Rhinitis ជំងឺរលាក ចមុះ

I. What’s the rhinitis ?

➔ Rhinitis is simply inflammation of the nasal lining. It is
characterised by
● Rhinorrhoea (េហៀរសំេប្រារ)
● Nasal congestion (តឹង ចមុះ)
● Sneezing (កណ្តាស)់ Itching (រមាស់)
➔ Rhinitis may be cause by :
● Allergic rhinitis or colds
● Infection (Viral infection or bacteria)
➔ The classify of allergic rhinitis
1. Intermittent : time < 4 days/weeks , < 4 weeks at a time
2. Persistent : time > 4 days/weeks , > 4 weeks at a time
 Rhinitis ជំងឺរលាក ចមុះ
II. How to differential diagnosis of allergic rhinitis
Question Relevance

Seasonal variation Symptoms in the summer months suggest intermittent allergic

rhinitis where as year round symptoms suggest perennial rhinitis

History of asthma,  eczema or If a first-degree relative suffers from atopy then

intermittent allergic  rhinitis intermittent.Allergic rhinitis is much more likely
in the family

Triggers When pollen counts are high symptoms of intermittent allergic

rhinitis worsen
Infective rhinitis and vasomotor rhinitis will be unaffected by pollen
count
Patients with persistent rhinitis might suffer from worsening
symptoms when pollen counts  are high but symptoms should  still
persist when indoors compared with intermittent  rhinitis
sufferers who usually see improvement of symptoms  when away
from pollen
 Rhinitis ជំងឺរលាក ចមុះ
III. The strategy therapeutic of rhinitis
Symptomatic treatment
● Rhinorrhoea (េហៀរសំេប្រារ)→ Antihistamine (anticholinergic ++)
● Nasal congestion (តឹង ចមុះ) → decongestants(sympathomimetic)
● Sneezing (កណ្តាស់) Itching (រមាស់) → Antihistamines
● Headache → analgesic

Etiologic treatment
● Inflammation of the nasal→ Mast cell stabilisers, Corticosteroid
● Infection → Viral infection ( rare case use ) or bacteria (ATB)
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
1. Symptomatic treatment
● Rhinorrhoea (េហៀរសំេប្រារ)→ Antihistamine (anticholinergic ++)

Drug Dose Pregnancy & breastfeeding

Chlorpheniramine Child 1–23 months: 1 mg twice daily - 1sd trimester cam used but 2nd
Child 2–5 years: 1 mg q4-6hr trimester prefer loratadine.
Child 6–11 years: 2 mg q4-6hr - Monitor the child if if the mother
Child ≥ 12 years and adult: 4 mg q4-6hr was treated

Promethazine Child 2–4 years: 5 mg twice daily before
meals and at bedtime
Child 5–9 years:5–10 mg twice daily before
meals and at bedtime
Child 10–adult: 10–20 mg 2–3 times a day
Most manufacturers of antihistamines
advise avoiding their use during
pregnancy
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
1. Symptomatic treatment
● Nasal congestion (តឹង ចមុះ) → decongestants(sympathomimetic)

Drug Dose Pregnancy & breastfeeding

Oxymetazoline 2-3 gtt/sprays per nostril q12hr Use with caution if benefits
outweigh risks

Pseudoephedrine Immediate release: 60 mg PO q4-6hr PRN Avoid, during first trimester

Extended release: 120 mg PO q12hr or Excreted in breast milk
240 mg PO q24hr

Phenylpropanolamine 2 to 6 years : 6.25 mg PO q4hr Use with caution if benefits

6 to 12 years : 12.5 mg PO q4hr outweigh risks
> 12 years : 25 mg PO q 4hr
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
1. Symptomatic treatment
● Sneezing (កណ្តាស់) Itching (រមាស់) → Antihistamines (Sedative )

Drug Dose Pregnancy & breastfeeding

Alimemazine Child 2–4 years: 2.5mg q 3-4/d Use with caution if benefits
Child 5–11 years : 5 mg q 3-4/d outweigh risks
Child 12–adult: 10 mg q 3-4/d
Elderly: 10 mg q 1-2/d

Chlorpheniramine Child 1–23 months: 1 mg twice daily - 1sd trimester cam used but 2nd
Child 2–5 years: 1 mg q4-6hr trimester prefer loratadine.
Child 6–11 years: 2 mg q4-6hr - Monitor the child if if the mother
Child ≥ 12 years and adult: 4 mg q4-6hr was treated
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
1. Symptomatic treatment
● Sneezing (កណ្តាស់) Itching (រមាស់) → Antihistamines (Sedative )

