|| || Antibiotics 1 Dr.

Sameh

:




: : :
:


Doses
Doses

Doses

Doses
,, doses how to calculate the dose of infant
or child
weight
weight is very important
weight

,,

accurate
Neonates infant child
weight

,, age
age one year

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weight ) ( age per months + 9 2

6
) ( 9 + 6 2
2/ 15 7.5

7 7.5
9
) ( 9 + 9 2
2/ 18 9
8.5 9
actual weight exactly weight

weight percentile curves

,, percentile curves

,, 11
) ( 9 + 11 2
2 / 20 10
9.5 10
3
) ( 9 + 3 2
2 / 12 6
5.5 6
,,
:



) age ( 9 + 2
very accurate infant
One year

,,
,,
weight ,,

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) age 8 + ( 2
4
) 8 + ( X 2 4
8 + 8 16
3
) 8 + ( X 2 3 14
,,
weight = ) 8 + ( age in year X 2

,,
Weight ,,

,,
,,
accurate dose
,, Under weight Obese
dose very bad
child

,,
under weight Over weight Obese
calculating dose
age ,,
dose antibiotics adult
maximum dose adult
30
weight
Doses

,,
,, Syrup
syrup concentration ,,
syrup forms

,, ml 5
concentration ml 5

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125 5
250 5
200 5
Paracetamol 120 mg 5
5

dose
,,
syrup 125 5

25
250
50
200 ,, erythromycin ,,

40
,,

dose ,,

) 6 7 ,, 5 ,, 4 ,, 3 ,, ( 8 12

dose
dose
syrup form

5 ,, 5
measurement
,, 3.5
,, 3.5 ,,
5 ,,
Measures 5 10

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7.5

15

,, curve


,, 30
30
measurements

) antibiotics 25 2013
10 37
,, ,,

,, ,,
(
,,
,, dose
,,
,, viral
bacterial

antibiotics
antibiotics
% 90 diseases viral infection

% 90 diseases ,, upper respiratory respiratory

,,, sinusitis otitis media viral infection

,,
viral 3 :

fever
activity
appetite

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fever
very high ,, viral 38 ) Low grade fever (
fever
) viral << very high ( 40 - 41

38 ,,
bacterial ,, ) 38.5 ( 39.5

activity

in between the fever is normal

viral
,, antipyretics fever Normal
) fever
( viral << No need for antibiotics

appetite
,, suckling power infant breast feeding
suckling power
:
: ,, suckling mechanism ,,
power suckling
:
viral disease
,, bacterial infection suckling power very poor
neonates
suckling power

sepsis Neonates
,,
3 :
fever .1
activity .2
suckling power .3
viral bacterial
clinical experience

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toxic septic ,,
fever ,, activity
signs of toxemia septicemia

antibiotics
follow up 48
follow up 48 ,, bacterial
bacterial
antibiotics
antibiotics

Antibiotics
antibiotics ,,
:

against gram positive

against gram negative

gram positive
by the way

,, antibiotics
Penicillin

the first upper hand antibiotics

penicillin resistance

,,
Penicillin
sensitivity penicillin
response penicillin very good
3 : Penicillin
" Penicillin G crystalline penicillin
dose 50.000 100.000
international unit / kg

) international unit (

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,, vial

) ( crystalline penicillin
50.000 100.000

international unit per kg per day

frequency ,, ,,
) route of administration IV IM ( oral
penicillin
50.000 100.000 dose
frequency
must be divided

) 6 (
3
neonates 12
kidney Not well developed
12 Neonates
dose

50.000 ( International unit ) 100.000

vial

,, penicillin G
,, penicillin V
penicillin V Oral penicillin
dose 50.000 100.000

) International unit per kg

(
oral syrup oral tablet
syrup ,,
international unit 300.000 ,,
300.000 ,, 5
Ospen << 400.000 international unit
Must be given every 6 hours orally

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,, tablet form
gram 1 gram 1.5

,, Benzathin penicillin

27
27
,,

,, 3 )
(
endemic rheumatic fever
,,
study
serum level ,,
sure rheumatic

suggest ,, 3
:
27 ) ,, 1 200 (
600 ) 1.2 (
,,
27 ) 200 (

,,
,,
,, rule
:
3 ,, ) 300 (
3 6 ,, ) 600 (
6 ,, ) 200 (
Benzathin penicillin
,,
antibiotics ,,
penicillin is the best drug for gram positive bacteria

