Guide of the medications in pediatric emergency unit

Antibiotics
Drug Indications
more active against Gm -ve
organism
Ceftriaxone - Septicemia, Meningitis
Cefotaxime (claforan) - Serious infection, RTI, UTI
vial 1g - Acute OM
- Gonococcal infection
- Pseudomembranous colitis
Strong against G-ve and may use
Gentamicin for G+v
(garamycin) amp - UTI, Gastroenteritis
80mg - Gm-ve bacterial Meningitis
- Infective endocarditis
UTI, RTI, Typhoid, Cholecystitis
Bacillary dysentery (Shigella)
Ampicillin Meningitis, Septicemia,
(Ampliclox) vial Endocarditis, Gonorrhea
Whooping cough (Erythromycin is
preferred)
Amoxicillin (Amoxil) same as ampicillin
syrup
50mg/5ml
Anti-protozoa
Metronidazole (flagyl)
- Amebiasis
bottle 5mg/ml
- Giardiasis [15-20mg/kg/day]
- Trichomoniasis
Tab 200mg
Anaerobic infection e.g clostridia
Syrup 200mg/5ml
Post GI surgery prophylaxis
Necrotizing enterocolitis
- Whooping cough
- Community acquired
pneumonia [Mycoplasma &
Azithromycin syrup Legionaires pneumonia]
200mg/5ml - Campylobacter enteritis
- Acute bacterial sinusitis, OM,
- Streptococcal & Chlamydial
infections
Vancomycin vial Resistant staphylococcal infections
Infective endocarditis (in Penicillin
allergic cases)
Infection with diphtheroids
Meropenam Life threatening infection &
septicemia, resistant to other
antibiotics
Dose, route
Ceftriaxone:
- 50-75 mg/kg/day q 12 hourly IM or
IV infusion
- For meningitis, typhoid: 100
mg/kg/day q 12 hourly IV infusion
Cefotaxime: 50-200 mg/kg/day q 8
hourly IM or IV infusion
5 mg/kg/day q 12hourly IM or IV
50 - 200 mg/kg/day q 6 hourly IM or IV Ampicillin is a very safe drug
50 – 100 mg/kg/day q 8 hourly
IV: 5 – 7 mg/kg/dose q 8 hourly IV
(1.5 ml/kg/dose)
Oral 30-50mg/kg/day q 8 hr
10mg/kg/day once daily for 3-5 days
< 7 days:
15 mg/kg/day IV OD
7 days - 1 month:
30 mg/kg/day IV q 12 hourly.
In older infants & children:
45-60 mg/kg/day IV q 8 hourly [IV
infusion over 1 hour or more]
Neonates :
40 mg/kg/day IV q 12 hourly (Dose
may be doubled in case of Meningitis)
Side effects
SE: Allergic reaction, eosinophilia,
thrombocytopenia, diarrhea, increase
transaminases and nephrotoxicity in high dose.
Interaction: Ca gluconate, heparin,
doxycycline
Caution: renal impairment, GI dz.
Nephrotoxicity is greater
Vestibular toxicity
Auditory toxicity
SE: Allergic rash & Diarrhea
SE: Diarrhea, N, V, pseudomembranous colitis
Anaphylaxis, anemia (appear in sensitive
persons)
SE: N, V, metallic taste, teratogenic
SE: diarrhea, Nausea, abd. Pain, dyspepsia
CI: hypers, pimozide, hepatic problem with
previous use.
Caution: hepatitis, liver dz
Interaction: pimozide, amiodarone, digoxin,
heparin, warfarin, ondansterone
SE
- Skin rashes – red man syndrome,
histamine mediated, self-limited and can
continue the medication.
- Hypotension during IV infusion
- Nephrotoxicity
- Sensory - neural deafness
- Bone marrow suppression
- Thrombophlebitis

Infants & Older Children :

60-120 mg/kg/day q 8 hourly (Higher
dose of 120 mg/kg/day in Meningitis)
Flucloxacillin vial

Anti-viral
Drug Indications Dose, route Side effects
- Neonatal herpes simplex 10 mg/kg/day IV q 8 hourly (10-14 GI upset (oral dose)
- Herpes simplex encephalitis days) When given parenterally: Vomiting,
Acyclovir - Severe generalized herpes infection Hypotension
- Chicken-pox (In immunosuppressed Renal damage
patients) Neurological symptoms: Convulsions, Coma

