Pocket Guidelines FINAL

POCKET
MEDICAL
GUIDELINES
INFECTIOUS
DENGUE
P> Diet: Regular Diet, No dark-colored

food
Increase Fluid Intake
Labs: • CBC with PC
and/or
• NS1 Antigen (Days 1-5 of fever)
• Dengue IgM/IgG (Days 7-14 of fever)
• If Dengue: Do serial CBC wth
PC, may add LFTs
Rx: • Paracetamol Q4 PRN fever
(avoid Aspirin, NSAIDs)
• ORS ( given based on weight
and hydration status, See:
Revised Dengue Guidelines
2011)
Advise: • Temperature monitoring Q1
• Tepid Sponge Bath
• Watch out for warning signs:
epistaxis, persistent vomiting,
severe, abdominal pain, black
stool, drowsiness, mental
confusion or seizures, pale, cold
or clammy hands and feet, DOB,
decreased or no UO within 6
hours- Refer to Hospital
SYSTEMIC VIRAL INFECTION
P> Diet: Regular Diet

Labs: CBC with PC, Urinalysis

• ORS (optional)
• Watch out for: epistaxis,
difficulty of breathing,
persistent vomiting, severe
abdominal pain, black stool,
changes in sensorium,
dysuria, diarrheal episodes
LEPTOSPIROSIS

Labs: • CBC with PC , UA
• Lepto MAT
• Serum creatinine
• PT/PTT
• Electrolytes
• CXR
• Antibiotics (Mild Lepto):
-Doxycycline 100 mg BID x 7 days
(Explain SE and proper intake of
meds)
- Alternative: Amoxicillin,
Azithromycin
• UO monitoring
• Moderate to Severe Lepto
(See Lepto CPG 2010) : Refer
to Hospital
DOXYCYCLINE
• CI: Pregnancy, Lactating, Children <8 years old, Hypersensitivity
• Precautions: Avoid exposure to sunlight. Use sunscreen and wear
protective clothing. Do not take iron and calcium sup, multivitamins,
antacids or laxatives 2 hrs before or after taking doxycycline
• Take it with food or after a meal
• Advise patient not to lie down for an hour after intake of the drug to
prevent esophageal damage
• Avoid taking it with NSAIDS
MUMPS
P> Diet: Soft Diet, Avoid sour and spicy

food

• Isoprinosine (optional)
• Wear mask
• Watch out for: Difficulty of
breathing, testicular pain,
changes in sensorium
VARICELLA INFECTION
P> Diet: Regular Diet, Hypoallergenic diet


• Acyclovir (given within 24 hours
after appearance of rash in >12 y/o or
if immunocompromised)
• Isoprinosine (Optional)
• Antihistamine (cetirizine,
hydroxyzine)
• Antibiotics for suspected
secondary bacterial infection(
Cloxacillin, Cefalexin,
Erythromycin)
Advise: • Avoid Scratching of Lesion
• Keep the rash covered
• Wear mask
• Regular bathing
• Frequent Handwashing
• Isolation until all lesions
crusted
• Watch out for: Difficulty of
breathing, seizure, epistaxis,
infected rash
MEASLES (Rubeola)


• ORS (optional)
• Vitamin A prophylaxis
• Wear Mask
• Watch out for: drowsiness,
mental confusion or seizures,
pallor, difficulty of breathing,
ear pain
GERMAN MEASLES (Rubella)


• ORS (optional)
• Wear Mask
• Watch out for: drowsiness,
mental confusion or seizures,
pale, Difficulty of breathing,
bleeding episodes
ROSEOLA (Exanthema Subitum)
P> Diet: Breast Feeding/Milk feeding with

Strict aspiration precaution
Labs: • CBC with PC , Urinalysis

• ORS (optional)
• Watch out for: epistaxis,
black stool, abdominal
enlargement, persistent
vomiting, difficulty of
breathing, changes in bowel
movement, weakness,
seizures
HERPES ZOSTER INFECTION
P> Diet: Regular Diet, Hypoallergenic diet

Rx: • Paracetamol/ NSAIDS for Acute

neuritis
• Antiviral: Usually given <72
hour after onset or given after
72 hours if with new lesion
- Valacyclovir 1g TID for 7 days
- Famciclovir 500 mg TID for 7
days
- Acyclovir 800 mg 5 times daily
for 7 days
• Antihistamine (cetirizine,
hydroxyzine)
Advise: • Avoid Scratching of Lesion
• Keep the rash covered
• Wear mask
• Regular bathing
• Frequent Handwashing
• Watch out for: blurring of
vision, eye pain, confusion,
fever, nausea, vomiting,
difficulty of breathing
Well Advised
HAND FOOT MOUTH DISEASE
P> Diet: Soft and cold foods

Increase Fluid intake
Labs: • CBCw/PC (rule out
secondary bacterial
infection)
Rx: • Symptomatic treatment:
• Fever: Paracetamol
• Hydration: ORS
• Oral Sores: Carbenoxolone,
Kamillosan spray
• Itching: Anti-histamines (i.e.
Cetirizine, Diphenhydramine)
• Bed rest and isolation of
personal utensils and other
belongings for 5-7 days
Advise: • If with signs of severe
dysphagia (inability to feed)
and dehydration- Refer to
Hospital
• Advise hand and oral hygiene
for whole family
• Avoid Hard and spicy food
• WOF: lethargy, T>38 for >48
hrs, cardiac complications
HERPANGINA
P> Diet: Soft, cold foods

Labs: • CBCw/PC ((rule out
secondary bacterial
infection)
Rx: • Symptomatic treatment:
• Fever: Paracetamol
• Hydration: ORS
• Oral Sores: Carbenoxolone,
Kamillosan spray
• Bed rest and isolation of
personal utensils for 3-5 days
Advise: • If with signs of severe
dysphagia (inability to feed)
and dehydration- Refer to
Hospital
• Advise hand and oral hygiene
for whole family
ORAL CANDIDIASIS

Labs: • FBS, CBC
Rx: • Mild disease: Clotrimazole

troches/lozenges 10mg, 5 times daily
OR Miconazole mucoadhesive buccal
tablet 50mg, apply 1 tablet to the
mucosal surface over the canine fossa
once daily for 7–14 days
• ALTERNATIVE: Nystatin suspension
(100,000 U/mL), 4–6 mL 4 times daily
OR Nystatin pastilles (200,000 U
each), 1-2 pastilles 4 times daily, for
7-14 days
• Moderate to severe disease:
Fluconazole 100-200mg tablet, 1 tab
daily for 7-14 days
• Recurrent infection: Fluconazole
100mg tablet, 1 tab once a day, 3
times a week
• HIV-infected patients: Antiretroviral
therapy
Advise: • If using inhaled corticosteroids, gargle
every after use
• Good oral hygiene
• Clean dentures
• Smoking cessation
RESPIRATORY
PULMONARY TUBERCULOSIS

