Common medications used in paediatrics

Antipyretics

Mechanism Available
Drugs Dose Remarks
of action dosage forms
Paracetamol Centrally acting • Tablet PO / IV: To be used with
analgesic and • 10 - 15 caution in patients
antipyretic with • Syrup mg/kg/dose with hepatic
minimal anti- Q4-6H impairment
inflammatory • Injection
properties
• Suppository PR / Suppository: Hepatotoxicity
• 10 - 20 with over-doses
Inhibits mg/kg/dose
formulation and Q4-6H
release of
prostaglandins in
the CNS Max doses:
• PO / PR: 90
mg/kg/day
Inhibits
endogenous • No more than
pyrogens at the 5 doses per
hypothalamic day
thermosregulator
centre • IV:
60 mg/kg/day
(< 2 years),

75 mg/kg/day
(> 2 years)

1
Ibuprofen Exhibits • Tablet 5 – 10 mg/kg/dose Common side
analgesic and Q6-8H effects include
antipyretic • Syrup gastric discomfort,
activities by Max dose: hence
inhibiting 40 mg/kg/day recommended to
prostaglandin be taken after
synthesis Usual adult food
max: 1.2 g/day
(OTC max)
To be used with
caution in patients
Diclofenac • Tablet 1 mg/kg/dose Q8-
with renal
12H
impairment /
• Suppository
nephrotoxic drugs
Max dose:
3 mg/kg/day
Not commonly
Usual adult
used in oncology
max: 150 mg/day
patients, patients
with dengue fever

Ibuprofen: Fewer
side effects than
other NSAIDs but
also has weaker
anti-inflammatory
properties

2
Antihistamine

Antihistamines can be used to manage allergies and certain symptoms commonly

seen in upper respiratory tract infections.

Drugs Mechanism of Action Remarks

1st Generation Competes with histamine for
H1-receptor sites on effector cells
• Chlorpheniramine in the gastrointestinal tract,
blood vessels and respiratory
• Promethazine tract
1st generation: Common
side effects: drowsiness,
anti-muscarinic (e.g.: dry
mouth, dry eyes)

• Diphenhydramine 2nd generation (vs.

Control itch and rhinorrhea,
allergic / hypersensitivity
2nd Generation reactions. Has anti-tussive, anti-
emetic effects
• Cetirizine
1st generation): Less drowsy
and anti-muscarinic effects,
less frequent dosing. Usually
used for treatment of
allergic rhinitis

• Fexofenadine
Note: Promethazine is
• Desloratadine contraindicated in < 2
years old due to potential
• Loratadine for fatal respiratory
depression

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 Drugs Available Usual doses Max dose (Usual) Age
dosage limits
form
1st Generation
Chlorpheniramine • Syrup 0.35 mg/kg/day 0.35 mg/kg/day > 6 months
Q6-8H
• Tablet Usual adult max:
24 mg/day

Promethazine • Syrup 0.2 - 0.5 Usual adult max: > 2 years old
mg/kg/dose 10 - 25 mg Q6-8H
• Tablet Q6-8H

Diphenhydramine • Syrup 1 - 2 mg/kg/dose PO: 300 mg/day > 2 years old

Q6-8H (allergies, rhinitis) (allergies)
• Injection
IV: 50 mg/dose > 6 years old
(rhinitis)

Hydroxyzine • Syrup < 40 kg: 2 50 mg/day (< 6 > 6 months

mg/kg/day (3 to year old)
• Tablet 4 divided doses)
100 mg/day (adult
max dose)

2nd Generation
Cetirizine • Syrup 6 - 12 months: 2.5 mg once daily > 6 months

• Tablet 12 - 23 months: 2.5 mg BD

2 - 5 yr: 5 mg/day

> 6 yrs: 10 mg/day

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Fexofenadine • Syrup 6 mth - 2 yr: 15 180 mg/day > 6 months
mg BD
• Tablet
2 - 11 yr: 30 mg
BD

> 12 yr: 60 mg
BD

Desloratadine • Syrup Once daily: Max adult dose: 5 > 6 months

mg/day
6 - 11 mth: 1 mg

1 - 5 yrs old:
1.25 mg

6 - 11 yrs old:
2.5 mg

> 12 yrs old: 5

mg

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Mucolytics

In children over the age of 2, mucolytics can be helpful in the management of

symptoms of increased and or thick sputum in respiratory tract infections.

Mechanism of Available
Drugs Dosage Remarks
action dosage forms
Acetylcysteine Exerts mucolytic • Oral sachet 2 - 6 yrs = 1 Common side
/ action through its (100 sachet effect would be
Carbocysteine free sulfhydryl group mg/sachet) cough, usually
which opens up the > 6 yrs = 2 would advise
disulphide bonds in • Effervescent sachets patient not to
the mucoproteins tablet (600 Q8-12H take to near
thus reduces sputum mg/tab) bedtime.
viscosity Usual adult
max:
600 mg once Contraindicated
daily in children
below 2 years
old (risk of
Bromhexine Increases the • Syrup 0.15 - 0.2
aggravation of
production of serous mg/kg/dose
respiratory
mucous in the • Tablet Q8H
symptoms
respiratory tract and
including
makes the phlegm Usual adult
obstruction)
thinner and less max: 24
sticky. In turn, it mg/day
helps the cilia to
transport the phlegm
out of the lungs.

6
Topical decongestants

Topical decongestants can be used for short duration in acute illnesses to relieve nasal
congestion.

Drugs Mechanism of Action Dose Remarks

Oxymetazoline Alpha agonist, causing 1 - 2 drops into each Not to be used for
nose drops vasoconstriction of nostril TDS: more than 5 days
vessels. (risk of rebound
• 0.01% (0 - 12 mths) congestion)
Relieves nasal
congestion by • 0.025% (1 - 6 yrs)
increasing the diameter
of the airway lumen and • 0.05% (> 6 yrs)
reduces fluid exudation
from post capillary
venules.