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close this bookEssential Drugs - Practical Guidelines (Médecins Sans Frontières)
View the document(introductory text...)
View the documentAcknowledgeements
View the documentPreface
View the documentPart one: drugs, infusions, vaccines
View the documentOral drugs
View the documentInjectable drugs
View the documentInfusion solutions and Electrolytes
View the documentVaccines and sera
View the documentDrugs for external use and Disinfectants
View the documentPart two
View the documentOrganization and management of a pharmacy
View the documentPreservation and quality of the drugs
View the documentPrescription, cost, compliance
View the documentUse of antibiotics in precarious situations
View the documentAntiseptics and disinfectants
View the documentThe New Emergency HeaIth Kit (WHO)
View the documentBibliography
View the documentPharmaco-therapeutical index WHO essential drug list (7th list, 1992)
View the documentAlphabetical index (with indicative prices)

Injectable drugs

Acetyl salicylate lysine
Adrenaline
Albuterol
Aminophylline
Amoxicillin
Ampicillin
Aspirin
Atropine sulphate
Benzathine penicillin G
= Benzathine benzyl penicillin
Benzyl penicillin = Penicillin G
Butylscopolamine = Butylhyoscine
Chloramphenicol
Chloramphenicol in oil
Chloroquine
Chlorphenamine = Chlorpheniramine
Chlorpromazine
Cloxacillin
Dexamethasone
Dexchlorpheniramine
Diazepam
Digoxin
Dihydralazine
Dipyrone*
Epinephrine
Ergometrine
Furosemide = Frusemide
Gentamicin
Glucose or dextrose (hypertonic)
Hydralazine
Hydrocortisone
Hydroxocobalamin
Hyoscine butylbromide
Ketamine
Levorenine
Lignocaine = Lidocaine
Lignocaine hyperbaric
= Lidocaine hyperbaric
Metamizol*
Methylergometrine
Metoclopramide
Noramidopyrine*
Oxytocin
Pentazocine
Pentobarbital
Phenobarbitone = Phenobarbital
Phytomenadione
Procaine penicillin = Procaine benzyl penicillin
Procaine benzyl penicillin + Benzyl penicillin = PPF
Potassium chloride
Promethazine
Quinine (salts)
Theophylline
Salbutamol
Sodium bicarbonate
Sodium chloride (hypertonic)
Streptomycin
Sulfadoxine + pyrimethamine*
Thiopentone = Thiopental
Vitamin B12
Vitamin K1

* The use of this drug is not advised.

ACETYL SALICYLATE LYSINE - "ASPIRIN" (Aspegic(R)...)

District hospital

Therapeutic action
Same as acetyl salicylic acid (aspirin):
- analgesic
- antipyretic
- anti-inflammatory
The action is fast, intense and prolonged (6 hours).

Indications
- Intense pain
- High fever

Preparation and route of drug administration
- Vial of 0.5 g of aspirin (0.1 g/ml, 5 ml) acetyl salicylate Iysine for deep IM injection, slow IV or infusion
- Vial of 1 g of aspirin (0.2 g/ml, 5 ml) acetyl salicylate Iysine for deep IM injection, slow IV or infusion

Dosage
- Children above 6 years: 10 to 25 mg/kg/d
· from 6 to 10 years
Vial of 0.5 g: 0.5 to 1 ml per injection, or 1/2 to 1 vial/d divided in 5 injections
· above 11 years
Vial of 0.5 g :1 to 2 ml per injection, or 1 to 2 vials/d divided in 5 injections

- Adult
0.5 to 1 g per injection, without giving more than 4 g/d divided in 4 injections (8 vials of 0.5 g or 4 vials of 1 g)

Duration: depending on clinical progress

Contra-indications, side-effects, precautions
- Do not administer to children under 6 years.
- Do not administer if gastro-duodenal ulcer, haemorrhage or risk of haemorrhaging.
- Do not administer for the treatment of gout.
- Use with care for asthmatic patients.
- Can cause allergic reactions, haemorrhage.
- Pregnancy: avoid, especially at the end of pregnancy
- Lactation: avoid

Remarks
- Do not use 1 g vials for children.
- Do not mix other drugs in the same syringe.
- Do not use solutions that are not clear or which contain crystals.
- Storage: keep below 30°C.

ADRENALINE = EPINEPHRINE = LEVORENINE

District hospital

Therapeutic action
- Sympathomimetic

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Anaphylactic shock
- Asthma
- Cardio-respiratory arrest
- Hypotension caused by local or regional anaesthesia (spinal anaesthesia)

Preparation and route of drug administration
- Ampoule of 0.25 mg (0.25 mg/ml, 1 ml) for SC or slow diluted IV injection
- Ampoule of 1 mg (1 mg/ml, 1 ml) for SC or given in slowly diluted IV injection

Dosage
- Child 0 to 1 year : SC: 0.10 mg/injection (IV diluted: same dose diluted in 20 ml)
- Child 1 to 5 years : SC: 0.25 mg/injection (IV diluted: same dose diluted in 20 ml)
- Child 5 to 15 years: SC: 0.50 mg/injection (IV diluted: same dose diluted in 20 ml)
- Adult : SC: 1 mg/injection (IV diluted: same dose diluted in 20 ml)
- Do not exceed indicated doses: risk of arrhythmia.
- Be careful when treating elderly patients: risk of heart failure.
- For IV injection, dilute with isotonic solution of sodium chloride or glucose.


FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions
- Do not administer in cases of:
· arterial hypertension,
· angina.

- If used intravenously (reanimation), preferably use diluted.
- Pregnancy: CONTRA-INDICATED except in emergencies
- Lactation: no contra-indication

Remarks
- The adrenaline solution is colourless; discard any ampoules showing a pink or brown coloration.
- Storage: keep cool

AMINOPHYLLINE (Euphyllin(R)...) and THEOPHYLLINE

District hospital

Therapeutic action
- Bronchodilator

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Asthma attacks
- Severe respiratory problems due to bronchopneumonia
- Apnoea in a premature infant

Preparation and route of drug administration
- Ampoule of 250 mg (25 mg/ml, 10 ml) for very slow IV injection (10 to 15 minutes) or infusion. NEVER GIVE IV QUICKLY. Better to use 10 % dilutions (especially if rectal use).
- Administration by IM is possible but painful.
- Children can be treated rectally (dilution 1/10), but the absorption is irregular.
- Apnoea in a premature infant: can be used orally (dilution 1/10) as adjuvant in the treatment of apnoea. Dosage: 2.5 to 5 mg/kg initial dose, following doses 2 mg/kg/24 hours.

Dosage
- Child and adult :5 mg/kg/injection
- Reduce the dose in cases of heart failure and for elderly patients.
- Make sure the patient has not taken oral theophylline before-hand.


FIGURE

Duration: depending on clinical progress, change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Paediatrics:
· never combine with erythromycin,
· the therapeutic dose is near the toxic dose.

- Toxic in case of overdose:
· early signs: vomiting, hyperthermia,
· sign of intoxication: convulsions.

- Administer with care to children under one year.
- Avoid combination with erythromycin or phenobarbitone.
- Pregnancy: avoid, particularly at the end of the pregnancy
- Lactation: avoid

Remarks
- Administration of theophylline for the same indications and at the same dosage (5 mg/kg) in very slow IV injection. Attention, preparation in ampoule of 240 mg/4 ml: calculate exactly the volume to inject.
- Storage: keep cool.

AMOXICILLIN (Amoxil(R), Clamoxyl(R)...) AMPICILLIN (Amfipen(R), Penbritin(R)...)