Drug Dose Pregnancy & breastfeeding

Promethazine Child 2–4 years: 5 mg twice daily before meals Most manufacturers of
and at bedtime antihistamines advise avoiding their
Child 5–9 years:5–10 mg twice daily before meals use during pregnancy
and at bedtime
Child 10–adult: 10–20 mg 2–3 times a day

Hydroxyzine Child 6 months–5 years: 5–15 mg daily in divided Avoid use

doses
Child 6–17 years (<40kg):Initially 15–25 mg daily in
divided doses
Adult: 25 mg 3–4 times a day
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
1. Symptomatic treatment
● Sneezing (កណ្តាស់) Itching (រមាស់) → Antihistamines
(Non-sedative)
Drug Dose Pregnancy & breastfeeding

Cetirizine Child 2–5 years: 2.5 mg twice daily Most manufacturers of

Child 6–11 years: 5 mg twice daily antihistamines advise avoiding their
Child 12–17 years: 10 mg once daily use during pregnancy
Adult: 10 mg once daily

Desloratadine Child 1–5 years: 1.25 mg once daily Most manufacturers of

Child 6–11 years: 2.5 mg once daily antihistamines advise avoiding their
Child 12–17 years: 5 mg once daily use during pregnancy
Adult: 5 mg once daily
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
1. Symptomatic treatment
● Sneezing (កណ្តាស់) Itching (រមាស់) → Antihistamines
(Non-sedative)
Drug Dose Pregnancy & breastfeeding

Levocetirizine Child 6–17 years: 5 mg once daily Most manufacturers of antihistamines

Adult: 5 mg once daily advise avoiding their use during pregnancy

Fexofenadine Child 6–11 years: 30 mg twice daily Most manufacturers of antihistamines

Child 12–17 years: 120 mg once daily advise avoiding their use during pregnancy
Adult: 120 mg once daily

Loratadine Child 2–11 years (to 31 kg): 5 mg once daily May be acceptable
Child 2–11 years (> 31 kg): 10 mg once daily
Child 12–17 years: 10 mg once daily
Adult: 10 mg once daily
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
1. Symptomatic treatment
● Headache → analgesic

Drug Dose Pregnancy & breastfeeding

Paracetamol Child under 1 month: 10 mg/kg 3 or 4/d May be acceptable

Child 1 month and over: 15 mg/kg 3 or 4 /d
Adult: 1 g 3 or 4 times daily (max 4g/d)

Ibuprofen Child over 3 months: 5 to 10 mg/kg 3 to 4/d -Avoid. Contraindication from the
Child 12 year and over and adult: 200 to beginning of the 6th month
400 mg 3 to 4 times/d -Breast-feeding: No contraindication
(short term treatment)

Diclofenac 100 mg PO once, then 50 mg PO q8hr PRN Avoid unless the potential benefit
outweighs the risk ( the third trimester)
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
2. Etiologic treatment
● Inflammation of the nasal→ Mast cell stabilisers, Corticosteroid

Drug Dose Pregnancy & breastfeeding

Sodium cromoglicate Child: 1 spray 2–4 times a day No data

Adult: 1 spray 2–4 times a day

Dexamethasone 0.75-9 mg/day PO divided q6-12hr Avoid

Nasal corticosteroids 100 µg twice/d ,to be administered into No data

Beclometasone each nostril

Triamcinolone Child 6–11 years: 55 µg one/d,to be No data

administered into each nostril
Child 12–adult: 110 µg one/d,to be
administered into each nostril
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
2. Etiologic treatment
● Infection → Bacteria (ATB)

Drug Dose Pregnancy & breastfeeding

Amoxicillin Mild to moderate infections Generally acceptable

500 mg PO q12hr or 250 mg PO q8hr for 10-14 /d
Severe infections
875 mg PO q12hr or 500 mg PO q8hr for 10-14 days

Cephalexin 250 mg PO q6hr or 500 mg PO q12hr; dosage range, Generally acceptable

1-4 g/day in divided doses

Roxithromycin Child: 6-40 kg: 5-8 mg/kg daily. Avoid

Adult: 150 mg bid or 300 mg once / d for 5-10 days
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
2. Etiologic treatment
● Infection → Bacteria (ATB)

