most strains of malaria. A dose of 25 mg weekly by mouth is adequate for prophylaxis of all forms of malaria. A child aged 5-15 should receive 12.5mg. Less than 5years should take 6.25mg all as a single weekly dose. Pyrimethamine may be given in conjunction with other rapid acting schizonticide like chloroquine to prevent the emergence of resistant strains. Adverse effect occur over long period of treatment, such effect include haemopoiesis due to interference in folic acid metabolism.

Brand name: Daraprim

QUININE

300mg/tab (sulphate or bisulphate);

300mg/ml (dihydrochloride) ampoule.

Quinine suppresses the asexual cycle of malaria parasites in the erythrocytes. It has no action on the tissue forms of the parasite and therefore cannot prevent relapse of Plasmodium vivax infection, It also has no action on P. falciparum gametocytes and therefore does not prevent transmission of the infection by the mosquito. A dose of 600 mg daily has been used as a suppressive measure. For the treatment of attack, 600mg of quinine bisulphate is administered orally three times daily for 4-5days.

If vomiting prevents the retention of oral dose, slow intravenous injection or more preferably by slow intravenous infusion will be recommended, for this purpose quinine dihydrochloride has usually been preferred. The intravenous administration should be employed in severe cases such as cerebral malaria when the patient is moribund. Intramuscular injections of quinine are slower in action, painful and may cause tissue necrosis; giving 200mg of quinine sulphate twice daily may relieve night cramps. By intravenous injection, quinine dihydrochloride should be dissolved in 20 ml of water for injection and injected slowly over at least 10minutes with the patient in a recumbent position. Alternatively, dissolve 600mg quinine dihydrochloride in 200ml of sodium chloride injection. A single intravenous injection which may be repeated if necessary will generally clear the parasites sufficiently enough to allow the resumption of oral doses.

Dose for children is 10mg/kg body weight. It is contraindicated in severe anaemia, and heart disease. Side effects: tissue neucrosis (if given intramuscularly), headache, blurred vision, itching. Overdose may cause permanent deafness or blindness, fall in blood pressure, death. Caution: monitor blood pressure while on therapy.

PYRIMETHAMINE plus SULFADOXINE

25mg and 500mg per tab, 5ml syrup and ampoule

Pyrimethamine plus sulfadoxine is an anti malarial agent which acts by a sequential blockade of two enzymes involved in the biosynthesis of folinic acid in the parasites. It is also effective against strains that are resistant to pyrimethamine, chloroquine and other 4-aminoquinoline derivatives. The risk of resistance emerging is reduced to minimum. Pyrimethamine plus sulfadoxine attacks the different stages of the life cycle of the malaria parasite. Effective concentrations are rapidly attained with a single dose and trophozoites and schizonts eliminated from the blood. The combination is therefore useful in the treatment of all forms of malaria due to plasmodium species. The drug is also indicated for prophylactic management.

Doses: patients weighing above 60kg: 3tablets at once. up to 31-60kg should receive 2tablets as a single dose. 20 to 30kg: 1½ tablet; 10 to 20kg: 1 tablet; 5-10kg: ½ tablet. When using injection of 25mg pyrimethamine plus 500mg sulfadoxin in 2.5ml ampoule, give as follows: above 60kg: 7.5ml; 31-60kg: 5ml; 20 to 30kg: 3.5ml; 10 to 20kg: 2.5ml; 5-10kg: 1 to 1½ ml; all as a single dose by deep intramuscular injection. It is contraindicated in hypersensitivity to sulphonamides, premature and new-born infants. Side effects involved are skin rashes (withdraw immediately), nausea, vomiting, fatigue, headache, fever, cough or shortness of breath (discontinue therapy).

Brand name: Fansidar, Maloxin

ARTEMETHER + LUMEFANTRINE

20mg + 120mg tablet

Artemether is synthesised from artemisinin but its poor bioavailbility together with half life of about 1-2hours limits its effectiveness. To overcome this setback, artemether is administered alongside Lumefantrine to treat uncomplicated falciparum malaria. Lumefantrine itself has a half life of about 3-6days. Such a combination therapy is called ACT (artemisinin based combination therapy). Other examples include artesunate-mefloquine, artesunate-amodiaquine and artesunate-sulfadoxine/pyrimethamine. It has been proved that ACT is more than 90% effective with a recovery of malaria after 3days especially for the chloroquine resistant plasmodium falciparum. WHO approved adult dose of artemether-lumefantrine is 4 tablets at 0, 8, 24, 48 and 60hrs (6doses). It is contraindicated in pregnancy and children below 10kg.