Pain, fever and Anti-inflammatory

Drug Indications Dose, route Side effects
Ibuprofen Pain, Fever 10 mg/kg/dose in q 6 hourly GI distress
100mg/5ml Rheumatoid arthritis (JRA) Skin rash (Allergic reactions)
40mg/1 ml Soft tissue injuries, Fractures Thrombocytopenia & Bleeding
Post-operatively to suppress Headache, dizziness, blurring of vision etc. are rare.
pain & inflammation.
Diclofenac sodium Same as ibuprofen 1 mg/kg/dose q 12 hourly GI distress (abdominal pain, nausea, Vomiting)
(Voltaren) amp Peptic Ulcer, GI bleeding
Dizziness, Fluid retention
Renal failure
Hyosine-N- - Acute spasm of bowel < 1 year: 5 mg q 8 hr Lazy bowel syndrome
butylbromide (colicky abdominal pain) > 1year: 5-10 mg q 8 hr Paralytic ileus
(buscopan) amp. - Biliary of renal colic GI upset
5mg/5ml Glaucoma
Paracetamol Fever and pain relief < 12 yrs: 10 mg/kg q 6hr not SE:
(antipyrol) to exceed 2.6 g/day - Angioedema, laryngoedema, rash, GIT bleed,
Tab: 500 mg > 12 yrs: 40-60 mg/kg q6hr - Nephrotoxicity, hepatotoxicity, leukopenia
Syrup: 120 mg/5ml not to exceed 3.7 g/day CI: hypersensitivity, severe active liver dz
Sup.
Prednisolone - Acute asthma Acute asthma: SE: Acne, wt gain, adrenal suppression, osteoporosis, DM,
(xilone) - Inflammation 2mg/kg/day once or q 12 hr menstrual irregularity, psychosis, hirsuitism, delay wound
- Nephrotic syndrome for 5 days healing, insomnia, myopathy, neuritis
Inflammation: C/I:
1 mg/kg/day once daily for 3- Hypersensitivity, systemic fungal infection, varicella, live
5 days attenuated vaccine.
NS: Caution: cirrhosis, HTN, thyroid dz, osteoporosis, pregnancy,
2 mg/kg/day divided dose 3-4 renal impairment, untreated systemic infection.
times daily Interaction with drugs: carbamazepine, cimetidine,
or 60mg/m2/day for 4-6 wks clarithromycin. With vaccine: Hib, BCG, MMR
Dexamethasone - Croup 0.6 mg/kg/day q 12 hr
Decadron amp - Inflammation
- Meningitis
Hydrocortisone vial - Status asthmaticus 10 mg/kg/day q 6 hourly IV SE:
100 mg - Acute adrenal crisis Hypertension, hyperglycemia, gastric upset
- Inflammation: allergy, insect Acute adrenal crisis: Paresthesia (for decadron)
Dissolve in 2cc NS bit, anaphylaxis Infant: 25 mg IV bolus then IV Cushnoid face, DIC, Acne, Hyperpigmentation, Growth
drip 50 mg/m2/day impairment, Cardiomegaly, arthralgia, depression, delirium,
Older: 50-100 mg rapid bolus fat embolism, myocardial rupture, pseudotumer cerebri,
then 50 mg/m2/day IV drip hypokalemic alkalosis
Inflammation:
1.5 mg/kg/day q 12 hr Caution: CHF, DM, thrombotic disorder, GI disorders,
diverticulitis
Chlorpheniramine Antihistamine 0.5-2 mg/kg/dose IM or IV q
(Allermine) amp 8 hourly
Codeine Anti-tussive and analgesic For cough: 0.25-0.5 Drowsiness
mg/kg/dose q 8 hourly Vomiting
For analgesia: 0.5-1 Dizziness
mg/kg/dose q 6-8 hourly Constipation

Anti-emetics
Drug Indications Dose Side effects
Antiemetic 0.1 mg/kg/dose q 6 hourly IV or IM Sedation, Diarrhea
Gastric hurrying agent Extrapyramidal reactions: Dystonias,
Metoclopramide
In peptic ulcers Oculogyric crisis
(Plasil) amp
To prevent reflux esophagitis Gynaecomastia (Male)
Galactorrhea (Female)
Pyridoxine B6
Domperidone

Gastric hyperacidity
Drug Indications Dose Side effects
Gastric ulcer Ranitidine 2-4 mg/kg/day IV q 8 hourly
Ranitidine (Zantac) amp GERD Cimetidine 20-40 mg/kg/day IV q 8 hourly
Cimetidine (tagamet) amp Stress ulcer
Esophageal varices
Omeprazole vial