District hospital

Therapeutic action
- Antibacterial (antibiotic) of the penicillin group

Indications
- Severe infections: septicemia, endocarditis, meningitis, pulmonary infections, burns
- First choice in the treatment of uro-genital infections in pregnant women

Preparation and route of drug administration
- Vials of powder of 500 mg or 1 g for IM, IV injection or infusion

Dosage
Amoxicillin and ampicillin have the same indications and doses when injected:
- Child: 50 to 100 mg/kg/d divided in 3 injections
- Adult: 3 to 4 g/d divided in 3 injections
- The 3 injections/day are necessary.
- In case of severe infections, the dose can be raised to:
Child: 200 mg/kg/d; Adult :12 g/d


FIGURE

Duration: 7 days of antibiotic therapy; change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Do not administer if known allergy to penicillin.
- If allergic reaction, stop treatment and refer to a doctor.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Combination with aminoglycoside (e.g. gentamicin) is sometimes necessary (need medical advice).
- THE POWDER IN THE VIALS IS THE SAME FOR ALL METHODS OF ADMINISTRATION ALTHOUGH THEY MAY BE LABELEED DIFFERENTLY. Some solvents that come with the vials contain lidocaine for IM injections. Once mixed with its solvent, the solution can no longer be used for IV injection. If you use sterile water as solvent, both IM and IV injections are possible.
- Storage: keep cool
· Once dissolved, the liquid must be clear and should be used the same day.
· Diluted in a glucose infusion, ampicillin stays stable for 6 hours; in sodium chloride it stays stable for 12 hours. It is recommended that it be injected directly into the infusion tube.
· Amoxicillin is not as stable as ampicillin (can not be kept more than one hour in glucose solution) and is more expensive (for the same dosage).

ATROPINE Sulphate

District hospital

Therapeutic action
- Antispasmodic and parasympatholytic

Indications
- Spasms of the digestive and uro-genital tract (colics, ulcers and severe gastritis)
- Premedication in case of anaesthesia
- Intoxication with organophosphate insecticide

Preparation and route of drug administration
- Ampoule of 1 mg (1 mg/ml, 1 ml) for SC, IV, IM injection or eventually for oral use

Dosage
- Child: 0.01 to 0.02 mg/injection or per os diluted
- Adult: 0.5 to 1 mg/injection or per os diluted
It is possible to repeat the injection if necessary.
- Intoxication with organophosphates: 2 to 4 mg/IV injection every 5 to 10 minutes until signs of effect of the atropine appear (dilation of pupils).


FIGURE

Duration: depending on clinical progress: single dose or 1 to 3 days

Contra-indications, side-effects, precautions
- Do not administer in cases of:
· urinary retention, cardiac problems, glaucoma,
· high fever in children: decreased transpiration, risk of hyperpyrexia, anoxia, convulsions, cardio-respiratory arrest.

- May cause: dry mouth, constipation, dizziness, headache.
- Do not combine with chlorpromazine or promethazine.
- Do not use for minor symptoms.
- Pregnancy: avoid, particularly at the end of the pregnancy; NO PROLONGED TREATMENTS
- Lactation: avoid; NO PROLONGED TREATMENTS

Remarks
- Do not use for convenience.
- Storage: no special temperature requirements.

BENZATHINE PENICILLIN G = BENZATHINE BENZYL PENICILLIN (Penidural(R)...)

District hospital

Therapeutic action
- Antibacterial (antibiotic) with prolonged action: 15 to 20 days

Indications
- Syphilis
- Bejel, Yaws
- Prevention of rheumatoid arthritis (RA)

Preparation and route of drug administration
- Vial of powder of 2.4 M IU = 1.44 g only for IM injection (NEVER IV or infusion)
There are also vials of 1.2 M IU = 0.72 g and 0.6 M IU = 0.36 g. Adapt dosage accordingly.

Dosage
- Child: 50,000 to 100,000 IU/kg/injection
- Adult: 1 to 3 M IU/injection


FIGURE

Duration: depending on indications:
- Bejel, Yaws: single dose
- Prevention of rheumatoid arthritis: every 4 weeks
- Syphilis (primary and secondary): repeat after 15 days

Contra-indications, side-effects, precautions
- Do not administer if known allergy to penicillin.
- If allergic reaction, stop treatment and refer to a doctor.
- Do not combine with other antibiotics.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- After injection, benzathine penicillin releases the penicillin G very slowly from its complex which provides the long action of 15 to 20 days. This form of penicillin is not suitable for urgent cases (blood level too low), nor for gonorrhoea.
- Benzathine penicillin should not be used as prevention, except in case of RA.
- Storage: keep below 30°C.
Afler preparation, the suspension must be used within 24 hours.

BENZYL PENICILLIN = PENICILLIN G = CRYSTALLINE PENICILLIN (Crystapen(R). . .)

District hospital

Therapeutic action
- Antibacterial (antibiotic) with rapid action and elimination (6 hours)

Indications
- Infections sensitive to penicillin: pneumonia, tonsillitis, anthrax, septicemia, meningitis...

Preparation and route of drug administration
- Vials of powder of 1 M IU and 5 M IU for IM, infusion, IV injection (preferably in the infusion tube)
This presentation is rarely used because it requires intensive monitoring in a hospital environment: INJECTION EVERY 6 HOURS THROUGH AN INFUSION TUBE.

Dosage
- Child: 80,000 IU/kg/d divided in 4 injections or infusions (maximum 400,000 IU/kg/d)
- Adult: 1 to 3 M IU/d divided in 4 injections or infusions (maximum 10 to 20 M IU/d)

Duration: depending on indications and clinical progress

Contra-indications, side-effects, precautions
- Do not administer in case of known allergy to penicillin.
- If allergic reaction, stop treatment and refer to a doctor.
- Do not mix in the same infusion with other antibacterials (gentamicin...).
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- 600 mg benzylpenicillin = 1 million international units (M IU) = 1 mega unit.
- Warning: the labels are not always very clear. Do not confuse penicillin G with LONG ACTING PENICILLIN CONTAINING PENICILLIN G: procaine penicillin G or benzathine penicillin G. Long acting penicillin CANNOT BE USED FOR IV INJECTION OR INFUSION.
- Storage: keep below 30°C.
After preparation, the solution must be clear and used within 24 hours.

CHLORAMPHENICOL (Chloromycetin(R), Tifomycine(R)...)

District hospital

Therapeutic action
- Antibacterial (antibiotic)

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST ME UNDER MEDICAL SUPERVISION
- Typhoid fever
- Meningitis
- Bronchopneumonia
when oral administration is not possible

Preparation and route of drug administration
- Vial of powder of 1 g of chloramphenicol (as sodium succinate) for IM or IV injection

Dosage
- Child : 50 to 100 mg/kg/d divided in 3 injections
- Adult: 1 to 4 g/d divided in 3 injections
- For any indication except typhoid fever, do not exceed a total dose of 26 g for adult.
- Typhoid fever: conform to national protocol; if not available, start the first day with half the dose and increase gradually.


FIGURE

Duration
- Minimum 5 days, change to oral treatment as soon as possible.
- Typhoid fever: continue antibiotic therapy for 15 days after the fever has gone.

Contra-indications, side-effects, precautions
- If treatment causes anaemia, stop treatment and refer to a doctor.
- Do not combine with other antibiotics without medical advice.
- For newborn babies: CONTRA-INDICATED.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED during the first two months

Remarks
- In spite of its severe but rare haematological toxicity, the use of chloramphenicol is justified because of its effectiveness on the serious infections mentioned above. This drug has also the advantage of being cheap.
- ORAL TREATMENT IS MORE EFFECTIVE THAN IM INJECTION (the blood- and tissue concentrations are better with oral absorption).
- Storage: keep below 30°C.
Once dissolved, the solution must be clear and used within 24 hours.