Labs: • CBC with PC, CXR-PA,
• PPD (<15 years old)
• DSSM x 2
• Xpert MTB/Rif (if presumptive
DRTB, HIV suspect, smear negative
but positive CXR, EPTB)
• If PTB: Check also LFTS,
Crea, UA, BUA(optional),
Visual Acuity test, HIV
screening, DM screening
• Appetite Stimulant: MV +
Buclizine OD, Heraclene Forte
OD
• Mucolytic: NAC, Ambroxol,
Carbocisteine
• If PTB:
• Refer to TB DOTS
• for private patients refer to
NTCP-MOP for management
guidelines
Advise: • Wear Mask
• Cover mouth when coughing
CAP
pneumonia
PNEUMONIA (Low to Moderate
Risk, Adult)
Labs: • CBC with PC, CXR PA/L
Rx: • Antibiotics: Amoxicillin,

Co-amoxiclav, Macrolides,
Cephalosporins,
Fluoroquinolones (SEE
Philippine CPG CAP Guidelines
2016)
• Paracetamol Q4 PRN Fever
• Zinc Supplement
• Optional: Mucolytic,
Expectorant, Antihistamine,
Bronchodilator
Advise: • For CAP HR- Refer to Hospital
Risk, Adult)
Risk, Adult)
PNEUMONIA (PCAP A and B,
PEDIA)
P> Diet: Regular Diet, NPO if with DOB
Labs: • CBC with PC, CXR PA or AP/L
Rx: • Antibiotics:
Amoxicillin/Co-amoxiclav,
Azithromycin, Clarithromycin,
(See PCAP Guidelines PPAP
2016)
• Paracetamol Q4 PRN Fever
• Zinc Supplementation
• Inhaled Bronchodilator
• Optional: Mucolytic,
Expectorant, Antihistamine
Advise: • For CAP C and D- Refer to
Hospital
UPPER RESPIRATORY INFECTION

Labs: (If Needed) CBC with PC, CXR-PA,
PPD
• Mucolytic (Ambroxol,
Carbocisteine, NAC)
• Expectorant (Guaifenesin,
Lagundi etc)
• Optional: Antihistamine,
Vitamins
• Avoid antibiotic use for initial
treatment (please explain to the
patients of the common etiology of
URTI and the emergence of ABx
resistance). If symptoms persists for 1
week with increasing severity of sx
advise to do CXR or CBC, if bacterial
then you may give Abx)
Advise: • Watch out for: difficulty of

breathing, changes in
sensorium, retractions
ACUTE BRONCHITIS

Labs: CBC, CXR PA/Lat (if needed)
Rx: ● Antibiotic (if needed):

Amoxicillin, Cefuroxime,
Co-amoxiclav, Doxycycline
● Inhaled bronchodilators
● Paracetamol Q4 PRN Fever
● Optional: Mucolytics
● Ascorbic acid
Advise: • Cough etiquette
• Lifestyle modification:
Smoking cessation or
avoidance
• Watch out for: difficulty of
breathing, changes in
ACUTE BRONCHIOLITIS
P> Regular Diet, NPO if with DOB

(If needed): CBC, CXR AP-Lat
● Oxygen supplementation
● Paracetamol Q4 PRN Fever
● Inhaled Bronchodilator,
Antibiotic (if needed)
● Optional: Mucolytics
●
breathing, decrease in
feeding, changes in
ENT/OPHTHALMOLOGY
ACUTE TONSILLITIS
P> Diet: Regular to Soft Diet

• May use Centor Score for
possible GAHBS, if > 2 (do
RADT or Throat Culture)
• Antibiotics: Penicillin,
Co-Amoxiclav, First Generation
Cephalosporins, Macrolides
• Optional: Kamillosan spray 2
puffs TID, Lozenges
Advise: • Good Oral Hygiene
• Bactidol Gargle every after
meal
• Consult to ENT:
• for possible tonsillectomy if
conditions are met ( See
AAO–HNS Guidelines for
Tonsillectomy)
• or if symptoms are severe
ACUTE LYMPHADENITIS
P> Diet: Regular diet as tolerated

Increase oral fluid intake
Labs: • CBCw/PC, UA
• PPD, Serology (EBV, CMV,
HIV, TB) if considering
infectious processes
• ESR, CRP (if considering
inflammatory/autoimmune
processes)
• Imaging (CXR) if considering
infectious (TB)
Rx: • Paracetamol
• Consider antibx: Flucloxacillin,
Cephalexin, Erythromycin,
Co-Amoxiclav
Advise: • If no resolution of symptoms
after antibiotic treatment, for
neck utz or referral to ENT
• WOF: adenitis >2 weeks,
easy bruisability, rashes,
weight loss, anorexia
ALLERGIC RHINITIS
P> Diet: Regular Diet, Hypoallergenic Diet

Labs: • None
Rx: • Intranasal corticosteroids

(DOC)
• Antihistamine oral or
intranasal
• Oral Decongestant (Avoid using
intranasal decongestants)
• Saline Sprays
Advise: • Avoid allergens and triggers
• Frequent hand washing
• Avoid smoking
ACUTE SINUSITIS
P> Diet: Regular diet

• PNS view (optional)
Rx: • Decongestant < 5 days
• > 5 days oral antibiotic:
• Co-amoxiclav 50 mkd (pedia),
Clarithromycin 500 mg BID x 7
days (Adult)
Advise: • Intranasal saline irrigation
• For referral to ENT, Infectious
Disease, Allergology if with
recurrent episodes
BENIGN PAROXYSMAL VERTIGO

Adequate Fluid intake
Tests: • CBG
• CBC
Rx: • Betahistine 8 mg, 16 mg, 24 mg
• Cinnarizine 15, 25 mg
Advise: • Avoid sudden head movements
• Upon waking, sit down for 10
minutes before standing
• Refer: if with persistent vertigo,
tinnitus, hearing loss
IMPACTED CERUMEN
P> Diet: Diet as tolerated

Labs: • none
Rx: • Cerumenolytic agent: Na

docusate (Otosol) otic drops fill
the ear OD x 5 days
Advise: • avoid ear manipulation
• ear toilette (hydrogen
peroxide + water)
• ff up after 7 days and refer to
ENT for possible flushing and
irrigation if with no
improvement
ACUTE OTITIS EXTERNA

Labs: • CBC (optional)
Rx: • Paracetamol or NSAIDs for pain

• OTIC drops:
• PND- if intact TM
• Ciprofloxacin + dexamethasone
intact or perforated TM
• Cotrimazole otic drops if fungal
Advise: • Avoid swimming
• Avoid ear manipulation
• Avoid applying alcohol,
betadine
• Refer to ENT if no
improvement of symptoms
after 3 days of treatment
ACUTE OTITIS MEDIA
P> Diet: Diet Fluid intake

Labs: • CBC c PC (optional)
Rx: • Pain medications (Stage 1-2)

• If no improvement within 72
hours: Give systemic antibiotic
(Co-amoxiclav)
• If stage 3 and 4 (positive
suppuration): Otic drops (
Ciprodex (perforated) or PND
(not perforated) )
• If no improvement within 72
hours refer to ENT
Advise: • avoid ear manipulation
• ear toilette (hydrogen
peroxide + water)
• ff up after 3 days and refer to
ENT if with no improvement
EPISTAXIS