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Beta hemolytic sterptococci

Organisms penicillin

beta hemolytic streptococci

endemic rheumatic fever
,, eradication rheumatic fever
cardiology
Over diagnose Under diagnose
cardiology
penicillin

calculation
,,
,, ,,
,,
penicillin is unstable
Unstable
>>
dose
once dissolved must be given

,, ,,
,, accepted ,,

,,
,, ,,

penicillin
,,
,, penicillin G 50 100 international
unit

,, critical 300
meningitis
200 300
,,
meningitis severe sepsis in neonates

10

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crystalline penicillin
has no allergy

,,
penicillin commercially used
procaine penicillin
sensitivity test ,,
sensitivity test 4 >> single daily
400 ) dose (
4 >> 12


results very good
cefotax cefoperazone

,,
chronic tonsillitis
once chronic tonsillitis
Procaine penicillin

400 ,,
>> single daily dose injection
>> ) (
Half life
) procaine ,, Prolongation half life (
sensitivity procaine
penicillin
sensitivity test
sensitivity test

course
) 7 ,, ( sensitivity test
benzathin penicillin
Injection
allergy Benzathin penicillin

,,
sensitivity test
) long acting penicillin ( Benzathin penicillin

11

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market ,,
Depopen
Retarpen ,,

most common used
Depopen ,,
,, ,, Retarpen
,,
Depopen
pain
long acting penicillin
,,
experience
long acting penicillin lidocain Normal saline
distilled water
pain
Lidocain ,,
lidocain cefotriaxone
,, Long
acting penicillin
Depopen Retarpen

Depopen ,, pain other

products

,,
11 40 25 2013
16 40
,, ,,

,, penicillin
ampicillin

Ampicillin

dose
dose ) antibiotics (

50 100

12

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mg / kg / day 100 - 50
dose of ampicillin << 50 - 100 mg / kg / day

,,

must be given every 8 hours

,, given every 6 hours
ampicillin

Market

ampicillin
epicocillin

ampicillin
epicocillin

syrup << 125

syrup << 250
>> vial 0.5
>> Vial 1
>> dose 50 100
,,
Mainly gram positive
>> meningitis 150 200


10
50 100
mild Moderate severe
50 Mild
,,
,,
50 100
60 90

60 90

13

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>> accurate dose 50 100

calculating dose >>
60 90
mild << 60
moderate << 75
severe << 90
divided doses 3

) 8 (
,,

,,

10
,, mild
X 60 = 600 10
3 ) 8 (
200
) per dose (
syrup ,,
250 ,,

50

12 = 50 / 600
12
) 200 8
4 8 (
,,

antibiotics 125
25
200 8



8 8

14

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,,
10 ,, severe
) ) X ( 10 900 = ( 90 ) ( severe

3
300 8
250

50
6 8

,,
,,


) (
= [ ) (
) X ( 5 syrup (]
,,
) (
=
[ ) ( ) x ( 5
) 125 250
200 ( ] ) 125 250
( 200


10 ,, severe
x 90 = 900 10
3
300
[ ) ] X 5 ( 300
) ( 250
= 1500 250
= 6

15

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,,

15 ,, mild
X 60 = 900 15
125
900 3
300
[ ) ] X ( 5 ) ( 300 125
= 1500 125
= 12 8

,,
20 ,, severe
X 90 = 1800 20
3
= 600 8
[ ) ] X ( 5 ) ( 600 ) ( 250
= 3000 250
= 12 8
ampicillin

60 90
60 90
60 90
maximum dose 90
100
,,
,,

Amoxycillin

Most common drug used up till now

,,
first drug of choice
amoxycillin
dose
) 60 90 (
divided doses 3

16

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8
12

8
,, 12

60 90
divided doses 3
) 8 (
amoxycillin
,,
amoxycillin ,,
E-mox

Biomox
Hiconcil
Ibiamox
Amoxil

amoxycillin

,,
,, 250 ,, 125 E-mox Amxoil Farconcil
0.5 ) vial (
E-mox 0.25
amoxycillin
dose 60 90
divided doses 3
,,
15 ,, Mild
X 60 = 900 15
3
300 8
250
) ( X 5 300 250
= 1500 250
= 6

17

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,,
Ibiamox market 200 syrup >> 400
200
40
400
80
,, 15 mild