Bronchodilator
Drug Indications Dose Side effects
Salbutamol Acute bronchospasm Ventolin nebulizer: add 0.5 cc of salbutamol Tachycardia
(Ventoline solution) solution in 1.5 cc of NS and put it in nebulizer Hypokalemia
(can repeated 3 times) Tremor
0.6 mg/kg/day
Aminophylline - Intractable asthma [severe 3-5 mg/kg/dose continuous IV slow infusion SE: Tachycardia, Convulsion , Cardiac
25mg/1ml asthma not responding to in 30 cc GW 5% over 20min arrhythmia, Narrow therapeutic index
salbutamol and HC] Cautions: acute peptic ulcer disease, seizure
- Apnea of prematurity disorders, cardiac arrhythmias (except
bradyarrhythmias)

Cardiovascular disorders
Drug Indications Dose Side effects
Furosemide (Lasix) Hypertension 1-2 mg/kg/dose IV (can be Hypovolemia and Hypotension
ampule Edema repeated 3 times) Hypcalcemia and Hypokalemia
Heart failure Hyperglycemia and Hyperuricemia
Nephritis & Nephrotic syndrome Ototoxicity
Digoxin amp - Congestive cardiac failure Digitalization (loading dose)
- To control the ventricular rate 0.02-0.04 mg/kg/day
in arrhythmias such as Atrial - ½ dose: 1st 8 hrs
flutter, atrial fibrillation & - ¼ dose: 2nd 8 hrs
Paroxysmal supraventricular - ¼ dose: 3rd 8 hrs
tachycardia Maintenance dose
0.005 – 0.01 mg/kg/day q
12 hourly
Atropine sulphate - Bradycardia not responding 0.01 mg/kg IV or IO SE: Flushing of face, Dry mouth, Tachycardia, Dilated pupil
to 100% oxygen Every ¼ , ½ and 2 hour till CI: glaucoma, MG, obstructive uropathy, thyrotoxicosis,
- Organophosphorus poisoning improvement paralytic ileus.
Albumin solution - Hypoalbuminemia 500-1000 mg/kg SE: Allergy (anaphylaxis, fever, rash, urticarial), hypervolemia,
5%: 50mg/ml - Intradialytic hypotension Infusion over 1 hr tachycardia, Pulmonary Edema, bronchospasm
25%: 250mg/ml - Hepatorenal syndrome Cautions/CI: CHF and hypersensitivity
Adrenaline - Anaphylaxis (given SC or IM) 0.01 mg/kg/dose SC or IM SE: Tachycardia, Hypertension
(epinephrine) amp. - Cardiac standstill (IV or of 1;1000 solution CI: heart attack, angina, sinus tachycardia, abnormal heart
1 mg/ml [1;1000] intracardiac) rhythm, high blood pressure.
0.1mg/ml [1;10000] - Severe laryngeal edema in
case of croup bronchiolitis
 Hydralazine amp Hypertension emergencies 0.1 – 0.5 mg/kg/dose every SE: Hypotension, palpitation, tachycardia, Peripheral edema,
20mg/ml 4 hr neuropathy
Caution: pregnancy, CVA
CI: CVD, mitral valve rheumatic dz, hypersensitivity.
Dopamine amp Hypotension and shock 2-20 mcg/kg/min IV
Acute renal failure to increase continuous
renal blood flow (in low dose) 0.5 – 4 mcg/kg/min
Metoprolol amp
Aminodarone amp

Anti-arrhythmic drugs
 Adenosine and verapamil – SVT
 Propranolol – SVT, hypercyanotic attach of Cyanotic heart disease
 Lidocaine – Ventricular arrhythmias
 Phenytoin – Ventricular arrhythmias

Bleeding disorders
Drug Indications Dose Side effects
Tranexamic acid In mucosal bleeding (gum, nasal, GIT, 45 mg/kg/day in q 8 hourly slow IV SE: Thrombosis, Hypotension, Nausea and
(Cyclocapron) amp vaginal, uterine) infusion with NS vomiting
CI: in case of hematuria (because it may cause
obstructive uropathy and acute renal failure)
Vit K Prophylaxis [decrease risk of Prophylactic: May cause anaphylaxis (after rapid infusion)
(phytomenadione) bleeding in neonate after birth] 1mg/kg IM Exacerbate jaundice
ampule
Therapeutic Therapeutic: Local: injection site reactions (inflammation,
- Hemorrhagic disease of newborn 5 -10 mg/day until bleeding stops, atrophy, necrosis)
(2-7 day of life) IM or IV Skin: erythematous, indurated, pruritic plaques
- Acute hepatic failure and DIC
- Chronic liver disease
- Malabsorption
- Antidote for warfarin