• PT, PTT, Liver Function Test
(Optional if bleeding is
recurrent or severe)
• CT scan/MRI (Optional if
suspected tumors or
neoplasm)
Rx: • Saline water or Decongestants
Optional:
• Naseptin nasal cream
(Chlorhexidine,Neomycin)
• Tranexamic acid nose gel
• Mupirocin ointment, lesions
and both nostrils
Advise: • Squeeze anterior nose for 10
minutes, use on an ice pack
• Avoid nasal picking
• Avoid hard nose blowing or
sneezing
• Avoid taking hot showers
• Avoid aspirin and NSAIDs
BACTERIAL CONJUNCTIVITIS

Labs: • CBC with PC (optional)
Rx: • Tobramycin e/s 1 ugtts TID to

QID x 7 days
• Erythromycin ointment BID x 7
days
Advise: • Lid hygiene
• Cold compress then warm
compress
• Avoid scratching of eyes
• Watch out for: periorbital
edema, photophobia,
proptosis, blurring of vision,
limitation of eye movement,
fever
VIRAL CONJUNCTIVITIS

Labs: • None
Rx: • Self Limiting

• May give Tobramycin otic
drops if with secondary
bacterial infection
• Optional: Eye Lubricants,
Antihistamine
compress
• Isolation
ALLERGIC CONJUNCTIVITIS

Labs: • None
Rx: • Antihistamine
• Olopatadine 1 ugtts Q6
• Optional: Eye Lubricants
• Cold compress
• Avoid contact lens use
• Avoid allergens/triggers
PRESEPTAL CELLULITIS


• Antibiotics: Co-amoxiclav, 2nd
or 3rd gen Cephalosporins,
Clindamycin
compress
• Watch out for signs of orbital
cellulitis: photophobia,
proptosis, blurring of vision,
limitation of eye movement-
Refer to hospital
HORDEOLUM

Labs: • CBCw/PC (optional)
Rx: • Lid scrub with a “No Tears”

shampoo formula tid
• Warm compress for 10-15 mins
q6-8 hrs a day
• Tobramycin ointment tid x 7
days (if with blepharitis)
Advise: • Avoid eye rubbing
• Advise hand hygiene for the
whole family
• Watch out for: proptosis,
photophobia, limitation of
eye movement
chalazion
CHALAZION

Adequate oral fluid intake
Labs: • none
Rx: • Conservative: Topical antibiotic

, generally not indicated, but
may be used if there are signs
of infection, severe blepharitis
or blepharitis associated with
Rosacea (doxycycline 50-100
mg once daily x 3 months,
avoided in pregnant and
chilren; Erythromycin and
Azithromycin as alternatives)
• If the lesion persists after four
weeks of medical therapy, it
may be incised and drained
• Rarely, injected with steroids
Advise: • warm compresses applied
for 15 minutes four times a
day
• eyelid massage or lid scrubs
SUBCONJUNCTIVAL
HEMORRHAGE
Adequate oral fluid intake
Labs: •
Labs: • none
Rx: •• workup for bleeding
disorders if with recurrent
Advise: • hemorrhages
• International Normalized
Ratio, if the patient is taking
warfarin
Rx: • blood reabsorption over a few
weeks, and no treatment is
needed
• Warm compresses and
ophthalmic lubricants (e.g.,
hydroxypropyl cellulose,
methylcellulose, artificial tears)
may relieve symptoms
Advise: • Referral to ophthalmology, If
with corneal involvement or
penetrating injury
DERMATOLOGY
IMPETIGO


• Antibiotics: First Gen Ceph
(Cefalexin) , Co-amoxiclav
• Mupirocin ointment, lesions
and both nostrils
Advise: • Daily Skin Care, Regular
Bathing
FOLLICULITIS/ FURUNCLE/
CARBUNCLE

• Antibiotics: First Gen Ceph
(Cefalexin) , Cloxacillin,
Co-amoxiclav, Erythromycin
• Mupirocin ointment
Bathing
• Warm compress
• I and D if warranted (consent
should be secured)
CELLULITIS

Labs: • CBC with PC , FBS
• X-ray
• Antibiotics: Clindamycin,
Cotrimoxazole, Co-amoxiclav
Bathing
• Warm compress
• If no improvement of
symptoms after 3 days or if
there is worsening of
symptoms- Refer to Hospital
URTICARIA
P> Diet: Hypoallergenic Diet

Labs: • Optional: CBC with PC, ESR/CRP,
liver enzymes, TFT (only for if
requiring confirming other
underlying conditions, chronic
urticaria, patient/parental
concern)
Rx: • Antihistamine (2nd gen are safe
and effective but not 1st line for
severe allergic reactions)
• Control: Antihistamines forested
2-4x normal dose
• Chronic: With or without 1st gen
or LTRA
• Steroids (for controlling flare ups)
Advise: • Avoid allergens/triggers
• Avoid ASA, NSAIDs, alcohol
• Avoid scratching, tight fitting
clothes
• Mild soap
• Apply hypoallergenic lotion
• Advised consult to allergologist
for skin prick test
IRRITANT/ALLERGIC CONTACT
DERMATITIS
Labs: • Patch testing, CBC pc (optional)
• Topical Steroids
Advise: • Use soap substitute
• Avoid irritants
• Avoid scratching
• Apply afterwork creams
• Gloves as mainstay of
protection
breathing, edema, abdominal
pain, vomiting, dizziness, loss
of consciousness- Refer to
Hospital
HYPERSENSITIVITY REACTION

Labs: • Optional: CBC with PC
• Steroids
Advise: • Mild soap
• Avoid
allergens/triggers/inciting
agents
• Avoid scratching
breathing, edema, abdominal
pain, vomiting, dizziness, loss
of consciousness- Refer to
Hospital
ATOPIC DERMATITIS
P> Diet: Hypoallergenic diet

Labs: • CBC w/ PC (optional)
Rx: • Topical corticosteroids

• (Desonide or Hydrocortisone)
• Antimicrobial ointment
(Mupircon)(for secondary
bacterial infection)
• Anthistamine (Cetirizine,
Hydroxyzine)
Advise: • Use mild soap
• Use emollients (Cetaphil lotion)
BID-TID (100-200 mg/week
children, 200-300g/week
adults)
• Avoid allergens
• Avoid skin injuries
• Avoid scratching skin
SEBORRHEIC DERMATITIS

Labs: • KOH Test
Rx: • Scalp/Hairy Areas:

Mild: Ketoconazole shampoo/
Selenium sulfide Shampoo
Moderate-severe: Ketoconazole
shampoo+ Hydrocrtisone 1%
ointment, OD for 4 weeks
• Non-Hairy Areas:
• Mild: Ketoconazole 2% cream,
BID x 4 weeks
• Moderate-severe: Ketoconazole
2% cream+ hydrocortisone 1%
cream, BID for 1-2 weeks