ARTESUNATE

50mg/tab,.

Artesunate kills the asexual form of plasmodium at erythrocytic stage. It is effective against plasmodium falciparum and plasmodium vivax, especially malaria parasite resistant to chloroquine. Adults: 4tablets stat then 2tablets daily for the next 4days. The dose of the first day should be double in order to maintain a high level of the drug in the bloodstream. Children between 1-3 years: 3tablets stat then ½ tablet daily for the next 4 days (1, ½, ½, ½, ½). 3-5years: 2 tablets stat then 1 tablet daily for the next 4 days (2, 1, 1, 1, 1). 6-12 years: 3 tablets stat then 2 tablets the next day followed by 1 tablet daily for the next 3 days. Artesunate can be combined with other antimalaria such as artesunate-mefloquine, artesunate-amodiaquine and artesunate-sulfadoxine/pyrimethamine.

Brand name: Artesunat

10. Cardiovascular drugs

Anti-anginal

Angina pectoris is chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle, generally due to obstruction or spasm of the coronary arteries. Most patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation. Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck, jaw, or shoulders. Typical locations for radiation of pain are arms (often inner left arm), shoulders, and neck into the jaw. Angina is typically precipitated by exertion or emotional stress.

GLYCERYL TRINITRATE

0,5mg sublingual tab

Glyceryl trinitrate causes the relaxation of involuntary muscles. Its effect is most pronounced on the circulatory system. With therapeutic dose, the arterioles dilate and the systolic blood pressure falls by 10 to 25 MmHg. It’s onset of action is 3-5minutes and lasts for 30 to 40 minutes. The drug is used chiefly in the prophylaxis and treatment of angina in which it affords relief by the dilation of the collateral coronary vessels. Dose: 0.3 to 1mg sublingually when necessary. Prophylaxis: 300-600 mcg (0.3 to 0.6mg) ten to fifteen minutes before activity. It is administered sublingually since the drug is effectively absorbed from the oral mucosa than from the stomach. Tablets, which should be swallowed whole, are also available and acceptable. Large doses causes flushing of the face, severe headache, feeling of fainting and suffocation. It is contraindicated in glaucoma, marked anaemia, and head injury

ISOSORBIDE DINITRATE

5mg sublingual tablets

Is a coronary vasodilator used to relieve acute attacks of angina pectoris. The usual dose being 10mg sublingually. A total daily dose of 20 to 90mg in divided doses has been used prophylactically though most conditions have been uncontrolled. Toxic effect is as for glyceryl trinitrate.

Brand name: Isordil

PROPRANOLOL

Tab, 10 and 40mg (HCl);

inj 1mg/ml (HCl) cap

Propranolol is a blocking agent, which acts by preventing or reducing sympathetic nerve stimulation, which produces an increase in both the rate and force of contraction of the heart and dilatation of blood vessels. It’s principal effect is to reduce the response of the heart to exercise thereby relieve and prevent attack of angina pectoris. Propranolol is of value in the treatment of cardiac arrhythmias. Administering propranolol intravenously may effectively control arrhythmia’s occurring during anaesthesia. It is also used in the treatment of hypertension. Propranolol is usually given by mouth beginning with a small dose, which should be increased gradually. Start with 10 to 30mg by mouth three or four times daily and increase according to need as follows: Hypertension: 160-320mg daily in 3-4 divided doses. Angina pectoris: 80-160mg daily in 3-4 divided doses. Cardiac arrhythmias: 30-160mg daily in 3-4 doses.

In emergency, give 3 to 10mg by slow intravenous injection if patient is conscious and 3 to5mg to patient under anaesthesia (unconscious) repeat after 15minutes if a adequate fall in blood pressure does not result. Side effect nausea, vomiting, diarrhoea, insomnia, lassitude, erythematous rashes, visual hallucinations, paraesthesia. Profound bradycardia occasionally follows intravenous administration. Bradycardia should be treated immediately by the intravenous injection of 1mg of atropine. Propranolol should not be given to patient with partial or complete heart block, bronchitis, bronchospasm, emphysema and patient with congestive cardiac failure (C.C.F) except when they are fully digitalised.

