MEDICATION ERROR IN PEDIATRICS

WHILE USING COMBINATION DRUGS-

CASE PRESENTATION
ON ACUTE FEBRILE ILLNESS
WITH UPPER
RESPIRATORY TRACT INFECTION
By
TAMIL SELVAN S
FORTIS HOSPITALS
PATIENT NAME : Ms. I / 2 years /12 kg/female

D.O.A : 29/03/2023

HISTORY OF ALLERGY : No known allergies.

HISTORY OF IMMUNIZATION : Immunized for age.

BIRTH HISTORY : Full term LSCS.

OTHER HISTORIES : No significant past history and

past medication history
Current complaints :High grade intermittent fever since 6 days, subsides with anti-
pyretics, dull during inter febrile period,
Cold and dry cough since 6 days, no breathing difficulty and
no post tussive vomiting and
Poor oral intake.
Vitals : Conscious, oriented and febrile 101 F, BP 100/60 mm of hg,
PR 130/min, RR 40/min, SPO2 95% and dull appearance with
dehydration, with mild crepitations and mild wheeze.
Investigations : Hb 10.8, WBC 9.00, PLT 280 , ESR 10, SGPT 27,
CRP 38.9
DENGUE – ve,
X-Ray investigations of chest shows prominal
bronchovascular markers in both lung.
Opacification in perihilar region.
DAY 1 TREATMENT GIVEN :

INJ CEFTRIAXONE 600 mg 1–0–1

INJ PANTOPRAZOLE 12 mg 1–0 -0

INJ ONDANSETRON 2 mg SOS if vomiting

SYP IBUGESIC PLUS 6 ml SOS IF FEVER (MAX 1-1-1-1)

(IBUPROFEN 100 mg + PARACETAMOL 162.5 mg )

SYP MEFTAL 5 ml SOS if fever not subsides with ibugesic after 1 hour
DAY 2
• Fever spikes present.
• Cough present.
• To send blood for investigations, chest X Ray and sPO2 monitoring.
• Respiratory biofire human rhino virus and adeno virus detected.
These medications were added.
SYP OSELTAMIVIR 12 mg /ml 3 ml 1–0–1

SYP CHERICOF 3.5 ml 1–0-1

NEB ASTHALIN WITH OXYGEN with NS 0.5 ml every 2nd hourly

NEB BUDECORT WITH OXYGEN with NS 1 ml 1–0–1

NEB IPRAVENT WITH OXYGEN with NS 0.5 ml every 2nd hourly

NEB HYPERNEB (3%) WITH OXYGEN with NS 3 ml 1 - 0 – 1 WITHIN 30 minutes gap

DAY 3
• Fever spikes present.
• Cough present.
• Mild swelling in peri orbital region.
• Blood culture request were made
• To send blood for investigations, chest X Ray and sPO2 monitoring
and
These medications were added.
INJ AMIKACIN 180 mg 1 -0- 0
SYP MONTICOPE ( MONTELUKAST 4 mg + 5 ml 0–0–1
LEVOCETIRIZINE 2.5 mg)/ 5 ml
SYP CETIRIZINE 5 mg / 5 ml 2.5 ml 1–0-1
PHARMACIST INTERVENTION :
• Maximum daily dose of Levocetirizine is 1.25 mg/ Day and
dose was changed as syp monticope was changed to 2.5 ml.
• The monitoring needed for concomitant administration of
cetirizine and levocetirizine was explained.
DAY 4
• Fever spikes absent.
• Intercostal and sub costal retraction present
• Repeated chest X Ray at night.
• Intake improved.
• Cough reduced.
OTRIVIN PEDIATRIC NASAL DROPS 1 drop in each nostril 1 – 1 – 1
And MUCOMIX 0.7 ml was added with NEB ASTHALIN EVERY 2nd hourly
DAY 5
• Fever spikes absent.
• Cough reduced.
• Breathing normal.
• Oral intake better.
• Advice for physiotherapy was given.
• Same medications were continued.
DAY 6
• No fever spikes.
• Repeated chest X Ray at night.
• Oral intake is good.
• Cough reduced.
• Same medications were continued.
DAY 7
• Afebrile for 24 hours.
• Cough reduced.
• Breathing normal.
• Oral intake better.
• Same medications were continued.
Day 8 DISCHARGE MEDICATIONS
SYP ZOCEF 5 ml 1–0–1 for 5 days
SYP IBUGESIC PLUS 6 ml As needed if fever max 1-1-1-1
SYP MEFTAL PLUS 5 ml If fever not subsiding with ibugesic plus
after 1 hour
SYP CHERICOF 3.5 ml 1–0–1 To continue
SYP MONTICOPE 2.5 ml 0–0–1 for 5 days
NEB ASTHALIN WITH 0.5 ml every 4th hourly
NS
NEB BUDECORT WITH 1 ml 1–0–1
NS
NEB IPRAVENT WITH NS 0.5 ml every 4th hourly
NEB HYPERNEB WITH 3 ml 1-0–1 WITHIN 30 minutes gap
NS
OTRIVIN PEDIATRIC NASAL 1 DROP 1–1–1 IN EACH NOSTRIL
DROPS
THANK YOU