Drug Dose Pregnancy & breastfeeding

Azithromycin Child 6 months–17 years (body-weight 15–25 kg): 200 mg Avoid

once daily for 3 days
Child 6 months–17 years (body-weight 26–35 kg): 300 mg
once daily for 3 days
Child 6 months–17 years (body-weight 36–45 kg): 400 mg
once daily for 3 days
Child 6 months–17 years (body-weight 46 kg and
above): 500 mg once daily for 3 days
Adult: 500 mg once daily for 3 day
 Rhinitis ជំងឺរលាក ចមុះ
IV. Pharmacotherapy of rhinitis
2. Etiologic treatment
● Infection → Bacteria (ATB)

Drug Dose Pregnancy & breastfeeding

Azithromycin Child 6 months–17 years (body-weight 15–25 kg): 200 mg Avoid

once daily for 3 days
Child 6 months–17 years (body-weight 26–35 kg): 300 mg
once daily for 3 days
Child 6 months–17 years (body-weight 36–45 kg): 400 mg
once daily for 3 days
Child 6 months–17 years (body-weight 46 kg and
above): 500 mg once daily for 3 days
Adult: 500 mg once daily for 3 day
Case study 1:
េលាកពូ សុខ ចូលមកកភ្នែុង ឱសថសា្ថាន របស់ អភ្នែកេដើមាបី រកថ្នាំ
បំប្រាត់េហៀរសំេប្រាររបស់គាត់
1. េតើ អភ្នែក តូវេធ្វើការសន្ទនា សាកសួរពីគាត់នូវព័ត៌មានេដើមាបី េអាយដឹងពី ជំងឺគាត់ (
diagnostic ) ?
2. េដើមាបី េអាយ ប្រាកដ ពីមូលេហតុ ែដលបញ្តាលេអាយ
េកើតជំងឺជំងឺរលាក ចមុះ (Rhinitis) េតើ អភ្នែក តូវ សាកសួរ អ្វី បែនន្ថែមេទៀត ?
3. េតើ អភ្នែក តូវសួរ ព័ត៌មានអ្វីខះេទៀតេដើមាបី ដឹងពីកំរត នឹងរយៈេពល េ បើ ប្រាស់ថ្នាំ ?
 Red eye

1. Red eye of conjunctivitis

2. Subconjunctival haemorrhage
3. Episcleritis
4. Scleritis
5. Keratitis (corneal ulcer)
6. Uveitis (iritis)
 Red eye
I. What’s Conjunctivitis ? (ែភភ្នែក កហម េដោយសារ ការរលាកសំបកថ្លារបស់ែភភ្នែក)

➔ Conjunctivitis simply means inflammation of the conjunctiva and is

characterised by varying degrees of
● Ocular redness,
● Irritation,
● Itching
● Discharge
 Red eye
I. What’s Conjunctivitis ? (ែភភ្នែក កហម េដោយសារ ការរលាកសំបកថ្លារបស់ែភភ្នែក)

➔ Conjunctivitis simply means inflammation of the conjunctiva and is

characterised by varying degrees of
● Ocular redness (ែភភ្នែក កហម)
● Irritation ( ការរលាក)
● Itching (រមាស់ េសស្កៀបកភ្នែុង គប់ែភភ្នែក)
● Discharge (េហៀរទឹកែភភ្នែក ឬ មានអាចម៍ែភភ្នែក)

➔ Conjunctivitis may be cause by :

● Allergic
● Viral infection
● Bacteria infection
 Red eye
II. How to know the etiology of Conjunctivitis

Symptoms that help distinguish between the different types of conjunctivitis

Bacterial Viral Allergic

Eyes affected Both, but one eye is often Both Both

affected first by 24–48 hr

Discharge Purulent Watery Watery

Pain Gritty feeling Gritty feeling Itching

Distribution of Generalised and diffuse Generalised Generalised, but greatest in fornices

redness

Associated None commonly Cough and cold Rhinitis (may also have family history of
symptoms symptoms atopy)
 Red eye
II. How to know the etiology of Conjunctivitis