300
80


) ( X 5 300 ) ( 400
= 1500 400
= 3.75
4
200 ) 400 ( Ibiamox
60 ,,
60
8
4
Biomox 80 ,,
5 8


5
Ibiamox 400
,, 80
80
3 ) 15 (
5

biomox 80
Ibiamox 400 ,,
80
5

18

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) 400 ,, 8
3 4 (
,,

,,
20 ,, severe
Ibiamox << 400

X 90 = 1800 20
3
600 8
= ) ( X 5 600 ( ( 400
= 3000 400
= 7.5
7.5
7.5 8
measurements 7.5

measurement 5 10
: 8



Hiconcil drops
>> antibiotics drops 1 ) (
100 amoxycillin
Hiconicl available drops

100
neonates infant
3 ,, mild
X 60 = 180 3
Hiconcil drops
) drops syrup vial ( drops

drops

19

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,, >> 1 ) 1 (
,, 100 ) 25 ( 50
100
>> ,,
100

Neonates small infant

3
Mild
X 60 = 180 3
3
60 8

0.6

2/3 8
,,
drops neonates young infancy
3 4
6
dose 50
X 50 = 300 6
3
100 8

100



8
8

2 ,, Moderate
X 75 = 150 2

3
50 8
8

20

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,, 9
26 2013
22 30
11
amoxycillin << is the best drug of choice
tonsillitis Pharyngitis otitis media ,, sinusitis

Peritonsilliar abscess
peritonsilliar abscess High dose
chronic cervical lymphadenitis
Upper respiratory tract
amoxycillin
accurate dose 60 90

,,

dose 20
mg / kg / dose 20
mild
mg / kg / dose 30
severe

60
3
20
90
3
30

75
Moderate
3
25
,,
13 severe

21

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X 30 = 390 13
Ibiamox
400

5
8 ,,
,, ,,

390 400
,,

12 Mild
X 20 = 240 12
syrup 250
8
,,

,,
10 ,, mild
X 20 = 200 10
200 8
250
4

8
,,
10 ,, severe
X 30 = 300 10
6
250
8

Mild << 20
Moderate << 25
severe << 30

Per dose

,,

22

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,,,
20 ,, severe
X 30 = 600 20
400
Ibiamox 400
600

7.5

8
Ibiamox
400

,,
10 ,, mild
X 20 = 200 10
,,
Ibiamox << 200

5

8
Amoxycillin + Calvulinic acid

Amoxycillin + Calvulinic Acid

,, amoxycillin calvulinic acid

beta lactamase producing bacteria << destruct ,, amoxycillin
resistant amoxycillin
calvulinic acid
augmentation action amoxycillin
amoxycillin
>> 156 312
156 syrup 5

31
312 62

23

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,, Magna-biotic << 312 156
>> E-moxclav 312 156

228.5 457
228.5 45
45
457 90
,, accurate dose
60 90
dose

60 90

: 60 90 amoxycillin

,,
amxoycillin + ,,
calvulinic acid

over dose of amoxycillin
,,
side effects calvulinic acid

,, Augmentin
the most expensive drug

augmentin syrup << 457 228.5

Hibiotic >> 230 460


Augmacillin << 457 228
>> 457 228

24

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>> Megamox 228.5 457

>> 457 228
228
45
457

90
available vial

,, ,, Augmentin vial dose

60 90
,,
must be given intravenously
available market
Augmentin ,,
600 vial IV >> 1200
never to be given intramuscular

,,
never to be given orally 9

,, >> G.I.T. disturbance vomiting diarrhea
,, 9 orally side
effects

dose >> 20 30
in the neonates
,, >> children 60 90

>> infancy 60 90
in my experience
9 orally

,,
Neonatal sepsis << can be given intravenously
dose << 20 30 divided doses 3
8 (

15 16 ,,
,,

25

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,,
11 ,, mild
X 20 = 220 11 dose
230
Hibiotic 230 8 >> 5
augmentin 228.5 8
,,