Bathing
• Use of mild soap and
hypoallergenic cosmetic
products
TINEA CAPITIS

Labs: • KOH Test
Rx: • Ketoconazole 2% cream

twice/week
• Selenium sulfide 1% shampoo
Advise: • Regular Bathing
• Avoid sharing of hairbrushes
TINEA CORPORIS

Adequate Fluid Intake
Labs: • KOH
Rx: • Topical Antifungals x 2 weeks: azoles

(econazole, ketoconazole,
clotrimazole, miconazole, oxiconazole,
sulconazole, sertaconazole);
Allylamines (naftifine, terbinafine);
Ciclopirox olamine
• Terbinafine 250 mg OD x 2 weeks
• Itraconazole 200 mg OD x 1 week
• Fluconazole 150 to 200 mg once
weekly for 2-4weeks
• Griseofulvin microsize 500 to 1000
mg OD or griseofulvin ultramicrosize
375 to 500 mg OD for 2-4 weeks
Advise: • Avoid close contact between

infected and noninfected
individuals and to stop the
sharing of fomites (eg,
towels, hats, clothing)
• Wear loose-fitting clothing
made of cotton or synthetic
materials
PTYRIASIS VERSICOLOR
Diet: Regular diet

P> Adequate Fluid Intake
Labs: • Wood’s lamp (4 or 5 inches from
skin; the affected skin appears
yellowish green)
Rx: • Topicals: selenium sulfide
(shampoo); Anti-fungal cream or
ointment containing miconazole,
clotrimazole, terbinafine,
ketoconazole, or pyrithione zinc
(applied thinly 2x/day x 2 weeks)
• Medicated cleanser: once or twice a
month, especially during warm and
humid periods, year round
• May give Oral antifungals if there is
large coverage
Advise: • Wash and dry the affected skin
• Shampoo: leave it on your scalp
for 5-10 min before rinsing
• Stop using skin care products that
are oily
• Wear loose clothes
• Use of Sunscreen
• Do not use a tanning bed or sun
lamp
SCABIES

Labs: • Optional CBC
Rx: • Adults, pregnancy, lactating

women, children: 2 applications of
Permethrin 5% for 8-12 hours at
one week apart
• Infants <2 months: Sulphur 6% in
petroleum in ointment base for 3
days
• If with secondary bacterial
infection: Antibiotics
• For itching: Antihistamine,
corticosteroid (0.5mg/kg) and
emollients
Advise: • Treat contacts: asymptomatic = 1
treatment, symptomatic = 2
treatments
• Treat fomites: laundered using a
hot wash cycle (>50°C) or hot
tumble dried to kill the mites OR
place them in a plastic bag and
leave them for 72 hours before
airing and reusing
• may return to school or work 24
hours after the first treatment
GASTROENTEROLOGY
DYSPEPSIA
P> Diet: Low Fat Diet,

Labs: • Optional: CBC, UA, WAB UTZ,
12 L ECG
Rx: • First line: full-dose PPIs for 2-4
weeks
• Second line: H2- receptor
antagonists (Ranitidine) and
Prokinetic agents
(Domperidone)
• Over the counter antacids or H2
blockers may be effective for
some patient with mild or
infrequent symptoms
Advise: • Lifestyle advice: healthy
eating, weight reduction and
smoking cessation
• Avoid: alcohol, coffee,
chocolate, fatty foods
• Head raised in bed
• If empiric treatment or trial
of a second drug fails,
proceed with Endoscopy and
H. Pylori testing
GASTROESOPHAGEAL REFLUX
DISEASE
P> Diet: Avoid: tomato products, citrus
products, greasy food, chocolate,
coffee, softdrinks, sour food
Labs: • WAB UTZ (optional)
• 12 L ECG
Rx: • PPI (DOC)
• Optional: Domperidone 10 mg
TID, AlMgOH3, Gaviscon
Advise: • Eat small meals throughout
the day
• Avoid carrying heavy objects
• Elevate Head at bedtime
• Avoid eating or drinking too
much at least 3 hours before
lying down
• Avoid smoking and drinking
alcohol
ACUTE GASTROENTERITIS (Mild)
P> Diet: BRAT Diet

Labs: • Optional: FA, CBC, UA,
Electrolytes
Rx: • ORS
• Probiotics
• Zinc
• Optional: Domperidone,
Dicycloverine, HNBB, Hidrasec
• If Infectious: Cefalexin,
Cotrimoxazole, Metronidazole
Advise: • Avoid drinking Gatorade
• Avoid giving Anti-diarrheal
medications
• If with moderate to severe
dehydration- refer to hospital
FUNCTIONAL CONSTIPATION
P> Diet: High Fiber Diet

Labs: • None
Rx: • Lactulose 1-3 ml/kg/day PO in

divided doses and glycerin
suppositories may be used
• Psyllium fiber
• Laxatives: (Bisacody)
Advise: • Chew food
• Watch out for: abdominal
distention and pain,
vomiting, anorexia
HEPATITIS A

Labs: • Hepatitis Profile (HAV IgM,
IgG)
• CBC c PC, PT. aPTT, AST, ALT
• Optional: LGBP ultrasound
Rx: • Supportive treatment
• Vaccination: VAQTA 50 U x 2
doses, with the second dose
given after 6-18 month OR
HAVRIX 1,440 (EL.U.) x 2 doses,
with the second dose given
after 6-12 months
• Post-exposure prophylaxis
vaccination: 1 dose of the
vaccine for 12 mos-40 yrs
• 1 dose IgG for > 40 yrs
Advise • Frequent handwashing

• Safe food preparation
• Avoid drinking alcoholic
beverages
• Avoid taking unprescribed
medications
AMOEBIASIS
P> Diet: Avoid oily food

Labs: • CBC c PC
• Fecalysis
• Optional: Serologic testing,
LGBP ultrasound
Rx: • Adults: Metronidazole TID x 10
days
• Children: Metronidazole 7-10
TID (30-50 mkday)
Advise: • Frequent handwashing
• Personal hygiene
• Avoid food preparation
• Educate about the risk of
sexual practices that permit
fecal-oral contact
• Educate about condom use
for safer sex.
ASCARIASIS

• Fecalysis
• Optional: CXR
Rx: • Albendazole 400 mg OD
• Mebendazole 100 mg BID x 3
days or Mebendazole 500 mg
OD
• Ivermectin 150-200 mcg OD
• Optional Antihistamine
Advise: • Frequent hand washing
NAIL
ENTEROBIASIS

Labs: • Tape Method
• Optional: CBC c PC, Fecalysis
Rx: • Mebendazole 500 mg OD;
repeat after 2 weeks
• Topical antipruritic ointment or
cream
Advise: • Frequent handwashing
• Daily bathing
• Cut fingernails regularly and
avoid biting the nails
• Avoid scratching around the
anus
• Frequent changing of
underclothes and bed linens
first thing in the morning
• Deworming the whole
household
HEMORRHOIDS
P> Diet: High Fiber diet,