CHLORAMPHENICOL IN OIL ("long acting") (Tifomycine(R)...)

Special department

Therapeutic action
- Antibacterial (antibiotic) with prolonged action (a few weeks)

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Epidemics of purulent méningococcal meningitis

Preparation and route of drug administration
- Ampoule of oily suspension of 500 mg (250 mg/ml, 2 ml) for IM injection only, NEVER IV

Dosage
- Child: 50 to 100 mg/kg/injection
- Adult: 2 to 3 g/injection
- A second injection can be given 3 days later if necessary (same dose).


FIGURE

Duration: single dose

Contra-indications, side-effects, precautions
- Do not combine with other antibiotics.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks
- "A single dose injection of chloramphenicol in oil has been proven effective in the treatment of patients of all ages. This antibiotic is therefore the recommended treatment in case of epidemics, however it is not suitable for the treatment of patients with Streptococcus pneumoniae or Haemophilus influenzae" (WHO - epidemiological record, n°16-20, April 1990).
- No chemoprophylaxis is recommended. It is necessary, for suspected cases, to be examined at the first sign of the disease.
- Storage: keep belozv 30°C.

CHLOROQUINE (Nivaquine(R), Resochin(R)...)

District hospital

Therapeutic action
- Antimalarial

Indications
- Severe malaria: outside chloroquine resistant areas, if oral treatment is not possible.
Attention: if malaria must be treated by injection, use quinine, if available, in preference.

Preparation and route of drug administration
- Ampoules of 80 mg base, 100 mg base, 200 mg base and 300 mg base (40 mg base/ml and 50 mg base/ml) for IM, SC injection, slow infusion

Dosage
- THE THERAPEUTIC DOSES ARE LOWER IF INJECTED THAN IF TAKEN ORALLY.
- THE MAXIMUM DOSE is 25 mg (base)/kg/d, whatever the way of injection.
· IM or SC
3.5 mg (base)/kg/6 hours up to a total dose of 25 mg (base)/kg
· Infusion
5 mg (base)/kg/8 hours up to a total dose of 25 mg (base)/kg; monitor that the infusion proceeds very slowly
In case of cerebral malarial, the initial dose can be 10 mg (base)/kg, up to a total dose of 25 mg (base)/kg.

Duration
- Maximum 1 to 3 days. Do NOT GIVE THE COMPLETE TREATMENT BY CHLOROQUINE INJECTIONS.
AS SOON AS POSSIBLE, CHANGE TO ORAL TREATMENT 24 HOURS AFTER THE LAST INJECTION, give the oral dose as recommended for the second day of the treatment. If necessary, use a gastric tube.

Contra-indications, side-effects, precautions
- Do not use IM for children under 5 years. IN CASE OF VITAL NEED, USE SC (absorption is slower).
- The therapeutic dose is near the toxic dose: check that the patient has not taken chloroquine tablets in the preceding days. If oral treatment, taken correctly, fails, use quinine.
- Risk of cardiac toxicity and hypotension: sudden death.
- Sign of toxicity: convulsions.
- Do not combine injectable chloroquine and injectable quinine.
- Follow strict aseptic procedures because abscesses frequently develop after injections.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Storage: no special temperature requirements

CHLORPHENAMINE = CHLORPHENIRAMINE (Piriton(R), Teldvin(R)...)

District hospital

Therapeutic action
- Antihistaminic

Indications
- Severe allergic reactions due to:
· contact, seasons...
· drugs, insect bites, food...

Preparation and route of drug administration
- Ampoule of 10 mg (10 mg/ml, 1 ml) for IM, slow IV or SC injection

Dosage
- Child (above 2 years): 1 mg/kg/injection
- Adult: 25 to 50 mg/injection


FIGURE

Duration: depending on indications and clinical progress; change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Risk of drowsiness.
- Do not administer to children under 2 years.
- Risk of sedation when combined with alcohol and other drugs that act on the central nervous system: diazepam (Valium(R)), phenobarbitone (Gardena(R)) and chlorpromazine (Largactil(R).
- Pregnancy:avoid
- Lactation :avoid

Remarks
- Chlorpheniramine has not anti-emetic properties.
- Promethazine has stronger sedative effects.
- 5 mg dexchlorpheniramine (Polaramine(R)) has the same effect as 10 mg chlorpheniramine.
- Storage: keep below 30°C.

CHLORPROMAZINE (Largactil(R)...)

District hospital

Therapeutic action
- Sedative and anti-emetic neuroleptic
- Major tranquillizer

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Severe state of agitation
- Very severe vomiting, intractable hiccup

Preparation and route of drug administration
- Ampoule of 50 mg (25 mg/ml, 2 ml) for deep IM injection or infusion

Dosage
Varies from one patient to another:
- Child: 0.5 mg/kg/injection
- Adult: 25 to 100 mg/injection
In cases of eclampsia, the dose can be doubled if necessary.
- Do not exceed indicated doses.


FIGURE

Duration
- Depending on indications and clinical progress, several days of treatment are sometimes needed for very agitated patients.

Contra-indications, side-effects, precautions
- If temperature rises after the injection, stop treatment. It may be a sign of the neuroleptic malignant syndrome.
- Risk of extrapyramidal disorder in case of prolonged treatment.
- Risk of orthostatic hypotension.
- Risk of sedation when combined with alcohol and other drugs that act on the central nervous system: diazepam (Valium(R), phenobarbitone (Gardenal(R)) and chlorpheniramine (Teldvin(R)).
- Pregnancy: avoid prolonged use
- Lactation :avoid

Remarks
- Can be used in case of an eclamptic attack. However, the use of diazepam (Valium(R)) is preferable.
- For intractable hiccup, use a gastric aspiration tube as well.
- Storage: keep below 30°C.

CLOXACILLIN (Orbenin(R)...)

District hospital

Therapeutic action
- Antibacterial (antibiotic) of the penicillin group, acting particularly on penicillinaseproducing staphylococci

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Staphylococcal infections resistant to other antibiotics: chronic osteomyelitis, pulmonary staphylococcal infections of the new-born...

Preparation and route of drug administration
- Vials of powder of 250 mg and 500 mg for IM or IV injection

Dosage
- Child: 100 mg/kg/d divided in 3 or 4 injections
- Adult: 1 to 2 g/d divided in 3 or 4 injections
- If severe infections, the dose can be doubled: maximum 6 g/d.


FIGURE

Duration
- Minimum 7 days of antibiotic therapy.
- Pulmonary staphylococcal infections of the new-born: 10 days.
- Change to oral treatment as soon as possible.

Contra-indications, side-effects, precautions
- Do not administer if known allergy to penicillin.
- If allergic reaction, stop treatment and refer to a doctor.
- Pregnancy: no contra-indication
- Lactation:nocontra-indication

Remarks
- A little enters the cerebro-spinal fluid.
- Storage: keep coal.
After preparation, the solution should be clear and must be used within 24 hours.

DEXAMETHASONE phosphate (Decadron(R), Oradexon(R)...)

District hospital

Therapeutic action
- Hormone glucocorticoid

Indications
- Anaphylactic shock
- Status asthmaticus
- Acute laryngitis with signs of respiratory distress
- Severe allergies: Quincke's oedema

Preparation and route of drug administration
- Ampoule of 4 mg dexamethasone phosphate (4 mg/ml, 1 ml) for deep IM, IV injection or infusion
Sometimes, the dose is expressed in dexamethasone sodium phosphate:
4 mg dexamethasone phosphate = 5 mg dexamethasone sodium phosphate.