13 ,, Mild
X 20 = 260 13 dose
9
270
90
3 = 90 / 270

457
,, ,,
228.5
45
457 ,,
90
,,
230 460
,,
18 ,, Mild
X 20 = 360 18

4 = 90 / 360
) >> 90 457 90 (

4

8

457
,,

26

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20 ,, severe
X 30 = 600 20

6.6666 = 90/ 600

7

8 severe
Mild 20
X 20 = 400 20
4.44444 = 90 / 400
5
4.5 exactly
,,
doses

14 ,, Mild
X 20 = 280 14
6.2222 = 45 / 280
45
6
,,
,,
11.5 12
228.5 8
11.5
X 20 = 230 11.5
230 8
230
14 ,,
14 accurate dose
3.5 ,, 457 8
3.5 ,,
18
4 ,, 8
230 11.5
,,

27

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13 14
457
standard 457
14 ,,
3.5 8
15 ,,
3.5 8
16 ,,
,, hesitated 3.5 4 8
4 8
16 >> 20
,, 20 ,, 21 ,, 22 25

5 8

accurate accurate
,, response ,, Hiboitic
460
Hibiotic
Hibiotic 230
augmentin ,, very expensive drug
N High
standard
augmentin

,,
,,
Hibiotic 230
the most safest drug

,,
,,
230
45
accurate dose

28

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rough idea
accurate

,, ,,
calculators
,, dose calculators
scientifically
you have your own calculator in your pocket
dose

,, ,,
calculator
dose

20 ,, severe
X 30 = 600 20
,, 630 9
630

= 90 / 630
7

11.5 ,, mild
X 20 = 230 11.5

5.1 = 45 / 230
5 8

,, 15 ,, mild
X 20 = 300 15

312

5 312

8

29

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under weight 8 ,, Mild

X 20 = 160 8

156
8


18 ,, Mild
X 20 = 360 18
4 = 90 / 360
90
457


23 ,, mild
X 20 = 460 23

5
8
!!!!
,,
very accurate
consultant ,, calculated dose

updated dose


amoxycillin calvulinic acid
,,

Augmentin
Hibiotic 460, 230
)Megamox (expensive
) ( expensive

augmacillin
) E-moxclav E-moxclav Magna biotic << 312 & 156
( market

amoxycillin calvulinic

30

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) ,, (
: ,, calvulinic acid side effects
14
645 ,, ,,
market dose
,, response

Augmentin Hibiotics Megamox augmacillin
E-moxclav magnabiotic

amoxycillin calvulinic
the most drug you have to be written
,,
,, amoxycillin amoxycillin calvulinic
,, drugs
the first drug of choice in your prescription
Most common diseases
upper respiratory

6 ,, ,,
Pneumonia

amoxycillin calvulinic

dose << 30 IV << response
% about 99

result
augmentin IV

30 8
orally
Augmentin
Hibiotic 30

90
results
% 90 : my prescription << Amoxycillin calvulinic

31

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,, drug ,,
drugs
amoxycillin amoxycillin calvulinic
,, the best << amoxycillin amoxycillin

calvulinic acid

,,

Ampicillin-Sulbactam

ampicillin
beta lactamase producing bacteria << destruct ampicillin
response
response
Sulbactam

,,
>> 250 ,,
market
Unasyn

Unictam

) Ampictam (
21

250
dose
50
100
100

,,



,,

can be given 12 hours or 8 hourly, but better to be given 8 hourly

32

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,, 12
It is very good ,, 8
12 ,,
8

X 50 = 600 12
8 3
200 = 3/ 600 8

4 8
,,

12
8
4 = 3/ 12
9
8 ,,
9
8
3 = 3 / 9
27
27
8 9

dose injection form
oral form
antibiotics Oral form injection form
Most specialist
Dose injection form

100 200
optimum dose >> 150
optimum dose << 150

33

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injection form
,, 375
2
,, 750
2
1500

1500 - 750 - 375
dose ,,
100 200
optimum results >> 150

150

Unasyn
Unictam

Sulbin
) ampictam Injection (
the best ,, so heavy gluteal

region
Heavy injection
,, oral forms
cultures throat swab tonsillitis Pharyngitis
positive amoxycillin calvulinic ,, ampicillin sulbactam

Amoxycillin calvulinic
ampicillin sulbactam
,,
,,
,, amoxycillin calvulinic
ampicillin sulbactam
sulbactam hepato toxicity
,,
,, feed back
feed back very good