Brand name: Inderal

Anti-arrhythmic

Drugs used to control irregularities of the heartbeat. Side effects vary considerably between different drugs in this class. Eye problems, dizziness, nausea, skin rashes and breathing problems are associated with certain anti-arrhythmics. Some antihistamines such as astemizole may cause serious effects on the heart if taken with anti-arrhythmics.

DISOPYRAMIDE

Tab. And Cap, 100mg and 150mg

Anti-arrhythmic drugs are those drugs that bring any deviation from the normal cardiac rhythm to normal. Disopyramide is a class I anti-arrhythmic agent which prevents the entry of Na⁺ ions into the cell thereby slowing the rate of depolarisation and excitability of atrial and ventricular muscle. So it is highly indicated in cases of cardiac arrhythmias. Adults: 300mg twice daily. Do not exceed 750mg per day. It is contraindicated in patient with heart block, cardiogenic shock, children, cardiomyopathy and hypotension. S/E: dry mouth, blurred vision, hypokalaemia, hypoglycaemia.

Brand name: Dirythmin SA

PROCAINAMIDE

Tab, 250mg (HCl); inj.,

100mg/ml (HCl) in 10ml amp.

Dose: 50mg/kg daily in 3 to 6hourly divided doses. It is indicated for use in atrial tachycardia and ventricular arrhythmia. Mode of action and contraindication are as for disopyramide.

Anti hypertensive

Anti hypertensive are drugs that lower blood pressure. Slight increases in blood pressure may be reduced in some individuals by achieving ideal body weight, reducing sodium and alcohol intake, and stopping smoking and taking regular exercise. Classes of drugs used to reduce blood pressure include diuretics, beta-blockers, calcium blockers and vasodilators. These drugs are usually given as tablets but injections may be used if a rapid response is needed.

BENDROFLUAZIDE

5mg, tablet

A diuretic, effective in smaller doses than chlorothiazide and produces a more prolonged diuresis which continue for about 18 hours. In the treatment of hypertension and oedema it is given 5 to 10mg daily after diuresis has been established, a maintenance dose of 2.5 to 5mg may be given daily. When treatment is prolonged loss of potassium may be enough to produce hypokalaemia. Potassium supplement should therefore be given. C/I: renal or hepatic dysfunction, electrolyte imbalance. S/E: hypokalaemia, allergy, nausea, dizziness, weakness, parasthesia, photosensitivity and skin rashes.

Brand name: Corgaretic, Inderetic.

CAPTOPRIL

12.5mg and 25mg, tablets

Captopril is an ACE inhibitor, which block angiotensin-converting enzyme (ACE). This enzyme is a powerful pressor agent (substance which raises the blood pressure). The inhibition of this enzyme prevents the formation of a vasoconstrictor and indirect facilitator of the sympathetic nervous system. This results in arteriolar and venous dilation, reducing total peripheral resistance and arterial blood pressure. It also increases renal blood flow. Therefore captopril is useful in the treatment of mild to moderate hypertension, severe hypertension where standard therapy is ineffective or inappropriate, initial dose of 12.5mg twice daily increasing if necessary to a maximum dose of 50mg three times daily is advised for adult. It is contraindicated in cardiac obstruction, pregnancy, lactation. Safety precautions: severe congestive heart failure, haemodialysis, renal impairment. Side effects: neutropenia, agranulocytosis, thrombocytopenia, anaemia, proteniuria, tachycardia, anorexia etc.

Brand name: Acezide, capoten.

Hydralazine

25 and 50mg,tab; inj powder,

20mg (HCl) in amp.

Is used in the treatment of hypertension but its mode of action is the ability to reduce peripheral vascular resistance by direct relaxation of vascular smooth muscles. Side effect includes gastrointestinal disturbances and fluid retention, tachycardia, severe headache, hypotension, anorexia, nausea and vomiting. Hydralazine is usually given in reduced dose in combination with diuretics. Oral dose for outpatient is 50mg daily in divided doses, increase slowly over one or two weeks to a maximum of 200mg daily if necessary. It is also given by intramuscular injection or intravenous infusion in a dose of 20 to 40mg. Repeat dose after 4 to 6hours if diastolic blood pressure is not reduced below 100MmHg. It is contraindicated in tachycardia,

Brand name: Apresoline

LABETALOL

100 and 200mg (HCl) tablets;