Anti-convulsants
Drug Indications Dose Side effects
Diazepam ampule - Status epilepticus For convulsion: SE: respiratory depression, Apnea, hypotension,
(Valium) - Sedative, muscle relax 0.1– 0.3 mg/kg/dose ataxia, neutropenia, jaundice, headache, blurred
10mg/2cc Given by slow IV, if there is no IV vision
access, you can give it rectally Caution: COPD, renal/hepatic dz, suicide
It can be repeated 2-3 times Interaction: clarithromycin, erythromycin,
carbamazepine, cimetidine, codeine
For sedation: CI: hypersensitivity, respiratory depression, breast
0.04 - 0.2 mg/kg feeding, child < 6 months, sleep apnea
Phenobarbital - Status epilepticus (2nd line) Loading dose SE:
(Luminal) amp - In convulsion whatever the cause 15 -20 mg/kg/dose IV slow infusion - Change in level of consciousness
And - Head trauma Maintenance dose - Nausea and vomiting
Phenytoin - Subarachnoid hemorrhage 5 mg/kg/day q 12 hourly IV slow
(epanutin) amp infusion Luminal is sedative used on convulsion caused by
*Compatible with NS, never give it CP and hypoglycemic fit
with G/W Phenytoin is non-sedative used in meningitis
Midozolam amp - Refractory status Epilepticus For status Epilepticus :
- Sedation (Prior to administration 0.15 - 0.2 mg/kg IV loading dose
of anaesthesia or Mechanical followed by continuous IV infusion at
Ventilation) the rate of 1 mcg/kg/min

For Sedation :
In Neonates : 0.15-1 mcg/kg/min
continuous IV infusion
In infants & older children : 0.5-2
mcg/ kg/min continuous IV infusion