Purulent Cough + cold symptoms Itching

Bacterial conjunctivitis Viral conjunctivitis Allergic conjunctivitis

 Red eye
III. How to differential diagnosis of Conjunctivitis
 Red eye
III. How to differential diagnosis of Conjunctivitis
 Red eye
IV. The strategy therapeutic of Conjunctivitis
Symptomatic treatment
● Ocular redness (ែភភ្នែក កហម)→ Anti-inflammatory
● Irritation ( ការរលាក)→Anti-inflammatory
● Itching (រមាស់ េសស្កៀបកភ្នែុង គប់ែភភ្នែក)→anti-H1
● Discharge (េហៀរទឹកែភភ្នែក ឬ មានអាចម៍ែភភ្នែក)→ no use drugs

Etiologic treatment

● Allergic→ anti-H1 + anti-inflammatory

● Viral infection →antiviral
● Bacteria infection→ATB
 Red eye
V. Pharmacotherapy of conjunctivitis
1. Symptomatic treatment
● Ocular redness (ែភភ្នែក កហម) ,Irritation ( ការរលាក)→ Anti-inflammatory

Drug Dose

Betamethasone Eye drop:

Child: Apply every 1–2 hr until controlled then reduce frequency
Adult: Apply every 1–2 hr until controlled then reduce frequency
Eye ointment:
Child: Apply 2–4/d, alternatively apply at night when used in combination with eye drops
Adult: Apply 2–4/d, alternatively apply at night when used in combination with eye drops

Dexamethasone Eye drop:

Child: Apply 4–6 times a day
Adult: Apply every 30–60 minutes until controlled, then reduced to 4–6 times a day
 Red eye
V. Pharmacotherapy of conjunctivitis
1. Symptomatic treatment
● Ocular redness (ែភភ្នែក កហម) ,Irritation ( ការរលាក)→ Anti-inflammatory

Drug Dose

Sodium Child: Apply 4 times a day

cromoglicate Adult: Apply 4 times a day

Nedocromil Child 6–17 years: Apply twice daily, increased if necessary to 4 times a day, max.12
sodium weeks duration of treatment for seasonal allergic conjunctivitis
Adult: Apply twice daily, increased if necessary to 4 times a day, max.12 weeks
duration of treatment for seasonal allergic conjunctivitis
 Red eye
V. Pharmacotherapy of conjunctivitis
1. Symptomatic treatment
● Itching (រមាស់ េសស្កៀបកភ្នែុង គប់ែភភ្នែក) → anti-H1

Drug Dose

Antazoline with Child 12–17 years: Apply 2–3 times a day for maximum 7 days
xylometazoline Adult: Apply 2–3 times a day for maximum 7 days

Azelastine Child 4–17 years: Apply twice daily, increased if necessary to 4 times a day
Adult: Apply twice daily, increased if necessary to 4 times a day

Ketotifen Child 3–17 years: Apply twice daily

Adult: Apply twice daily

Olopatadine Child 3–17 years: Apply twice daily for maximum 4 months
Adult: Apply twice daily for maximum 4 months
 Red eye
V. Pharmacotherapy of conjunctivitis
2. Etiologic treatment
● Bacteria infection→ATB
Drug Dose

Chloramphenicol Child over 2 years : one drop every 2 hours for the first 48 hours,
then reducing to four times a day for a maximum of 5 days’
treatment

Betamethasone with neomycin Adult: Apply up to 6 times a day

Dexamethasone with Eye drop:

hypromellose, neomycin and
polymyxin B sulfate
Adult: Apply every 30–60 minutes until controlled, then reduced to
4–6 times a day
Eye ointment:
Adult: Apply 3–4 times a day, alternatively, apply at night when used
with eye drops
 Red eye
V. Pharmacotherapy of conjunctivitis
2. Etiologic treatment
● Bacteria infection→ATB
Drug Dose

Tobramycin Child 1–17 years: Apply twice daily for 6–8 days
Adult: Apply twice daily for 6–8 days

Ciprofloxacin Eye drop:

Child: Apply 4 times a day for maximum duration of treatment 21 days
Adult: Apply 4 times a day for maximum duration of treatment 21 days
Eye ointment:
Child 1–17 years: Apply 1.25 centimetres 3 times a day for 2 days, then apply 1.25
centimetres twice daily for 5 days
Adult: Apply 1.25 centimetres 3 times a day for 2 days, then apply 1.25
centimetres twice daily for 5 days
 Red eye
V. Pharmacotherapy of conjunctivitis
2. Etiologic treatment
● Viral infection →antiviral
Drug Dose

Aciclovir Child: Apply 1 centimetre 5 times a day continue for at least 3 days after complete healing
Adult: Apply 1 centimetre 5 times a day continue for at least 3 days after complete
healing