5mg/ml in 20ml ampoule

Indicated in hypertension including hypertension of pregnancy. Initial dose of 100mg b.i.d for 14days, then if necessary increase gradually but do not exceed 2.4g per day in three or four divided doses. In elderly, initial therapy should be reduced to 50mg twice daily, all with food. Side effect involved are rare hepatic reaction (discontinue use if occur)

Brand name: Trandate

METHYLDOPA

250 and 500mg per tab

Reduces sympathetic vasoconstriction and decreases total peripheral vascular resistance. Sedation and drowsiness are the major dose related effects. Methyldopa is particularly of value in hypertension especially pregnancy hypertension and all grades of hypertension. Adults: 250mg twice or thrice daily adjust at two-day intervals if improvement is not satisfying. Maximum dose is 3g daily. Elderly: give half of adult dose. C/I: active liver diseases, depression. S/E: sedation, headache, asthenia, bradycardia dry mouth, nasal congestion.

Brand name: Aldomet

NIFIDIPIN

Tab and Cap, 10 and 20 mg

Nifidipin belongs to class II Ca²⁺ antagonist, which acts by blocking the inward movement of calcium ions into muscle cells. This leads to more efficient cardiac contraction and reduced the oxygen requirement of cardiac muscle. It also dilates coronary and peripheral arteries and reduces blood pressure. It is therefore a good anti hypertensive agent especially in mild to moderate hypertension. Dose is 10mg twice daily. Increase if necessary to 40mg twice daily. Contraindicated in pregnancy and lactation as it hinders the action of oxytocin, unstable angina, hepatic diseases, obstructive and inflammatory bowel disease. Side effect: headache, flushing, dizziness, oedema, tachycardia, hypotension, paraesthesia, and impotence.

Brand name: Adalat retard

PRAZOSIN

Tab, 1,2 and 5mg (HCl)

Prazosin is an anti-hypertensive agent, which lower blood pressure by arteriolar and venous dilatation. Dose: 0.5mg increasing gradually to 1-2mg three times daily. Maintenance dose of 1-20mg daily in divided doses. Start with lower initial dose to avoid the effect of sudden response. Avoid in children, pregnancy and lactation.

Brand name: Minipress

PRAZOSIN plus POLYTHIAZIDE

Tab, prazosin (HCl) 0.5mg +

Polythiazide 0.25mg

Is a combination of antihypertenive and diuretics. It is very essential in the treatment of hypertension especially where diuretics are required. One tablet containing 0.5mg prazosin and 0.25mg polythiazid every morning, increase at 2-weekly intervals to two tablets. Further tablet may be added in the evening if necessary. C/I: children, pregnancy, lactation. S/E: hypotension, hypokalaemia. S/P: potassium supplement may be required, impaired hepatic or renal function. Brand name: Minizide

RESERPINE plus DIHYDROERGOCRISTINE

Plus CLOPAMIDE

Tab, 0.1mg + 0.5mg + 5.0mg respectively

The above combination is an effective and well tolerated anti hypertensive agent. Reserpine exerts its effect through a central action. Clopamide is a diuretic of the thiazid group, which promotes water and sodium excretion; dihydroergocristine inhibits the hypertensive response to stress. The additive effect of the three components in relatively low doses leads to an easily controlled lowering of blood pressure with minimal side effects. Blood pressure is reduced after 4-7 days of therapy. Optimum effect is reached after 1-4weeks; therefore, it is indicated for the treatment of essential hypertension of all grades of severity. Dose: tablets containing 0.1mg reserpine, 5.0mg clopamide and 0.5mg dihydroergocristine is required; Adults: 1tablet per day. In severe hypertension 2 or 3 tablets daily may be needed. Since the drug is slow in onset, the dose should not be increased more frequently than one per week. Maintenance dose of 0ne tablet per day or alternate days is sufficient in most cases. This drug may be combined with other antihypertensive drugs, S/E: gastrointestinal disturbances, electrolyte imbalance, hypotension, fatigue, muscle weakness, nasal congestion. C/I: hypersensitivity to any of the components, hypokalaemia, hepatic or renal disorders, severe coronary insufficiency, active peptic ulcer, pregnancy and breast-feeding

Brand name: Brinerdin

Cardiac glycosides

DIGOXIN

Tab, 0.0625 and 0.25mg; Elixir, 0.05mg/ml in 60ml b0ttle;