Fluids
Drug Indications Contents Dose Side effects
ORS Treat dehydration or prevent further According to WHO CI: abd. Distention due to paralytic ileus,
dehydration especially due to diarrhea plans comatose child due to severe dehydration
and severe persistent vomiting
N/S Shock Isotonic, no glucose 20 cc/kg (bolus)
Severe dehydration
G/W - For treatment of hypoglycemic state GW 5%: 5 gm G/100cc 2-4 ml/kg for Extravasation
such in diabetic hypoglycemia and in water immediate effect Thrombophlebitis
liver disease GW 10%: 10 gm Intra-ventricular hemorrhage (In
- Hypoglycemic convulsions GW 25%: 25gm premature & newborns) due to
GW 50% vial: 50 gm hyperosmolar solution
G/S Maintenance fluid requirement ½ GS
¼ GS
Ringer lactate In Dehydration 20 cc/kg (bolus)
- Grade II & III & in shock C/I: liver dysfunction
- As a Plasma Expander
After hemorrhage, As an initial replacing
solution & if blood is not available urgently
In shock with low CVP
To differentiate between oliguria of pre-
renal & Renal origin
Therapeutic effect in case of pre-renal
oliguria.
 Mannitol 20% - To reduce cerebral edema due to any Initially: C/I: CHF, dehydration, subdural
cause 0.25-1g/kg/dose hemorrhage and renal failure
- In forced alkaline diuresis
7 cc/kg/dose q 8
hourly given fast
over 20 minutes.
Electrolyte
Drug Indications Dose Side effects
Calcium gluconate - Hypocalcemic tetany 1 cc/kg/dose q 8 hourly by SE: hypotension, arrhythmia, heart arrest, N/V,
10% amp - Hypocalcemic convulsions slow IV infusion in GW over headache, Stridor, Apnea, Convulsion, Carbo pedal
- Hyperkalemia 20 min spasm, diarrhea/constipation.
- Renal failure Caution: liver or renal impairment, acidosis, CVS
Dissolve in 30 cc water problem, hypophosphate
Monitor of HR and BP Interaction: ceftriaxone, doxycycline, tetracycline,
amlodipine, digoxin
C/I: hypersensitivity, hypercalcemia, sarcoidosis,
digoxin, VF.
Potassium chloride Hypokalemia whatever the cause 2 meq/kg/day Diluted with SE: Hyperkalemia & subsequent arrhythmia
amp - DKA fluid C/I: Hyperkalemia, Chronic renal failure, Systemic
- Dehydration with repeated acidosis such as diabetic acidosis, Acute dehydration,
1 cc = 2 meq vomiting Hypokalemia: 20-40 meq/L Extensive tissue breakdown as in severe burns,
- Paralytic ileus DKA: 40meq/L = 20ml KCl/L Adrenal insufficiency, Administration of a potassium-
= 2ml/100cc fluid sparing diuretic (e.g., spironolactone, triamterene or
amiloride)
Cautions: Should be given slowly by infusion.
Sodium bicarbonate In severe acidosis: DKA, renal failure 1 cc/kg/dose 4 time daily SE: Hypokalemia, Hypoglycemia, Cerebral edema,
vial Hyperkalemia slow IV over 10min (not more Tissue hypoxia, metabolic alkalosis, Paradoxical brain
Cyanotic spell than 25 mg/dose) acidosis , Tetanus hypocalcemia
1 cc = 1 meq Cardiac arrest C/I: Patients who are losing chloride, such as by
vomiting, Congestive heart failure (CHF), Severe renal
insufficiency (RF)
Cautions: Patients receiving corticosteroids, Low
sodium intake is strongly indicated to prevent sodium
retention in patient with CHF, RF
Sodium chloride 3% Severe symptomatic hyponatremia
Magnesium Hypomagnesemic convulsions or 1 ml/kg
sulphate 10% tetany
Glucose regulators
Drug Indications Dose Side effects
Insulin injection DKA and hyperglycemia
Types: Soluble, NPH, Mixed
Glucagon vial Severe hypoglycemic reaction in < 20 kg: 0.5 mg SC, IM or IV
patient with DM treated with insulin > 20 kg: 1 mg SC, IM or IV
Blood products
Drug Indications Dose
Whole blood Exchange transfusion Volume: According to blood loss:
Replacement of acute blood loss as - 20 cc/kg in class II
hypovolemia, shock, bleeding - 30 ml/kg in class III
- 40 ml/kg in class IV
- 70 ml/kg in massive transfusion in massive trauma, orthopedic and
cardiopulmonary bypass surgery.
Rate of infusion:
- In emergency case, as fast as the patient can tolerate
- In less urgent case, within 1-2 hours
Packed RBC Symptomatic hemolytic anemia (intense pallor Type
with acute hypoxia as tachypnea and - In emergency case: uncross matched group O, Rh negative or uncross
tachycardia) matched type specific ABO packed RBC
Fluid overload, HF - Less urgent case, a full cross matched type specific PRBC
Chronic blood loss - In case of repeated transfusion, washed RBCs preferable
Volume: 10-15 cc/kg [each 4ml/kg PRBC raises the Hb by 1 gm/dl]
Rate of infusion: same as whole blood
Plasma Bleeding varices 15 cc/kg
Platelets Severe Thrombocytopenia with plt < 20,000 Volume: 1 unit/ 5 kg (or 10 ml/kg)
Associated with active bleeding Rate of infusion: one unit every 10 minutes
DIC and consumptive thrombocytopenia due to
fulminant sepsis
FFP Coagulation defects as DIC and acute hepatic Type: ABO compatible plasma
failure Volume: 10-15 ml/kg and can be repeated every 12 hr
Also for hemophilia if cryo not available Rate of infusion: 0.5ml/kg/min
Cryoprecipitate Hemophilia A and Von willebrand disease Volume: one bag/ 5 kg (or 5 ml/kg) every 12 hour
Fibrinogen deficiency or dysfunction Rate of infusion: 10ml/minute
DIC
Granulocyte Neutropenia with fulminant bacterial or fungal Volume: 1-2 x 109/kg neutrophils per transfusion
infection not responding to appropriate Rate of infusion: one leukapheresis unit over 2-4 hours
antimicrobial therapy
Leukocyte dysfunction with fulminant infection
Iron overload
Drug Indications Dose Side effects
Desferal vial Acute iron overload 30-50 mg/kg/day q 8-12 hr Local: pain, allergy, induration
500mg Chronic iron overload SC and 5-6 nights/wk General: anaphylaxis, ototoxicity, retinal toxicity, growth
2g Aluminum toxicity retardation
Monitor: RFT, LFT, S. ferritin every 3 months, hearing and
vision assessment, growth assessment