34

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,, ,, Unasyn ,, unictam ampictam

available Market
injection Sulbin Unictam ampictam unasyn

,,
amoxycillin amoxycillin calvulinic
ampicillin sulbactam
,,
,,
9 ,,
,, history
antibiotics
:

amoxycillin
,,
,, amoxycillin calvulinic

amoxycillin calvulinic

filing ,,
file ,, tonsillits
amoxycillin
revisit improved

,, antibiotics
tonsillits ,,
: ,, amoxycillin
,, amoxycillin
amoxycillin ,, dose >> 20
mild
30 severe

20
,,
don't shift

35

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>> high dose 30 )

90 (
otitis media
>> History

amoxycillin

,,
otitis media
amoxycillin 30 ,, dose

response ,,
filing system
zero day
regular ,, regular ,, regular

follicular tonsillits
follicular follicles suckling power weak bacterial
amoxycillin

toxic ,, ,, ,, tonsillitis
pharyngitis laryngitis
,, amoxycillin calvulinic ampicillin sulbactam


high dose
30 dose
injection form ampicillin sulbactam

150
>> follow up
amoxycillin calvulinic
,,
,, scientific


step one, step two, step three and step four

amoxycillin

36

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) ,, ,, ,, antibiotics ,,
,, results 48 ,, ,,
dose ,, ,,
serum level ,, 48 72 ,,
(
amoxycillin

,,,
: ,,
,,

scientifically

,, dose

: ,,
,, dose ,,
20 dose
30 dose
:
72 ,,
,,
: ,, : chance one day
more

dose
very accurate dose
calculated
choice

% 90 3 ,, fever
activity

throat congestion
edema
minute follicles tonsils
: for seven day
>> course of antibiotics 5 10
>> 14

37

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5 10
optimum << 7 days
5
,,

infection ,, days 7
,, ,,
severe follicular tonsillitis ,,
dental abscess
unicatm

8 8



,, ,, dose

,, : ,,

: ,,
:
,,
,,

:
,, ,,
,, antibiotics
reassurance
,, 8
regular for seven days
,, :

,,
4 8 7
,,
:
: ,,

,, ,, 3 ,, ,,
8 3 for
seven days

38

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,,
2 42 31 2013 48
,,

:


,,
,, ,, ,,

days 7 :

,, documented
,, ,,
7
X 3 X 7 1
X 3 X 7 1
,, Nurse
X 3 X 7 1
>> 4 8 7 ,, ) 7
(
objection ,,

: ) (
: ,,

3 : ,,

) (
: ,,

39

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:
:




:
:
,, 7

,, :
,,
:
,,
:
: !!!
: ,,



:
,, !!!

,, ,, low




,,
,,
,,
,, ,,
: ,,

40

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nurse
nurse
,,
:
!!! ,,
,, ,,

,,
,,
,, 3 ,, 30
) 3 (
,,

,,
) ,, (
,, branch
twin
,, twin ,,
treatment
,, ,,
,,
: ,, ,, ,,
10

,,
,,

black list

ampicillin sulbactam
drug ,, first generation
Cephalosporin

41

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First generation Cephalosporin

Cephalosporins

,,

,,
Cephalosporin
,, ,,
Cephalosporins
first second third

fourth




,,

Cephalexin
first generation cephalosporin
% 80 gram positive
% 20 gram negative
>> Cephalexin dose >> 50 100

60 90
>> ,, accepted
Cephalexin

Keflex
) Ceporex (
Ospexin

125 250
80
Keflex
,,
dose
60 90
must be divided over 8 hourly ,,

42

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12
Keflex : 12
,,
8
available << 125 & 250