Labs: • Optional: CBCw/PC, FA, FOBT
• Proctosigmoidoscopy
Rx: • Hot sitz bath bid-tid
• Stool softener: Docusate Na
50-300 mg PO OD
• Topical anesthetic: Lidocaine
ointment 5% tid-qid
• Faktu oint/supp: bid-tid
following evacuation of bowel
• Hesperidin + Diosmin: 6
tablets daily for the 1st 4 days
followed by 4 tablets daily for
the next 3 days
Advise: • Avoid spicy and fat-rich foods,
as well as NSAIDs
• Advise surgical intervention for
patients who have Grade III-IV
hemorrhoids w/ failed medical
tx
CHOLELITHIASIS
P> Diet: Low fat diet

Labs: • Whole abdominal ultrasound
• CBC, Serum amylase and lipase
(optional,when considering
ascending cholangitis or acute
cholycystitis)
• Serum alkaline phophatase,
liver trans aminases and
bilirubin levels (optional, when
considering CBD Stone
obstruction)
Rx: • Nonsurgical management
include pain relief with
analgesic
Advise: • Avoid fatty foods
ACUTE APPENDICITIS
P> Diet: NPO temporarily

Labs: • CBC
• For equivocal appendicitis:
• in pediatric age group
Abdominal ultrasound
Abdominal CT scan
• For adult age group
Abdominal CT scan
Abdominal ultrasound
Rx: • None
Advise: • To hospital of choice

• For surgical reassessment for
possible appendectomy
ACUTE PANCREATITIS
P> Diet: NPO temporarily

Labs: • Whole abdominal ultrasound
• Serum amylase, serum lipase
Rx: •
Advise: • To hospital of choice, for

evaluation, monitoring and
hydration
CARDIOMETABOLIC
HYPERTENSION
P> Diet: DASH Diet

Labs: • CBC, UA, FBS, Lipid profile,
AST/ALT, BUN, Crea, BUA,
Na, K
• 12 L ECG
• CXR (optional)
Rx: • Anti-Hypertensive Medications
(See: JNC 7 and 8)
Advise: • BP monitoring
• Lifestyle modifications
• Exercise
• Reduce Weight
• Avoid smoking, drinking
alcohol
DIABETES MELLITUS
P> Diet: DM Diet

Labs: • FBS, RBS
• HbA1c
• OGTT
• Lipid Profile
• Optional: CBC, UA, LFTs, Crea
Rx: • Anti-DM Medications (See
AACE/ACE executive summary
2019
Advise: • CBG monitoring
• Lifestyle modifications
• Exercise
• Reduce Weight
alcohol
• Vaccination
PREDIABETES
PREDIABETES
P> Diet: DM Diet

Labs: • OGTT or HbA1c; quarterly
monitoring of lipid profile,
Liver enzymes, Creatinine,
HbA1c
Rx: • Metformin (Glucophage XR)
500mg ODHS
Advise: • Lifestyle modifications
• Exercise
• Reduce Weight
alcohol
• Vaccination
DYSLIPIDEMIA
P> Diet: Low Fat, Low cholesterol Diet

High Fiber Diet
Labs: • Lipid Profile
• LFTs
• Optional: FBS, Crea
Rx: • Statins (SEE: Philippine CPG in
Dyslipidemia 2015)
• Use of Fenofobrate if with
Hypertriglyceridemia only
Advise: • Lifestyle modifications
• Exercise
• Reduce Weight
alcohol
ANGINA
P> Diet: Low salt, low fat diet

Labs: •12-L ECG
•Troponin T or I
•Fasting lipid profile
•FBS/OGTT/HbA1c
•Creatinine
•CBC
•SGPT, SGOT
•TSH (if clinically indicated)
•2D-echocardiography
•Stress imaging (not during active
angina)
Do PTP to determine additional
evaluations to request.
ANGINA
P> Rx: Acute Care:

•Aspirin NEC tablet, 160 to 320
mg chewed and swallowed
● Aspirin low-dose (80 to

160 mg/day) or
● Clopidogrel (75 mg/day)
● Statins
● Beta blockers post-MI
● ACEIs or ARBs
● Long-acting Nitrates
Advise: ● Smoking cessation

● Periodic monitoring of
co-morbids (hypertension,
dyslipidemia, DM).
● Aerobic exercise, 30 mins,
3-4x/week
● Maintain BMI <25 kg/m2
● Refer to cardiologist for
definitive treatment of
coronary disease.
NSTEMI
P> Diet: NPO until stable
Labs: ● 12-L ECG (within 10 mins

of presentation)
● Troponin I and/or T
Rx: ● Aspirin NEC tablet

(160-320 mg), chewed
and swallowed
● NTG
Advise: ● Refer to hospital for
observation of
progression.
STEMI

Labs: ● 12-L ECG (within 10 mins
of presentation)
● Troponin I and/or T
Rx: ● Aspirin NEC tablet
160-320 mg chewed and
swallowed.
● NTG
Advise: ● Facilitate immediate

(within 1 hour) transfer to
tertiary hospital with PCI
capabilities.
Stage C HF with Preserved EF
P> Diet: Sodium-restricted diet (1500

mg/d or <3 g/d)
Limit fluid intake (1.5-2 L/d)
Labs: ● BNP
● CBC/PC
● UA,
● BUN, Crea
● Glucose
● Lipid profile
● AST/ALT
● TSH
● 12L ECG
● Serum electrolytes
● 2D echocardiogram
● CXR
Rx: ● ACE or ARB
● Beta Blockers
● Omega-3 PUFA 1 g/day
(850 mg to 882 mg
EPA/DHA) or matching
placebo
● Statins
(See appropriate guidelines for
for management of
co-morbidities)
Stage C HF with Preserved EF
P> Advise: ● Periodic monitoring of

co-morbidities
(hypertension, obesity,
DM, dyslipidemia, see
appropriate guidelines)
● Smoking cessation
● Optimal blood pressure
(BP) of <130/80 mmHg
● Cardiac rehabilitation
● Refer to Cardiologist for
further evaluation and
management.
CHRONIC VENOUS
INSUFFICIENCY
P> Diet: Regular Diet, NDCF
Labs: • Duplex Ultrasonography
• Ankle-brachial index
• Ancillary for specific
co-morbids:
FBS
CBC/PC
BUN, Creatinine
Rx: • Compression Stockings,
pressure gradient 30-44 mmHg
(contraindicated in
concomitant PAD)
• Topical emollients or steroids
for stasis dermatitis
Advise: • Leg elevation.
• Daily wound care if with
stasis dermatitis
• Discontinue edema-causing
medications; shift to
alternative medications.
• Refer to specialist care for
definitive treatment (e.g.,
sclerotherapy, venoablation)
HYPERTHYROIDISM