Inj, 0.25mg/ml in 2ml amp. and 0.1mg/ml in 1ml ampoule

The most important indication for the use of digoxin is congestive cardiac failure, aterial fibrillation, and increased heart rate. Venous pressure is lowered and the heart becomes capable of dealing with an increased venous return of blood. The main property of digoxin is its ability to increase the force of myocardial contraction thereby slowing the heart rate, increase cardiac output, and decrease cardiac enlargement and reduction in venous pressure. When administered orally, dioxin takes effect in about 1hour. The usual effective dose for an adult is 0.5 to 1.5mg by mouth for 3-5days followed by 0.25mg once to thrice daily as maintenance dose. In urgent cases, provided that the patient has not been treated with cardiac glycosides during previous fortnight, digoxin may be given by injection from 0.5 to 1g. The suggested dose for children is 0.025mg/kg every six hours.

It is contraindicated in heart block, cardiac infarction and other acute lesions of the heart. Injection of calcium salts or administration of non-potassium sparing diuretic should be avoided during digitalis therapy. Avoid treatment (in pronounced bradycardia) if heart rate is below 60 beats per minutes, impaired kidney or liver function and in elderly, electrolyte imbalance particularly hypokalaemia. Side effects include anorexia, nausea, vomiting, confusion, disorientation, headache, blurring of vision