500 250
syrup

,,

12 ,, Mild
X 20 = 240 12

250
8

10 ,, Mild
X 20 = 200 10

8

4

250
,, 125
8
,, Keflex ) Ceporex (
Ceporex
Cephalexin
Cephalexin
,,

,, Cephalexin
24 ,,
,, cephalexin

gram positive follicular tonsillitis pharyngitis

43

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Cephradine

Cephradine

dose ,, 50 100 ,, 60 90
,,
25 ,, 100
25
,,
60 90
the optimum dose

:
,, Cephradine ) ( 250 & 125
Velosef ,, ( 125 & 250 ) ,, market
80 ,,

syrup form << 125 & 250
velosef Cephradine
Vial forms

0.5 1
Cephalexin
>> Keflex injection
,, available

group

Cephadroxil

drugs can be given 12 hourly

12

,, Durisafe market << 125 250 ,, 500 >> 500
syrup

,, 500 100
dose
) 25 50 (

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) 25 100 ( Cephadroxil

25 100

50
optimum dose
20 ,,
X 50 = 1000 20
,,
dose
500
syrup
500
12

5

,,
16
X 50 = 800 16

400 ) 12 (
4

500
4 12
,,

14
X 50 = 700 14

350 ) 12 (
500 3.5
250 7
250 7 12
500 3.5 12

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,,
injection

,,, 250

,, 500

divided over two doses

12
market

Durisafe
) Biodoxil 500 (
Ibidroxil

Cephadrol
Curisafe
longicef

Cephadroxil

,,
) ultrasef ultrasef
Cephradine Cephadroxil
,,
ultrasef Cephadroxil
,,
Cephadroxil
upper respiratory gram
positive

,,
results .U.T.I Urinary tract infection

in high concentration in urine
renal excretion very high
results ,, Urinary tract infection
urinary tract infection
first generation cephalosporin
first generation!!!!

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,,
>> shift shift injection
,,
injection = emergency
injection
,,

,, injection ,, response drug

,,
,, injection drugs
,, Cefotax Durisafe
,, third generation cephalosporin
first generation cephalosporin
mistake

,,
febrile ,, antibiotics
throat
severe infection
toxic Oral
E-mox vial ,, 1 12
amoxycillin

Biomox

Biomox 8 500

choice ,, injection
availablity injection oral form

unictam
injection unictam
Unasyn injection
Syrup

,,

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amoxycillin calvulinic acid

available ,, injection IV
difficult ,,, hospitalized

,,,
,,
response ,, response
oral
,, Velosef injection
oral

amoxycillin
amoxycillin << oral
ampicllin sulbactam
oral
,, chance injection << oral
first generation

unasyn ,,
,, Durisef
,, ,,

Durisef ,,
Unasyn ,,
Hiconcil ,,
second generation cephalosporin

Second Generation Cephalosporin

Cefuroxime
Zinnat

,, ,,

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,,

,, oral dose
20
divided over two doses
oral dose Zinnat

20
two divided doses
Zinnat Susp << 125
250
injection form

50 100
250 vials >> 750
,, Unictam
oral injection form
Oral << 20 divided doses 2

injection << 50 100

12
available << 250 750

,,
20 two divided doses

10 ) ( Per dose

drug most used drug in second generation cephalosporin

Cefaclor
Cefaclor ,,
I like it very much ,,
Cefaclor gram positive
gram negative
anaerobic

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,, Mycoplasma
cover
Cefaclor market
,, Ceclor ,, ,, most expensive ,,
Price
,, Bacticlor
,, Clorocef ,,

Cefaclor
dose
30 40
must be given 8 hourly
,, 30 3
10 ) ( Per dose
available
syrup >> 250 ,, 125

,,
10 ,, Bacticlor
X 10 = 100 10
125 ,,
25
100
4

8

20 ,,
X 10 = 200 20
,, 250
50

4

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8


7.5
X 10 = 75 7.5
125

25

3
,,

8
Zinnat
7.5 ,, Zinnat
X 10 = 75 7.5

3

12

Zinnat 12
Cefaclor 8
second generation cephalosporin
drug second generation
I ll mention it

,,
,,
second generation

,,
otitis media
first drug of choice

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,,
!!!
: ,, throat

throat


otitis media



: ,, Mild pharyngitis
Moderate ,, severe
tonsillitis

Mild pharyngeo-tonsillitis otitis media

dose
30 8
,,
,,
otitis media severe tonsillitis chest infection
,,
price
24 36
>> 125 24
>> 250 36
chest ,,
tonsillitis
,,

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very good manufacturing

,,
otitis media
,,
: chest
(
chest
action chest

Bacticlor Cefaclor

second generation

second generation

second line
otitis media Pharyngitis tonsillitis

first line
amoxycillin ,, ,, ,, ,,

,, amoxycillin amoxycillin

Cefaclor

,,
chest infection
mycoplasma
second generation
the most prescription

Amoxycillin calvulinic acid

ampicillin sulbactam
Bacticlor ,, Clorocef Cefaclor

Price
125 >> 12.5
>> Cefaclor 14.5

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250 >> 22.5

Price >> 12.5
Cefaclor << 14.5
250 22.5

antibiotics
,, 47
31 2013

www.facebook.com/dr.tafreegh

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