Labs: • TSH, T3, FT4, Thyroid ultrasound
• Baseline CBC, liver profile with
bilirubin and transaminases (If
baseline absolute neutrophil count
<1000/mm^3 or liver transaminase
enzyme levels >5x upper limit of
normal reconsider initiation of
antithyroid drugs)
• Monitoring: free T4, total T3 every 2-6
weeks after initial start of therapy,
then biochemical testing repeat in 4-6
weeks
• If euthyroid, decrease med by 30-50%,
repeat 4-6 weeks. If euthyroid with
minimum meds, repeat at 2-3 months.
If taking meds for >18 months, repeat
at 6 months
• Measure WBC during febrile illness or
if with pharyngitis
• Measure LFT if with symptoms of
pruritic rash, jaundice, light-colored
stool, dark urine, joint pain, abdominal
pain or bloating, anorexia, nausea or
fatigue
HYPERTHYROIDISM
P> Rx: • Methimazole (Initial 10-30mg

OD, maintenance 5-10mg OD) -
first choice due to decreased
side effects and OD
administration: 5-10mg if free
T4 is 1-1.5x the upper limit of
normal, 10-20mg if free T4
1.5-2x , 30-40mg if free T4
2-3x, PTU (50-150mg 3x/day)
if in first trimester of
pregnancy, treatment of
thyroid storm, minor reactions
to Methimazole
• Beta-adrenergic blockade
(Propanolol 10-20 mg BID) for
symptomatic thyrotoxicosis,
elderly patients, >90HR,
coexistent cardiovascular
disease
Advise: • Refer to hospital if with
thyroid storm
(Burchwartofsky point scale of
>=45)
HYPOTHYROIDISM

Labs: • TSH, T4, T3, Thyroid ultrasound
• TSH assessment 4–6 weeks after
any dosage change
Rx: • Levothyroxine 25,50,100,150mcg
(take 60 minutes before breakfast
or at bedtime (3 or more hours
after the evening meal) for
optimal, consistent absorption
• For young and healthy patients:
full replacement doses (1.6mcg/kg
ideal body weight)
• For elderly >65yo or with CV risk:
start with lowest dose and inc by
25mcg every 4 to 6 weeks until
normal TSH
Advise: • Separate intake with calcium
carbonate and ferrous sulfate
• Avoid use of dietary supplements,
nutraceuticals, or other
over-the-counter products either
in euthyroid individuals or as a
means of treating hypothyroidism
• Caution against the use of
pharmacologic doses of iodine
HYPOKALEMIA
P> Diet: Potassium-rich foods (>12.5

meq/3.5 ounces; e.g., Banana 1
meq per inch)
Increase fluid intake.
Labs: ● Serum K, Mg, Bicarbonate
● CBG/RBS/FBS
● 12-L ECG
Rx: Non-diagnostic ECG changes
● Potassium chloride PO
20-80 mEq/d in divided
doses
Advise: ● Discontinue diuretics (if
applicable)
● Increase intake of dietary
potassium
● Re-assess serum K after
oral treatment.
● Advice BP control
● Admit to hospital if with
cardiac abnormalities,
unstable patient or other
electrolyte derangements.
HYPERKALEMIA
P> Diet: Restriction of food and beverages

rich in potassium
Labs: • Serum K+
• Serum electrolytes
• ECG
• CBG/RBS
Rx: Acute Care if with ECG changes:
● Regular insulin 10 units IV
plus 50 ml D50 (if
available) or
● Albuterol/Salbutamol 20
mg, nebulized
For non-emergent lowering::
● Kayexalate (sodium
polystyrene sulfate) 15 g
orally in 50-100 ml of
20% Sorbitol; May be
repeated every 3-4 hours
up to 4 doses/day
● Furosemide 20-40 mg
orally daily to twice daily
(BP precaution)
HYPERKALEMIA
P> Advise: • Eliminate K supplements and

K sparing diuretics
• Give Loop diuretics to
promote K excretion
• Advice BP control
• Refer to higher level facility
for emergent monitored
correction.
GENITOURINARY
Urinary Tract Infection
(AUC, Acute Pyelonephritis)
Labs: • Urinalysis, CBC
• Urine Culture, KUB UTZ
(recurrent, complicated UTI)
• Antibiotics:
Nitofurantoin
Ciprofloxacin
Co-amoxiclav
Cephalosphorins
Advise: • Cranberry juice (optional)
• Vulvar Hygiene
• Safe sex
Urinary Tract Infection in children

Labs: • Urinalysis
• KUB UTZ (recurrent,
complicated UTI)
• Antibiotics:
Co-amoxiclav
Cephalosphorins
Co-trimoxazole
Advise: • Cranberry juice (optional)
• Regularly check diapers in
infants and toddlers.
• Prevent constipation
Urinary Tract Infection in children
LUTS in men
P> Diet: Regular Diet. Avoid artificial

sweeteners.
Avoid caffeinated, carbonated
and alcoholic beverages.
Labs: • Urinalysis, CBC
• Urine Culture, KUB UTZ
(recurrent, complicated UTI)
Rx: • Alpha-blockers
• 5 alpha reductase inhibitors
• Anticholinergics
Advise: • Urethral milking

• Bladder training (pelvic floor
exercises)
• May use pads or sheaths
STI (Gonococcal/ Chlamydial)

Labs: • CBC with PC, UA, Discharge
GS/CS, HIV screening,
VDRL/RPR, Hep B
• Pap smear
Rx: • Ceftriaxone 250 mg IM single
dose plus Azithromycin 1 g PO
SD
• Alternatives:
• Cefixime 400 mg PO SD plus 1
g azithromycin SD
• If proved purely Chlamydial:

Azithromycin 1 g PO SD or
Doxycycline 100mg BID x 7
days
Advise: • Safe sex, condom use
• Post coital hygiene
Bacterial Vaginosis

GS/CS,
• HIV screening, VDRL/RPR,
Hep B (optional)
• Pap smear
Rx: • Metronidazole 500 mg PO BID x
7 days or
• Metronidazole gel 0.75 5 g
intravaginally OD x 5 days or
Advise: • Vulvar hygiene
• Avoid using panty liner every
day
• Avoid using soap in washing
• Advise use of feminine wash
2x/week only
Trichomoniasis

GS/CS,
• HIV screening, VDRL/RPR,
Hep B (optional)
• Pap smear
Rx: • Metronidazole 2g PO SD or
• Metronidazole 2 mg PO BID x 7
days
Advise: • Safe sex, condom use
• Post coital hygiene
VAGINAL CANDIDIASIS

Labs: • Wet mount with KOH
preparation or papsmear
• FBS
Rx: • Uncomplicated: topical
antifungal agents (Clotrimazole,
Miconazole, Tioconazole) OR
alternative: single 150-mg oral
dose of fluconazole
• Severe: fluconazole, 150 mg,
given every 72 hours for a total
of 2 or 3 doses
• If pregnant: topical azole
therapies, applied for 7 days
• Recurring: 10–14 days of
induction therapy with a topical
agent or oral fluconazole,
followed by fluconazole, 150
mg weekly for 6 months
Advise: • No need for treatment of
sexual partners
• Good perineal hygiene
UROLITHIASIS