DRUG INDEX

Abacavir 71

Acetylsalicylic Acid 12

Acezide 104

Acriflavin 109

Actifed 160,175

Activated Charcoal 24

Acyclovir 68,116

Adalat 106

Adrenaline 21,158

Akineton 93

Albendazole 33

Aldactone 125

Aldoment 105

Allopurinol 16

Aludrox 126

Aluminium Hydroxide 126

Amiloride123

Aminophyilline 158

Amitriptyline 157

Amoxil38

Ampicillin 39

Amoxycillin + Clavulanic Acid 39

Amoxycillin 38

Amphotericin B 64

Ampiclox 41

Amylobarbitone 150

Amytal 151

Antepar33

Anti Scorpion Serum 141

Anti-D Immunoglobulin140

Anti-Snake Serum 140

Antistine 174

Anugesic Hc 139

Anusol 138

Anzoline + Naphazoline 174

Apresoline 104

Aprinox 124

Arelen 73

Artane93

Artemether + Lumefantrine 77

Artesunate 78

Ascabiol 114

Ascobic Acid 162

Aspirin 13

Astemizole 20

Ativan 153

Atropine 8

Augmentine 39

Avloclor74

Avomine 19,132

Azithromycin 46

B.C.G Vaccine142

Baccitraicin 109

Bactrim 49

Baneocin 110

Banocid35

Belladonna 133

Bendrofluazide 103

Bendrofluazide 124

Benylin161

Benzhexol 93

Benzoic Acid 112

Benzoin 122

Benzyl Benzoate 114

Benzyl Penicillin 42

Betamethasone 110,173

Betamethazone + Neomycin 119

Betnesol – N 119

Betnesol 111,173

Betnovate 111,138

Biltricide 36

Biperiden 93

Bisacodyl 135

Bisolvon 160

Bradosol 176

Brinadin 107

Broflex 93

Bromazepan 151

Bromhexine Hcl 160

Bromocriptine 88

Buscopan 133

Calamine Lotion 112

Calcium Salts 167

Canesteen 66,113

Capoten 104

Captopril 103

Carbamazepine 28

Cefotaxime 42

Ceftazidime 43

Ceftriaxone 44

Cefuroxime 44

Cetrimide 121

Chloral Hydrate 151

Chloramphenicol 46,116,172,

Chlorhexidine 120

Chlormezanon 151

Chlormycetin 47,119

Chloropramazine 130

Chloroquine 73

Chloroxylenol 122

Chlorpheniramine 19

Chlorpromazine 154

Chlorpropamide 91

Cholera Vaccine 144

Chorionic Gonadotrophin 89

Cimetedine 128

Ciproflox 48

Ciprofloxacin 47

Ciproxin 48

Claforan 43

Clemastine 21

Clofazimine 62

Clomid 89

Clomiphene 88

Clopamide 107

Clotrimazole 65,113

Clotrimazole 65

Cod Liver Oil 166

Combantrin 34

Contac 12 175

Corgaretic 103

Cotrimoxazole 48

Crystalline Penicillin 42

Cyanocobalamin 94

Cyclizine 130

D.P.T Vaccine 142

Danazole 89

Danodiol 89

Daonil 91

Dapsone 62

Daraprim 75

Darrow’s Solution 171

DDS 62

Delavirdine Mesylate 70

Depixol 157

Depo Provera 87

Depomedrone81

Dequadin 176

Dequalinium Hcl 176

Dermazine 109

Dexamethasone 20,80

Dextrose 169

DF118 10

Diabemide91

Diabenase 91

Diamicron 91

Diazepam 28, 152

Didanosine 71

Diethylcarbamazine 34

Diflucan 65

Diflunisal 14

Digoxin 107

Dihydrocodeine 10

Dihydroergocristine 107

Dipyridamole 98

Dirythmin Sa 102

Disopyramide 102

Dittol 122

Domiphen Bromide 176

Doxycycline 49

Ducolax 135

Ear Wax Removal 174

Econazole 113

Ecostatin 113

Efavirenz 71

Emeside 29

Epanutin 31

Epilim 30

Epsom Salt 136

Ergocalciferol 162

Ergometrine 149

Erythromycin 49

Eskornade 175

Ethambutol 64

Ethambutol 64

Ethinyloestradiol 83

Ethosuximide 29

Euglucon91

Eusol 121

Fansidar 77

Fasigyn 73

Feldene 16

Ferrous Salt 95

Flagyl 54,72

Flammazine 109

Fluconazole 65

Fluocinolone 111

Flupenthixol 157

Fluphenazine 155

Folic Acid 95

Formaldehyde 121

Fortum 43

Framycetin 172

Frusemide 124

Fulcin67

Fungizone 65

Garamycin 52

Gardinal 30

Gentamicin 172

Gentamicin 51

Gentian Violet 110

Genticin 52

Glibenclamide 91

Glibesseis 131

Gliboral91

Gliclazide91

Glucophage 92

Glyceryl Trinitrate 100

Gramicidin 117

Griseofulvin 66

Gyn-Daktarin 67,113

Gyno-Pevaryl 113

Gyn-Trosyd 114

Haldol 156

Halfan 74

Halofantrine 73

Haloperidol 156

Heparin Sodium 98

Herpid 70

Hetrazan 35

Hexetidine 176

Hibitan 120

Hydralazine 104

Hydrochlorothiazide123

Hydrocortisone + Neomycin 173

Hydrocortisone 22,80,111,159

Hydrocortistab 23,81

Hydrocortisyl 23,81

Hydrogen Peroxide 120

Hydroxocobalamin 94

Hydroxyprogesterone 85

Hyoscine N-Butylbromide 133

Hyospan 133

Ibuprofen 15

Idoxuridine 69

Imferon 96

Imipenem + Cilastatin 45

Inderal 102

Inderetic 103

Indocid 13

Indomethacin 13

INH 63

Insulins 90

Iodine 167

Ipecacuanha 24

Iron Dextran 96

Isoniazid 63

Isordil 101

Isosorbid Dinitrate 101

Ivermectin 35

Jik 122