Dosage
- Child and adult: 0.5 to 10 mg/d depending on indication and severity


FIGURE

Duration: Depending on clinical progress; for the treatment of shock, a single injection can be sufficient

Contra-indications, side-effects, precautions
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- If prolonged treatment, reduce the doses gradually, otherwise adrenal failure may develop.
- 5 mg prednisolone has the same anti-inflammatory activity as:
· 5 mg prednisone
· 4 mg methyl prednisolone
· 0.75 mg dexamethasone
· 20 mg hydrocortisone

- Dexamethasone acetate (Dectancyl(R) is a suspension only used for local treatments: intra- or peri-articular injection, peridural...
- Storage: keep cool if possible.

DIAZEPAM (Tensium(R), Valium(R)

District hospital

Therapeutic action
- Anxiolytic, sedative
- Anticonvulsive
- Muscle relaxant

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Agitation
- Premedication in anaesthesia
- Convulsions, eclampsia
- Tetanus

Preparation and route of drug administration
- Ampoule of 10 mg (5 mg/ml, 2 ml) for IM, slow IV injection or rectal administration
- The injectable solution can also be used orally.

Dosage
- Agitation - Premedication child :0.3 mg/kg/injection adult :10 to 20 mg/injection
- Convulsions child :0.5 mg/kg/injection adult :25 mg or + /injection
- Tetanus child :0.3 to 1 mg/kg/iniection adult :50 to 100 mg/injection
- For elderly patients, halve the dose.
- Newborn and child, rectal administration: 0.5 mg/kg, repeat if necessary.


FIGURE

Duration
- Depending on clinical progress: 1 to 2 days.
- In case of tetanus or convulsions: repeat every 6 hours.
- If convulsions do not stop after the first injection, the same dose can be repeated 10 minutes later.

Contra-indications, side-effects, precautions
- Do not administer if respiratory depression.
- Risk of respiratory depression if injected IV too quickly.
- IV, IM: painful injection; rectal or oral administration are preferred.
- If administered IV or rectally: dilute 1 to 5 = 10 mg in 10 ml.
- Signs of intoxication (5 times the therapeutic dose): hypothermic coma.
- Risk of sedation when combined with alcohol and other drugs that act on the central nervous system: chlorpromazine (Largactil(R), phenobarbitone
(Gardenal(R)) and chlorpheniramine (Teldvin(R)).
- When used intravenously, make sure that respiratory equipment is available.
- Pregnancy: avoid, except if vital risk
- Lactation: avoid

Remarks
- Treat also hyperthermia which often causes convulsions.
- The diluted solution is normally cloudy.
- Storage: no special temperature requirements

DIGOXIN (Lanoxin(R). ..)

District hospital

Therapeutic action
- Cardiotonic (supports the cardiac contraction, slows down and regulates the cardiac rhythm)

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Heart failure, sinus arrhythmia (fibrillation, flutter, paroxysmal tachycardia)
DIAGNOSED BY A DOCTOR

Preparation and route of drug administration
- Ampoule of 0.50 mg (0.25 mg/ml, 2 ml) for IM or slow IV injection

Dosage
- Child
· Initial dose : 0.010 mg/kg (= 10 mcg/kg), repeat 3 to 4 times/24 hours if necessary
· Maintenance dose: 0.010 mg/kg/d once daily

- Adult
· Initial dose : 0.25 to 0.5 mg/d, repeat 3 to 4 times/24 hours if necessary
· Maintenance dose: 0.25 mg/kg/d once daily

Duration: depending on clinical progress; change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Do not administer if:
· bradycardia,
· ill defined heart rhythm disorders.

- The pulse must be monitored closely at the beginning of the treatment.
- The therapeutic dose is near the toxic dose.
- Signs of overdose: nausea, vision problems, disorientation or confusion, rhythm problems, problems of atrio-ventricular conduction. If so, decrease dose or stop the treatment. Nausea or vomiting are early signs of overdose.
- Higher risk of toxicity in case of hypokalemia (especially in combination with a diuretic treatment) and in case of calcemia (do not inject calcium at the same time).
- Administer with care in cases of renal failure.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Storage: no special temperature requirements.

ERGOMETRINE and METHYLERGOMETRINE (Methergin(R)...)

District hospital

Therapeutic action
- Uterotonic

Indications
- Treatment of post-partum and post-abortion haemorrhage

Preparation and route of drug administration
- Ampoule of 0.2 mg/ml, 1 ml of methylergometrine maleate
- Ampoule of 0.5 mg/ml, 1 ml of ergometrine maleate for IM, slow IV or intramural injection (injection in the uterus)

Dosage
- 0.2 mg/injection, to be repeated if necessary every 2 to 4 hours depending on urgency (0.2 mg = 1 ml of methylergometrine = 0.4 mg of ergometrine)
If bleeding persists after 3 injections, refer to a doctor.
- Do not exceed a total of 5 doses.

Duration: depending on clinical progress

Contra-indications, side-effects, precautions
- Before administration, be sure that the expulsion of the placenta is complete.
- Do not administer during delivery.
- Do not administer in cases of severe hypertension, pre-eclampsia.
- Pregnancy: CONTRA-INDICATED
- Lactation :avoid

Remarks
- Before using this drug, be sure there is no multiple pregnancy. Do not use before the birth of the last child.
- Do not confuse with ergotamine, a related drug, used for totally different indications.
- Storage: refridgerated
· Do not freeze.
· The colour of the solution is normally white to pink; if it becomes yellow/green, the solution has deteriorated.
· Methylergometrine is as sensitive to heat as ergometrine.

FUROSEMIDE = FRUSEMIDE (Lasix(R)...)

District hospital

Therapeutic action
- Diuretic

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
Emergency treatment of:
- Oedema caused by renal, heart or liver failure
- Hypertensive crisis

Preparation and route of drug administration
- Ampoule of 20 mg (10 mg/ml, 2 ml) for IM or slow IV injection

Dosage
- Child: 0.5 to 1 mg/kg/injection
- Adult: 20 to 40 mg/injection
- In cases of acute pulmonary oedema, up to 250 mg can be given.


FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions
- Do not administer in cases of oedema caused by kwashiorkor.
- Risk of hypokalemia (increased toxicity of digoxin if administered simultaneously).
- Pregnancy:avoid
- Lactation: no contra-indication

Remarks
- In case of prolonged treatment, change to oral treatment as soon as possible, after the injectable emergency treatment.
- Storage: keep below 30°C.

GENTAMICIN (Cidomycin(R), Garamycin(R), Gentallin(R)...)

District hospital

Therapeutic action
- Antibacterial (antibiotic)

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Severe infections caused by bacteria resistant to other antibacterials (gram negative, pyocyanic): septicemia, osteomyelitis...
- Severe upper urinary tract infections: pyelonephritis...

Preparation and route of drug administration
- Ampoule of 10 mg (10 mg/ml, 1 ml) for IM or slow IV injection or infusion
- Ampoule of 40 mg (20 mg/ml, 2 ml) for IM or slow IV injection or infusion
- Ampoule of 80 mg (40 mg/ml, 2 ml) for IM or slow IV injection or infusion
- Ampoule of 160 mg (80 mg/ml, 2 ml) for IM or slow IV injection or infusion

Dosage
- Child and adult: 3 to 6 mg/kg/d divided in 2 or 3 injections


FIGURE

Duration: depending on indications and clinical progress: 7 days minimum Limit the duration of the treatment because of the risk of toxicitv.

Contra-indications, side-effects, precautions
- Do not administer if:
· renal failure,
· hearing and vestibular problems (dizziness),
· allergy to gentamicin.