Low Salt Diet
Labs: • Urinalysis, KUB UTZ
• CBC, Creatinine, calcium,
Sodium, potassium, blood
uric acid, C-reactive protein
(optional)
Rx: • NSAIDs
• Rowatinex cap TID x 12 weeks
(stone size 4-5mm)
• Tamsulosin 0.4 mg/tab, OD (BP
monitoring)
• Potassium Citrate TID
• Sambong Forte TID
Advise: • Avoid excessive
consumption of vitamin
supplements
• Adequate physical activity
• For stone >10mm (Refer to
Urologist)
PCOS (Amenorrhea)

Adequate fluid intake
Labs: • CBC c PC
• FBS
• Lipid profile
• AST, ALT, BUN, crea
• TV UTZ
Rx: • Induce Widthrawal bleeding:
Provera or Duphaston 10 mg
OD for 10 days
• Then if with bleeding start, d/c
progesterone. To start
Cyproterone acetate 2 mg,
ethinyl estradiol 35 mcg
(Althea, Diane ) 21 day cycle
Advise: • Lifestyle modification
• 150 minutes of exercise per
week over a 24 week period
• Advised annual papsmear,
mammogram to rule out
breast or endometrial ca
MUSCULOSKELETAL
OSTEOARTHRITIS

Labs: • Xray, BUA
Non- Non-pharmacologic
Pharma ● Use of local heat/cold
● Exercise
- Local muscle strengthening
- Aerobic fitness
● Weight loss
● Electrotherapy
● Aids and Devices
(footwear/brace)
● Arthroscopic lavage
- knee arthritis with a clear
history of mechanical locking
Pharma • Analgesics
First line: Paracetamol and/or
topical NSAIDs
- if first line provide insufficient pain
relief- substitute or add either oral
NSAIDs, COX2 inhibitors or opioids
• Intra-articular CS injection-
adjunct to core treatments for the
relief of moderate to severe pain
GOUTY ARTHRITIS
P> Diet: Low Purine Diet

Labs: • BUA, Crea, UA
• X-ray
Rx: • Pain management: (Acute
Attack): Colchicine. NSAIDs,
steroids
• Intercritical phase: Allopurinol,
Febuxostat
Advise: • Avoid drinking alcohol
LOW BACK PAIN SYNDROME

Labs: • Lumbosacral X-ray
• Optional: UA, KUB UTZ
Rx: • Pain medications: Paracetamol,
NSAIDs
• Muscle Relaxant: Eperisone
Advise: • Proper posture
• Reduce weight
• Massage
• Warm Compress
• Ergonomic chair
MUSCULOSKELETAL STRAIN

Labs: • Optional: X-ray

NSAIDs
Advise: • Reduce weight
• Massage
• Warm Compress
COSTOCHONDRITIS
P> Diet: Regular Diet, NDCF

Labs: • 12 L ECG (Optional)

NSAIDs
Advise: • Avoid carrying heavy objects
• Apply warm compress
• Avoid strenuous activities
• Massage
CARPAL TUNNEL SYNDROME

Labs: • UTZ and electrodiagnostic
studies (Optional)
NSAIDs
• Oral prednisone at a dosage of 20
mg daily for 10 to 14 days
• NSAIDs, diuretics, and vitamin B6
are not effective therapies
• Local corticosteroid injection is
effective for more than one month
in patients with mild to moderate
carpal tunnel syndrome and delays
the need for surgery at one year.
• CONSERVATIVE TREATMENT (mild
to moderate): Splinting,
corticosteroids, therapeutic
ultrasound, physical therapy and
yoga.
Advise • Use of immobilization
: (brace/splint/orthosis) should
improve patient reported
outcomes.
NEUROLOGY
TENSION HEADACHE

Labs: None
CBC (optional)
Rx: • Paracetamol + Orphenadrine
TID PRN pain
• NSAIDs
Advise: • Regular exercise
• Avoid triggers
• Massage
• Adequate Sleep
MIGRAINE HEADACHE

Labs: • None
Rx: • Ibuprofen 400-600 mg up to 4

doses in 24 hrs
• Naproxen sodium 750-825 mg
up to 2 doses in 24 hours
• Metoclopramide 10 mg
• Domperidone 20 mg
• Atenolol 25-100 mg BID
(prophylaxis)
• Amitryptyline 10-150 mg OD
(when co-existing w/ TTH)
Advise: • Avoid triggers: bright lights and
loud noise, alcoholic drinks,
cheeses, strenuous exercise,
skipping meals
SYNCOPE

Labs: •CBC/PC (optional)
•ECG
•Carotid sinus massage (>40 years
old; avoid in TIA or stroke in the
past 3 months or if with carotid
bruit)
•Orthostatic challenge (or Tilt test
if possible)
•Holter monitoring – if
cardiovascular syncope
Rx: •None needed for reflex syncope
Advise: •Avoid triggers.

•Reassure patient of benign nature
of Reflex syncope.
•Tilt education in patients with
orthostatic syncope.
•Cardiological referral for further
evaluation if suspected to be
cardiac syncope
BENIGN FEBRILE CONVULSION

Labs: Ancillary in determining fever
source:
● CBC/PC
● Fecalysis
● Urinalysis
● Chest X-ray
Rx: Acute Care (if with active seizures)
● Midazolam (0.3 mg/kg),
buccal or
● Diazepam, 0.3-0.5 mg/kg
rectal
● Paracetamol
Advise: ● Temperature monitoring
Q1.
● Tepid sponge bath.
● Educate on recurrence and
epilepsy risk.
● Admit to hospital if with
meningeal signs.
● Specialist referral if with
high recurrence or epilepsy
risk.
SEIZURE

Labs: ● CBC/PC
● RBS
● BUN, Creatinine
● Serum electrolytes
● EEG
● CT-scan or MRI - for focal
seizures
● Chest X-ray (optional)
● Urinalysis (optional)
● Lumbar puncture - (for
those with meningeal
signs)
SEIZURE
P> Rx: ● Treat underlying co-morbid

trigger.
● Anti-epileptic drug - choice
is based on seizure-type,
patient characteristics and
drug safety profile
● Monotherapy - mainstay of
treatment
Tonic-clonic - CBZ, PHT, PB or VPA
Myoclonic - VPA, CZP
Absence - VPA, Ethosuximide
Atonic - VPA
Tonic - VPA
Focal - PHT, PB, CBZ, VPA or GBP
Advise: ● Admit to hospital if with
meningeal signs.
● Patient education on
recurrence risk, safety
issues (driving, first aid,
etc.)
● Specialist referral based on
co-morbid trigger.
● Refer to neurologist for
further evaluation and
management.
TRANSIENT ISCHEMIC ATTACK
P> Diet: DASH Diet

Labs: •CBG/RBS/FBS
•CBC
•PT, aPTT
•12-L ECG
•Plain cranial CT scan
● Lipid profile
● BUN, Creatinine
TRANSIENT ISCHEMIC ATTACK
P> Rx: If BP still elevated (>/=160/100)