Kaolin 137

Ketalar 8

Ketamine Hydrochloride 8

Ketoconazole 67

Ketoprofen 15

Ketrax 33

Konakion 94,164

Labetalol 105

Lamivudine 71

Largactil 130, 154

Lasix 125

Lentizole 157

Levamisol 33

Lexotan 151

Lignocaine Hydrochloride 7

Lincocin53

Lincomycin 52

Lindane 115

Liquid Paraffin 135

Lorazepam 153

Losec 129

Luminal 30

Magnesium Sulfate 135

Magnessium Hydroxide127

Magnessium Trisilicate 127

Malox 131

Maloxin77

Mannitol 125,170

Marevan 99

Measle Vaccine 143

Mebendazole 34

Medaxonum 44

Medroxyprogesterone Acetate 87

Melleril 156

Metaclopramide 131

Metformin 92

Methionine 25

Methocarbamol 145

Methydopa 105

Methylprednisolone 81

Methysalicylate 111

Metosyn 111

Metrifonate 37

Metronidazol 53,72

Micogel-F 111

Miconazole 67,113

Mictizan 35

Migril 131

Milk Of Magnesia 127

Minipress 106

Minizide 106

Minovlar87

Mitigal 110

Modecate 155

Modretic 123

Mogadon 153

Monosulfirm 115

Morphine 11

Mostergmine 146

Motrin 15

Multivitamins 166

Myambutol 64

Mycostatin 68

Naloxon 25

Naproxen 15

Narcan 25

Neo-Cortef 173

Neomedrone81

Neomycin 54,109

Neomycin Sulphate 117

Neo-Naclex 124

Neosporin 117

Neostigmine 146

Nevirapine 71

Niclosamide 32

Nifidipin 105

Nitrazepam 153

Nitrofurantoin 55

Nivaquine 74

Nizoral 67

Norethisterone 84

Norethisterone Enanthate 87

Norflex 146

Norfloxacin 55

Noristerat 87

Novorine174

Nystan68

Nystatin 68

Ofloxacin 56

Oframax 44

Omeprazole 128

Oral Polio Vaccine 143

Oraldene 176

Orasel 138

Orlest87

Orphenadrine 145

ORS 137

Otosprin 173

Otrivin 174

Oxamniquine 37

Oxytetracycline 57

Oxytocin 149

Padrax 33

Paludrin 75

Panadol 13

Paracetamol 12

Paradote 25

Paraldehyde 29

Paraxin 47

Partobulin 140

Penicillin V 58

Penbritin 40

Pergonal 90.

Pethidine 11

Pethilorfan 12

Phenergan 19,132

Phenobarbitone 30

Phenoxymethyl Penicillin 57

Phenylpropanolamine 175

Phenytoin Sodium 30

Phthalysulphathiazole 58

Phytomenadione 94

Phytomenadione164

Piperazine 32

Piriton 19

Piroxicam 16

Plasil 131

Polynyxin B Sulphate 117

Pottasium Chloride 170

Praziquantel 36

Prazosin 106

Prednesol 82

Prednisolone 23,81

Primaxin 45

Privine 174

Probantheline Bromide 134

Probanthin134

Procainamide 103

Procaine Penicillin 51

Prochloperazine 131

Profasi 89

Proguanil 74

Proluton Depot 85

Promethazine 18

Promethazine 18, 132

Propranolol 101

Pseudoephedrine + Tripolidine 175

Psyllium 136

Pyrantel 34

Pyrazinamide 63

Pyridostigmine 146

Pyridoxin 164

Pyrimethamine 75

Quinine 75

Rancotrim 49

Ranitidine 128

Reserpine 107

Resochine 74

Retinol 163

Retonavir 72

Rhesogamma 140

Rhogram 140

Riboflavine 165

Rifampicin 63

Rifampicin 63

Ringers Lactate 171

Robaxin 145

Rocephine 44

Romilar 161

Salbutamol 159

Salicylic Acid 112

Saquinavir 72

Savlon 120

Scabenz 114

Senna 136

Septrin 49

Silver-Suphadiazine 109

Simatin 29

Sodium Amytal 151

Sodium Chloride 169

Sodium Hypochlorite 122

Sodium Valporate 30

Soframycin Drops 172

Solu-Cortef 23

Solu-Cortef81

Spectinomycin 58

Spironolactone 125

Stavudine 71

Stelazine 156

Stemetil 132

Stilboestrol 84

Strepsil 176

Streptomycin Sulphate61

Sulphadimidine60

Sulphatriad 59

Sulphonamides59

Sulphur-Mesulphen 110

Sultamicillin60

Suramin 36

Tagament 128

Tarivid56

Tavegyl 21

Tegretol 28

Teracortil 173

Terracortril 119

Terramycin 57

Testosterone 82

Tetanus Antitoxin 141

Tetanus Toxoid 143

Tetmosol 115

Tetrahydrozoline 119,174

Thalazole 58

Thioridazine 155

Tinidazole 73

Tioconazole 114

Tocophery Acetate 163

Togamycin 58

Trancopal 151

Trandate 105

Trifluoperazine 156

Trobicin 58

Trosyd 114

Tyzine 174

Utinor 56

Unasyn 60

Valium 28

Valium 28, 152

Valoid 131

Ventolin 159

Vermox 34

Vibramycin 49

Visine119

Vitamin A 163

Vitamin B Complex 166

Vitamin B₂ 165

Vitamin B₆ 164

Vitamin C 162

Vitamin E 163

Vitamine D 163

Voltaren 14

Warfarin Sodium 99

Whitefield's Ointment 112

Xylocaine 8

Xylometazoline 174

Yeast 165

Yellow Fever Vaccine 144

Yomesan 32

Zalcitabine 71

Zantac 128

Zarontin 29

Zentel 33

Zinnacef 45

Zinnat 45

Zithromax 46

Zovirax 116

Zovirax 69

Zyloric 17

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