- Risk of renal, cochlear and vestibular toxicity.
- Potentiates the action of muscle relaxants and certain general anaesthetics: risk of respiratory paralysis.
- Do not use with potent diuretics (furosemide).
- Gentamicin can be used in combination with a penicillin (benzyl penicillin or ampicillin), but only on medical advice.
- Gentamicin must not be mixed with other products in the same syringe or infusion, specially with penicillin.
- Pregnancy: avoid
- Lactation :avoid

Remarks
- This drug has no effect on gonorrhea and syphilis.
- Does not enter the cerebrospinal fluid (cannot be used in the treatment of meningitis).
- Storage: keep below 30°C.
When using plastic syringes, inject immediately after preparation. The solution must be clear.

HYDRALAZINE (Apresoline(R)...) and DIHYDRALAZINE (Nepressol(R)...)

District hospital

Therapeutic action
- Antihypertensive with vasodilatory action

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Hypertensive crisis and especially eclampsia and pre-eclampsia

Preparation and route of drug administration
- Ampoule of 20 mg (20 mg/ml, 1 ml and 10 mg/ml, 2 ml) of powder for IM or slow IV injection or infusion

Dosage
- Adult: 5 to 20 mg/injection depending on clinical situation; this dose can be repeated after 20 to 30 minutes.
- Infusion: dilute 4 ampoules in 500 ml sodium chloride 0.9 %; increase infusion rate progressively up to 30 drops/minute; do not dilute in glucose solutions which inactivates hydralazine.
- Do not exceed indicated doses.
- In case of overdose (uncontrolled hypotension), use a plasma substitute, preferably a polygeline fluid (Haemacel(R)).
- If the hypertension is under control, reduce the doses progressively. A sudden stop can provoke a hypertensive crisis.


FIGURE

Duration: depending on clinical progress; change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Do not administer if:
· coronary insufficiency,
· recent myocardial infarction,
· tachycardia.

- Take care when administering to elderly patients or patients who have had cerebrovascular accidents in the past.
- Do not combine with adrenaline.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Storage: keep below 30°C.

HYDROCORTISONE phosphate, succinate, hemi-succinate (Efcortesol(R), Solu-cortef(R)...)

District hospital

Therapeutic action
- Glucocorticoid hormone

Indications
- Anaphylactic shock
- Status asthmaticus
- Acute laryngitis with signs of respiratory distress
- Severe allergies: Quincke's oedema

Preparation and route of drug administration
- Vial of powder of 100 mg for IM or IV injection or infusion
There are also other doses. Adapt dosage accordingly.

Dosage
- Child: 1 to 5 mg/kg/d divided in 2 or 3 injections
- Adult: 100 mg/injection, repeat if necessary


FIGURE

Duration: depending on clinical progress; change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Avoid prolonged administration if:
· peptic ulcer,
· diabetes
· cirrhosis.

- Increases the toxicity of digoxin.
- Pregnancy: avoid, particularly during the first 3 months
- Lactation: no contra-indication

Remarks
- 5 mg prednisolone has the same anti-inflammatory activity as:
· 5 mg prednisone
· 4 mg methyl prednisolone
· 0.75 mg dexamethasone
· 20 mg hydrocortisone

- Hydrocortisone acetate suspension is only used as a local treatment: intra- or
periarticular injection, epidural...
- Storage: keep below 30°C.

HYDROXOCOBALAMIN = VITAMIN B12 (Cobalin(R), Docemine(R), Novobedouze(R), Redisol(R)...)

District hospital

Therapeutic action
- Vitamin

Indications
- Biermer anaemia (due to decreased absorption of vitamin B12).
- Intoxication with cyanide ions, caused by a diet based on insufficiently prepared cassava.

Preparation and route of drug administration
- Ampoule of 1 mg/ml, 1 ml (1 mg = 1,000 microgrammes) for IM injection

Dosage
- Child and adult
· Initial treatment: 1 mg/d or 3 times/week up to a total dose of 10 mg
· Followed by :1 mg/month

Duration
- Biermer anaemia: continue for life.

Contra-indications, side-effects, precautions
- Do not administer in cases of malignant tumor.
- May cause allergic reactions (urticaria, erythema...), pain at injection site, acne.
- Colors urine red.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Cyanocobalamin has the same indications, the same preparation and the same dosage.
- Except for Biermer anaemia, lack of vitamin B12 (stored in the liver) is rare. Daily needs: 0,002 to 0,004 mg.
- Vitamin B12 at high doses is recommended as an antalgic by certain manufacturers (2 mg, 10 mg, 20 mg/ampoule): this antalgic activity has not been proven.
- Storage: keep below 15°C.

HYOSCINE BUTYLBROMIDE = BUTYLSCOPOLAMINE = BUTYLHYOSCINE (Buscopan(R)...)

District hospital

Therapeutic action
- Antispasmodic, parasympatholytic

Indications
- Spasms of the digestive and uro-genital tract (colics, ulcers and severe gastritis)

Preparation and route of drug administration
- Ampoule of 20 mg (20 mg/ml, 1 ml) for IM or IV injection

Dosage
- Child: 0.3 to 1 mg/kg/injection
- Adult: 10 mg/injection
It is possible to repeat the injection if necessary.


FIGURE

Duration: depending on clinical progress: single dose or 1 to 3 days

Contra-indications, side-effects, precautions
- Do not administer if:
· urinary retention, cardiac problems, glaucoma,
· high fever in children: loss of transpiration, risk of hyperpyrexia, anoxia, convulsions, cardio-respiratory arrest.

- May cause: dry mouth, constipation, dizziness, headache.
- Do not combine with chlorpromazine or promethazine.
- Do not use for minor symptoms.
- Pregnancy: avoid, particularly in the third trimester of pregnancy, NO PROLONGED TREATMENTS
- Lactation: avoid, NO PROLONGED TREATMENTS

Remarks
- Storage: no special temperature requirements.

KETAMINE (Ketalar(R), Ketanest((R)...)

District hospital

Therapeutic action
- General anaesthetic

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- General anaesthesia for short interventions

Preparation and route of drug administration
- Ampoule of 10 mg/ml (5 ml and 20 ml) for IM or IV injection or infusion of 50 mg/ml (5 ml and 10 ml) for IM or IV injection or infusion of 100 mg/ml (5 ml) for IM or IV injection or infusion

Dosage
- Child and adult
· IV : 2 mg/kg injected slowly over 1 to 2 minutes. The anaesthesia lasts for 5 to 10 minutes
· IM: 10 mg/kg in deep IM over 3 to 4 minutes. The anaesthesia begins after 10 minutes and lasts for 12 to 25 minutes.

Duration: depending on the duration of the intervention
To prolong the anaesthesia, repeat with half dose injection.

Contra-indications, side-effects, precautions
- Do not administer if:
· arterial hypertension, intracranial or intraocular pressure
· renal or heart failure or pre-eclampsia.

- Risk of hypertension, hallucinations on waking (less frequent with children or when injected IM).
- Use with care for obstetric cases: passes the placenta barrier.
- Give atropine premedication to prevent hypersalivation and vagal reactions.
- Use diazepam as premedication.
- Always have resuscitation and respiratory equipment available and ready for use.
- Pregnancy: no contra-indication, except in case of pre-eclampsia; with caesarian sections, there is a risk of the newborn having respiratory problems.
- Lactation: no contra-indication

Remarks
- Do not mix in the same syringe with barbiturates (thiopentone, phenobarbitone).
- Ketamine has no muscle relaxant properties.
- In certain countries, ketamine is on the list of narcotics. In that case, follow the national rules for imports, handling and storage.
- Storage: no special temperature requirements

LIGNOCAINE = LIDOCAINE (Xylocaine(R), Xylocard(R)...)

District hospital

Therapeutic action
- Local anaesthetic

Indications
- Local anaesthesia:
· suturing, whitlow (= panaris): solution of 1 %.
· dental care: solution of 2 %, (with or without adrenaline)

Preparation and route of drug administration
- Solution of 1 % (10 mg/ml), vials of 20 and 50 ml, for SC injection (and infusion)
- Solution of 2 %, (20 mg/ml), vials of 20 and 50 ml, for SC injection (and infusion)

Dosage
- The volume to be injected depends on the surface area to be anesthetized.
- Do not exceed:
Child: 5 mg/kg/injection
Adult: 200 mg = 20 ml solution of 1 % or 10 ml solution of 2 %


FIGURE

Duration: single injection, to be repeated if necessary

Contra-indications, side-effects, precautions
- Do not administer if known allergy to lignocaine, problems of blood coagulation or impairment of cardiac conduction.
- Lignocaine with adrenaline:
· In dental care, adrenaline added to lignocaine prolongs the anaesthesia.
· Do not administer solutions containing adrenaline for the anaesthesia of the extremities (fingers, penis): risk of ischemia and necrosis.

- When anaesthetizing the extremities, inject distally (at the root), in circle, without tourniquet and without adrenaline.
- Do not use lignocaine for the incision of abscesses: risk of spreading the infection.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- The anaesthesia sets in after 2 to 5 minutes and lasts 1 to 1.5 hours.
- Preferably use lignocaine 2 % for dental applications.
- Do not confuse with lignocaine 5 % hyperbaric which is reserved for spinal anaesthesia.
- The more concentrated the lignocaine, the more localised the anaesthetic effect.
- To simplify the protocol, choose lignocaine 2 % with adrenaline for dental use and lidocaine 1 % without adrenaline for skin anaesthesia.
- Storage: keep below 30°C.

LIGNOCAINE Hyperbaric = LIDOCAINE Hyperbaric (Xylocaine(R) of 5 % for spinal anaesthesia)

Special department

Therapeutic action
- Local or regional anaesthetic

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Spinal anaesthesia = injection in the cerebro-spinal fluid: anaesthesia for the surgery of the lower limbs and the lower abdomen (below the umbilicus)

Preparation and route of drug administration
- Ampoule of 100 mg (50 mg/ml, 2 ml, equals 100 mg lignocaine in a hyperbaric glucose solution), for injection in the cerebro-spinal fluid

Dosage
According to the weight of the patient:
- Adult (shorter than 1.55 m): 50 to 75 mg
- Average adult : 100 mg
- Heavy adult : 150 mg


FIGURE

Duration: the anaesthesia sets in after 2 to 3 minutes and lasts 90 minutes

Contra-indications, side-effects, precautions
- Spinal anaesthesia should not be applied if there is no proper intubation and respiratory equipment.
- Do not administer in cases of :
· shock,
· disease of the central or peripheral nervous system,
· septicemia, meningitis,
· coagulation problems; severe haemorrhages, skin infection near the place of injection,
· known allergy to local anaesthetics.

- May cause:
· hypotension which should be prevented by the administration of a 500 ml ringer lactate infusion before spinal anaesthesia,
· nausea, vomiting, often linked to hypotension,
· sometimes urine retention,
· frequent headache after surgery.

- Use spinal anaesthesia only for adults.
- Before anaesthesia, the patient should be premedicated with atropine.
- Before spinal anaesthesia, the patient should be very well hydrated with ringer lactate or isotonic sodium chloride (500 ml). There should be good venous access, and the arterial pressure should be strictly monitored.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Lignocaine hyperbaric is strictly reserved for spinal anaesthesia.
- Storage: keep below 30°C.

METAMIZOL = DIPYRONE = NORAMIDOPYRINE (Nolotil(R), Novalgin(R), Novaminsulfon(R)...)

RESERVE THIS DRUG FOR SERIOUS SITUATIONS WHERE NO OTHER TREATMENT IS POSSIBLE:
- it is potentially dangerous;
- it is not included in the WHO essential drug list;
- its marketing is forbidden in several countries;
- its use is never justified as a first-line treatment.

District hospital

Therapeutic action
- Analgesic
- Antipyretic

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Severe pain
- High fever

Preparation and route of drug administration
- Ampoule of 1 g (500 mg/ml, 2 ml) for IM, SC or slow IV injection or infusion

Dosage
- Child: 10 mg/kg/injection
- Adult: 500 mg/injection


FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions
- Do not administer if gastric ulcer.
- SEVERE AND LETHAL CASES OF AGRANULOCYTOSIS HAVE BEEN FOUND. THE RISK IS UNPREDICTABLE AND INDEPENDENT OF THE DOSE ADMINISTERED.
- Pregnancy: avoid
- Lactation: avoid

Remarks - Storage: no special precautions.

METOCLOPRAMIDE (Anausin(R), Maxolon(R), Primperan(R), Reglan(R)...)

District hospital

Therapeutic action
- Anti-emetic

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Vomiting

Preparation and route of drug administration
- Ampoule of 10 mg (5 mg/ml, 2 ml) for IM or slow IV injection

Dosage
- Adult: 5 to 10 mg/injection 1 to 3 times per day, IM or slow IV injection


FIGURE

Duration: depending on clinical evolution, as short as possible

Contra-indications, side-effects, precautions
- Contra-indicated in case of gastro-intestinal haemorrhage, obstruction or perforation.
- In case of elevated doses or prolonged treatments, risk of extrapyramidal disorder (agitation and spasms), specially in young patients.
- Increase of crisis for epileptics and those suffering from Parkinson's disease.
- Reversible methaemoglobinemia in newborns.
- Association with propanthelin, hyoscine, atropine and chlorpromazine is not advised.
- Risk of drowsiness.
- Pregnancy: no contra-indication
- Lactation : avoid

Remarks
- It is most important to treat the cause of vomiting; look for bowel obstruction or malaria...
- Storage: keep below 30°C.

OXYTOCIN (Pitocin(R), Syntocinon(R)...)

District hospital

Therapeutic action
- Uterotonic

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Induction of delivery on medical indication

Preparation and route of drug administration
- Ampoule of 5 IU (5 IU/ml, 1 ml) for injection in infusion
- Ampoule of 10 IU (10 IU/ml, 1 ml) for injection in infusion

Dosage
- 1 to 5 IU diluted in 500 ml isotonic solution in a very slow infusion :2 to 4 drops a minute. Increase the dose progressively until the contractions are normal: maximum 40 drops a minute.

Duration: depending on clinical progress

Contra-indications, side-effects, precautions
- Do not administer if:
· hypertonia of the uterus,
· fragile uterus: former caesarian section,
· placenta praevia,
· pre-eclampsia.

- The cervix of the uterus should be dilated (3 to 4 cm) and effacing.
- The foetal membranes should be ruptured.
- The foetus must be monitored throughout, since there is a risk of fetal distress.

Remarks
- If not contra-indicated, preferably use (methyl)-ergometrine for uterine atonies and postpartum haemorrhage.
- Storage: refrigerated
Do not freeze.

PENTAZOCINE (Fortal(R)...)

District hospital

Therapeutic action
- Central analgesic (opioid analgesic)

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Severe pains not responding to other analgesics

Preparation and route of drug administration
- Ampoule of 30 mg (30 mg/ml, 1 ml) for IM, slow IV or SC injection, infusion or rectal administration

Dosage
- Child (above 3 years): 0.5 mg/kg/injection for slow IV injection 1 mg/kg/injection for IM or SC injection
- Adult: 30 to 60 mg/injection, repeat every 3 to 4 hours if necessary


FIGURE

Duration: depending on indications and clinical progress

Contra-indications, side-effects, precautions
- Do not administer if:
· liver impairment,
· respiratory depression,
· head injury.

- May cause: sedation, dizziness, hypotension, respiratory depression.
- Prolonged treatment can cause addiction.
- Signs of overdose: respiratory depression, hypotension, hypothermia.
- Pregnancy :avoid
- Lactation: avoid

Remarks
- In some countries, pentazocine is on the list of narcotics. In that case, follow the national rules for imports, handling and storage.
- Storage: keep cool.

PHENOBARBITONE = PHENOBARBITAL (Gardenal(R), Luminal(R)...)

District hospital

Therapeutic action
- Anticonvulsive, sedative and hypnotic

Indications
- Epilepsy: tonic-clonic ("grand mal") and partial (focal) seizures

Preparation and route of drug administration
- Ampoule of 200 mg (100 mg/ml, 2 ml) for deep IM or slow IV injection

Dosage
- Child and adult: 3 to 5 mg/kg/d (maximum 200 mg/d)
- Do not exceed indicated doses.

Duration: depending on clinical progress; change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Do not administer in case of respiratory depression.
- Depresses the central nervous system: drowsiness, respiratory depression.
- Risk of sedation when combined with alcohol and other drugs that act on the central nervous system: diazepam (Valium(R)), chlorpheniramine (Teldvin(R)) and chlorpromazine (Largactil(R)).
- Pregnancy: avoid (refer to a doctor)
- Lactation: no contra-indication

Remarks
- For convulsions, in cases of extreme agitation and in emergencies, it is better to use diazepam (Valium(R)).
- Phenobarbitone should be injected in glass syringes; if not available, inject immediately after filling the syringe.
- Do not mix phenobarbitone with other drugs in the same syringe.
- Storage: no special temperature requirements.

PHYTOMENADIONE = VITAMIN K1 (Konakion(R)...)

District hospital

Therapeutic action
- Vitamin

Indications
- Haemorrhagic disease of the newborn: treatment and prevention.
- Haemorrhage in patients subject to an anti-coagulant treatment (anti-vitamin K).
- Lack of vitamin K.
Vitamin K has no immediate haemostatic action: it is not indicated in cases of haemorrhagia of traumatic origin. Its therapeutic indications are very limited since vitamin K1 deficiency is rarely seen.

Preparation and route of drug administration
- Ampoule of 1 mg/ml, 1 ml for oral, IM or IV injection

Dosage
- Haemorrhagic disease of the newborn: oral
· prevention: 1 mg in a single dose at birth
· treatment : 1 mg/d x 7 days

- Prophylaxis and treatment of lack of vitamin K: 10 to 20 mg/IM injection
- Haemorrhagia due to anti-vitamin K: 10 to 20 mg/slow IV injection

Duration

Contra-indications, side-effects, precautions
- Injectable administration is contra-indicated in newborn and infants.
- Risk of haematoma at IM injection point.
- Risk of allergic reactions by IV injection.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Vitamin K should not be mixed with another medicine.
- Use glass syringe.
- Storage:

PROCAINE PENICILLIN = PROCAINE BENZYL PENICILLIN = PROCAINE PENICILLIN G

District hospital

Therapeutic action
- Antibacterial (antibiotic) with prolonged action (24 hours)

Indications
- Pneumonia
- Gonorrhoea
- Anthrax
- Prophylaxis of septicemia following abortion

Preparation and route of drug administration
- Vial of powder of 3 M IU procaine penicillin for IM injection, NEVER IV injection or infusion After diluting the powder with distilled water, the suspension has to be shaken before it can be used.

Dosage
- Child : 50,000 to 100,000 IU/kg/d
- Adult: 1 to 4 M IU/d


FIGURE

Duration
- Gonorrhea: single dose divided between each buttock. COMBINE WITH A DOSE OF 1 G PROBENECID TABLETS at the time of injection.
- Other indications: 5 days minimum.

Contra-indications, side-effects, precautions
- Do not administer if known allergy to penicillin.
- If allergic reaction, stop treatment and refer to a doctor.
- For children under 1 year, administer with care: risk of convulsions and allergies caused by the procaine.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Procaine penicillin is penicillin G bound to procaine, which gives it an action lasting for 24 hours.
- 1 g procaine penicillin equals 1 M IU penicillin.
- Procaine penicillin is replaced in some countries by a mixture of procaine penicillin and penicillin G (3 + 1 M IU), often called procaine penicillin forte (PPF) which has the advantage of the immediate action of penicillin G, followed by the delayed action of procaine penicillin.
- Penicillin benethamine (Bi-clinocilline(R)) has a prolonged action (2 to 3 days): administer every other day.
- In case of gonorrhea, ALWAYS TREAT THE PARTNER AS WELL.
- Storage: keep below 30°C.
After preparation, the suspension must be used within 24 hours.

PROCAINE BENZYL PENICILLIN + BENZYL PENICILLIN = PROCAINE PENICILLIN FORTE = PPF (Bicillin(R)...)

District hospital

Therapeutic action
- Antibacterial (antibiotic) with double action prolonged (24 hours) by the procaine penicillin and immediate by the benzyl penicillin

Indications
- Pneumonia
- Gonorrhoea
- Anthrax
- Prophylaxis of septicemia following abortion

Preparation and route of drug administration
- Vial of powder of 3 M IU procaine penicillin + 1 M IU benzyl penicillin (penicillin G) for IM injection, NEVER IV injection or infusion. After diluting the powder with distilled water, the suspension has to be shaken before it can be used.
There are also vials of 600,000 IU procaine penicillin + 300,000 IU benzyl penicillin.

Dosage
- Child: 50,000 to 100,000 IU/kg/d
- Adult: 1 to 4 MIU/d


FIGURE

Duration
- Gonorrhea: single dose divided between each buttock. COMBINE WITH A DOSE OF 1 G PROBENECID TABLETS at the time of injection.
- Other indications :5 days minimum.

Contra-indications, side-effects, precautions
- Do not administer if known allergy to penicillin.
- If allergic reaction, stop treatment and refer to a doctor.
- For children under 1 year, administer with care: risk of convulsions and allergies caused by the procaine.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Compared to procaine penicillin, PPF has the advantage of the immediate action of penicillin G, and 24 hours action of procaine penicillin.
- In case of gonorrhea, ALWAYS TREAT THE PARTNER AS WELL.
- Storage: keep below 30°C.
After preparation, the suspension must be used within 24 hours.

PROMETHAZINE (Phenergan(R)...)

District hospital

Therapeutic action
- Anti-emetic
- Antihistaminic
- Sedative

Indications
- Vomiting
- Allergic reactions due to:
· contact, seasons...
· drugs, insect bites, food...

Preparation and route of drug administration
- Ampoule of 50 mg (25 mg/ml, 2 ml) for IM or IV injection or infusion

Dosage
- Child: 1 mg/kg/d
- Adult: 25 to 100 mg/d


FIGURE

Duration: depending on clinical progress; change to oral treatment as soon as possible

Contra-indications, side-effects, precautions
- Risk of drowsiness.
- Risk of sedation when combined with alcohol and other drugs that act on the central nervous system: diazepam (Valium(R)), phenobarbitone (Gardenal(R)), chlorpromazine (Largactil(R)) and chlorpheniramine (Teldvin(R)).
- In case of anaphylactic shock: use adrenaline and/or corticoid-steroids.
- Pregnancy: avoid in the first 3 months of the pregnancy and in the perinatal period
- Lactation: no contra-indication

Remarks
- The use of promethazine as an anti-emetic can mask the symptoms of the causal disease. Do not use for convenience.
- Storage: keep below 30°C.

QUININE Salts

District hospital

Therapeutic action
- Antimalarial

Indications
- Plasmodium falciparum malaria, pernicious attack, when the patient cannot take oral treatment: cerebral malaria (coma), convulsions, vomiting and diarrhoea

Preparation and route of drug administration
- Ampoules of 200 mg (100 mg/ml, 2 ml), 300 mg (150 mg/ml, 2 ml) and 600 mg (300 mg/ml, 2 ml) for infusion
There are also other doses. Adapt dosage accordingly. IM injection is possible, but only when absolutely necessary because there are numerous complications: paralysis of sciatic nerve, muscular necrosis, infections...

Dosage
- Child and adult: 30 mg/kg/d in slow infusion divided in 3 infusions of 10 mg/kg in 500 ml glucose 5 % administered slowly (4 hours or 40 drops/minute)


FIGURE

Doses and dosages are expressed in salts. They are all equal: formiate or bi-chlorhydrate (quinine dihydrochloride).

Duration
- One day or more until oral treatment is possible: change to quinine or chloroquine tablets according to national protocol.

Contra-indications, side-effects, precautions
- Possible allergic reactions.
- Never inject in direct IV, always dilute: risk of cardiac depression. Infuse slowly. Do not combine with chloroquine.
- Signs of overdose: obvious hearing and visual disturbances.
- If shock or renal failure: halve the dose.
- If convulsions, combine with diazepam (Valium(R)).
- Pregnancy: no contra-indication (do not exceed the therapeutic doses)
- Lactation: no contra-indication

Remarks
- In some regions of South-East Asia, the combination of quinine + tetracycline (25 mg/kg/d) or doxycycline (10 mg/kg/d orally) for 10 days is necessary because of resistance.
- Storage: keep below 30°C.

SALBUTAMOL = ALBUTEROL (Salbulin(R), Salbutan(R), Ventolin(R)...)

District hospital

Therapeutic action
- Bronchodilator
- Uterorelaxant

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Treatment of severe asthmatic crisis and of status asthmaticus
- Emergency treatment of threatening premature delivery, except in case of toxemia or haemorrhage

Preparation and route of drug administration
- Ampoule of 0.5 mg/ml, 1 ml for SC, IM injection or infusion

Dosage
- Asthma
Adult: 0.5 mg SC or IM to be repeated every 4 to 6 hours if necessary
- Threatening premature delivery
· Emergency treatment: 5 mg (10 ampoules) in infusion, diluted in 500 ml of dextrose; approximately 30 to 40 drops/minute, to be progressively increased until contractions stop, then decrease dosage. Injectable salbutamol should only be used under strict medical surveillance, with regular checking of the pulse, blood-pressure and the fœtal heart rate.
· Maintenance dose: 2 mg/d divided in 4 IM injections; change to oral medication as soon as possible.

Duration: depending on clinical progress

Contra-indications, side-effects, precautions
- Do not administer to children.
- Do not administer in cases of myocardial infarction and acute coronary insufficiency.
- Administer with care to patients with cardiac insufficiency, arrhythmia, high bloodpressure, haemorrhage, diabetes, hyperthyroidism.
- May cause: tachycardia, trembling, dizziness, headache.
- Do not use with beta-blocking agents (propranolol).
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks
- Storage: keep below 30°C.

STREPTOMYCIN

Special department

Therapeutic action
- "Antituberculous" antibacterial (antibiotic)

Indications
- Only for tuberculosis, bacteriologically proven if possible

Preparation and route of drug administration
- Vials of powder of 1 g and 5 g (base) to be diluted respectively in 5 or 10 ml sterile water, for IM injection, NEVER IV injection of infusion.

Dosage
According to national protocol.
For information:
- Child: 20 mg (base)/kg/d in 1 injection
- Adult: 750 mg to 1 g/d depending on the weight of the patient, in 1 injection
- Do not exceed a total dose of 60 g because of the oto-toxicity of streptomycin.

Duration: according to national protocol (generally 2 months)

Contra-indications, side-effects, precautions
- Do not administer if severe renal failure.
- Stop treatment if dizziness, buzzing of ears, hearing loss.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks
- Streptomycin is also used for the treatment of plague and brucellosis. Other antibacterials are active against these diseases. Reserve this drug for the treatment of tuberculosis.
- Warning: antituberculous treatment should only be prescribed in the context of an organised program (well established protocol, regular patient checks and the possibility of laboratory examination).
- Streptomycin should not be used alone, but in combination with other "antituberculous" drugs to avoid resistance.
- Storage: keep cool.
After preparation, the solution must be clear and can be kept for only one hour.

SULFADOXINE + PYRIMETHAMINE (Fansidar(R)...)

Therapeutic action
- Antimalarial

Indications
- Treatment of Plasmodium falciparum malaria resistant to chloroquine and other amino-4 quinolines (amodiaquine(R)...)

Preparation and route of drug administration
- Ampoule of 400 mg sulfadoxine + 20 mg pyrimethamine (200 mg sulfadoxine + 10 mg pyrimethamine/ml, 2 ml) for IM injection or infusion

Dosage
- Child: 25 mg/kg sulfadoxine in a single dose for IM injection or infusion (1/2 amp./10 kg)
- Adult: 800 ma sulfadoxine in a single dose for IM injection or infusion
- Never give in direct IV, always dilute.


FIGURE

Duration: single dose

Contra-indications, side-effects, precautions
- Do not administer if:
· allergy to sulfonamides,
· renal or liver failure.

- May cause: gastro-intestinal problems, nausea, vomiting, sometimes severe allergic reactions.
- Do not combine with chloroquine.
- Avoid for children under 5 years.
- Pregnancy: CONTRA-INDICATED
- Lactation: avoid

Remarks - Preferably use injectable quinine.
- Warning: there is an increasing number of resistant strains.
- Storage: no special precautions

THIOPENTONE sodium = THIOPENTAL sodium = PENTOBARBITAL sodium (Pentothal(R)...)

Special department

Therapeutic action
- Anaesthetic
- Anticonvulsive

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
- Induction of general anaesthesia
- Anaesthesia of short duration (not more than 15 minutes)
- This drug has no analgesic action and is not a muscle relaxant

Preparation and route of drug administration
- Vials of powder of 0.5 g or 1 g for IV injection, to be dissolved in a glucose 5 % solution or in 0.9 % NaCl solution (0.5 g in 20 ml)

Dosage
- Dose:
· average :1 to 10 mg/kg
· total maximum :1 g

- Induction of anaesthesia: test dose 50 mg, afterwards 100 to 200 mg in 20 seconds
- Lower dose for elderly patients.

Duration: depending on duration of the intervention

Contra-indications, side-effects, precautions
- Use only if intubation and ventilation equipment are available.
- Do not administer in cases of shock.
- Do not administer to ambulatory patients or to children under 4 years.
- May cause:
· apnoea, laryngospasm, bronchospasm,
· initial bloodpressure drop.

- Possible depression of circulation and respiration if overdose.
- Risk of pain and necrosis if extravenous or intra-arterial injection.
- Use with care in cases of asthma, heart failure, liver, renal or severe adrenal insufficiency, porphyria, myasthenia.
- The anaesthesia has to be preceded by a premedication with atropine and, if necessary, with analgesics and muscle relaxants.
- Pregnancy: use with care near term (causes foetus to sleep)
- Lactation :avoid

Remarks
- The concentration should not exceed 2.5 % due to risk of thrombo-phlebitis.
- Do not mix with another injectable drug, nor with ringer lactate.
- Storage: keep cool.
After preparation, the solution can be kept for up to 24 hours if kept cool.