•Short acting oral
antihypertensive (if MAP >130,
drop should be not >15% of
initial)
•Aspirin 160-320 mg/tab (if
cardioembolism not suspected)
Maintenance
•Anti-hypertensive medications
(See JNC 7 and 8 guidelines)
•Anti-diabetic agents
•Statins
Advise: •Follow up after 24 hours.
•Hospital admission if TIA within
48 hours, crescendo-type, ABCD2
score>3 (Use ABCD2 score to
determine stroke risk)
•Advise neurological consultation.
stroke
STROKE
Labs: •CBG/RBS
•12-L ECG
To be done at receiving
institution:
•CBC/PC
•PT, aPTT
•Serum Na+, K+
•Plain cranial CT scan or MRI-DWI
Rx: Acute Care
•Supplemental O2 – maintain
O2sat >94%
•Short-acting oral
antihypertensive medication if
able to swallow (avoid
precipitous drop in
BP-MAP>15% of initial)
Advise: •Facilitate immediate transfer to
tertiary institution preferably
with stroke unit..
SYNCOPE

Labs: •12-L ECG
• Orthostatic challenge
•Holter monitoring – if
cardiovascular syncope
•CBC/PC (optional)
Rx: •Treat underlying cause.
Advise: •Avoid triggers.

•Refer to cardiologist if cardiac
syncope or admit to hospital if
with evidence of heart failure or
structural heart disease.
HEMATOLOGY
G6PD DEFICIENCY
P> Diet: Increase Fluid Intake

Avoid sulfite-containing foods
and medications (see CPG for
complete listing)
Labs: • NBS
• CBC with PC
• PBS
• Reticulocyte count
• Bilirubin count
Rx: • NONE
Advise: • ANTICIPATORY
• WOF: signs of hemolysis-
dark urine, jaundice, heart
murmur, increased heart
rate, enlarged spleen,
enlarged liver
G6PD DEFICIENCY
NEMIA
IRON DEFICIENCY ANEMIA

Increase fluid intake
Labs: • CBC with PC,
• PBS, Serum Ferritin, TIBC,
Transferrin, BMA (Optional)
• Repeat CBC after 1 month
(pedia), 3 months (adults)
Rx: • Ferrous sulfate 325 mg/tab
TID for 3 months (adults)
• Ferrous sulfate (3 mg/kg/day)
Advise: • Increase intake of foods high in
iron
SURGICAL
LACERATION

Labs: CBC, X-ray (Optional)
Rx: • Antibiotics: Cloxacillin,

Co-amoxiclav, Cephalosporins,
Clindamycin,
• Pain Medications: Paracetamol,
NSAIDs
• TT/ATS
Procedure: • Secure Consent
• Wound Cleaning, suturing and
dressing
Advise: • Daily Wound Care
• Apply Warm Compress
• Bathing done 24 hours after
procedure
• TCB after 1 week for ROS
ABRASION

Labs: CBC, X-ray (Optional)
Rx: • Pain Medications: Paracetamol,

NSAIDs
• TT/ATS
Procedure: • Wound Cleaning and dressing
Advise: • Trauma precaution

• Daily Wound Care
CIRCUMCISION

Labs: None
Rx: • Antibiotics: Cloxacillin,

Co-amoxiclav, Cephalosporins,
Clindamycin,
• Pain Medications: Paracetamol,
NSAIDs
• Mupirocin ointment (optional)
Procedure: • Secure Consent
• Cleaning, dorsal slit incision,
suturing and dressing
Advise: • Daily Wound Care
• Apply Warm Compress
• Bathing done 24 hours after
procedure
• Avoid swimming
• Avoid activities like
basketball, running for 2
weeks
• TCB after 3 days
BURN
Labs: CBC with PC (Optional)
Rx: • Anti-tetanus Ig, Tetanus toxoid

(if > 1st degree burn)
• Silver Sulfadiazine BID x 7 days
• Pain Medications: Narcotic
analgesics, NSAIDS
• Oral Antibiotics if warranted
• Cetirizine for postburn pruritus
• Pregabalin for postburn
neuropathic pain
Procedure • Sterile water to remove debris
• Apply wet to dry dressing
• Absorptive dressings (Duoderm)
• Debridement if necessary (<6mm
bullae be left intact)
• No scrubbing with providing
iodine, chlorhexidine
Advise: • Close monitoring and follow up
• Trauma Precaution
• Daily wound care
• If severe Burn, worsening in
72hrs, signs of contractures -
Refer to Hospital

Pocket Guidelines FINAL

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POCKET

P> Diet: Regular Diet, No dark-colored

P> Diet: Regular Diet

Rx: • Paracetamol Q4 PRN fever

P> Diet: Regular Diet

P> Diet: Soft Diet, Avoid sour and spicy

Rx: • Paracetamol Q4 PRN fever

P> Diet: Regular Diet, Hypoallergenic diet

Rx: • Paracetamol Q4 PRN fever

P> Diet: Regular Diet

Rx: • Paracetamol Q4 PRN fever

P> Diet: Regular Diet

Rx: • Paracetamol Q4 PRN fever

P> Diet: Breast Feeding/Milk feeding with

Rx: • Paracetamol Q4 PRN fever

P> Diet: Regular Diet, Hypoallergenic diet

Rx: • Paracetamol/ NSAIDS for Acute

P> Diet: Soft and cold foods

P> Diet: Soft, cold foods

P> Diet: Regular Diet

Rx: • Mild disease: Clotrimazole

P> Diet: Regular Diet

Rx: • Antibiotics: Amoxicillin,

P> Diet: Regular Diet

Advise: • Watch out for: difficulty of

P> Diet: Regular Diet

Rx: ● Antibiotic (if needed):

P> Regular Diet, NPO if with DOB

P> Diet: Regular to Soft Diet

P> Diet: Regular diet as tolerated

P> Diet: Regular Diet, Hypoallergenic Diet

Rx: • Intranasal corticosteroids

P> Diet: Regular diet

P> Diet: Regular Diet

P> Diet: Diet as tolerated

Rx: • Cerumenolytic agent: Na

P> Diet: Regular Diet

Rx: • Paracetamol or NSAIDs for pain

P> Diet: Diet Fluid intake

Rx: • Pain medications (Stage 1-2)

P> Diet: Regular Diet

P> Diet: Regular Diet

Rx: • Tobramycin e/s 1 ugtts TID to

P> Diet: Regular Diet

Rx: • Self Limiting

P> Diet: Regular Diet

P> Diet: Regular Diet

Rx: • Paracetamol Q4 PRN fever

P> Diet: Regular Diet

Rx: • Lid scrub with a “No Tears”

P> Diet: Regular Diet

Rx: • Conservative: Topical antibiotic

P> Diet: Regular Diet

Rx: • Paracetamol Q4 PRN fever

Rx: • Paracetamol Q4 PRN fever

P> Diet: Regular Diet

P> Diet: Hypoallergenic Diet

P> Diet: Hypoallergenic Diet

P> Diet: Hypoallergenic diet

Rx: • Topical corticosteroids

P> Diet: Regular Diet

Rx: • Scalp/Hairy Areas: