Oral drugs

Acetaminophen
Acetyl salicylic acid = ASA
Albendazole
Albuterol
Aluminium hydroxide
Aminophylline
Amoxicillin
Ampicillin
Aneurin
Ascorbic acid
Atropine sulphate
B Complex
Butylscopolamine
Charcoal
Chloramphenicol
Chloroquine
Chlorpheniramine = Chlorphenamine
Chlorpromazine
Cimetidine
Clofazimine
Cloxacillin
Cotrimoxazole = SMX + TMP
Dapsone
Dexamethasone
Dexchlorpheniramine
Diazepam
Diethylcarbamazine
Digoxin
Dihydralazine
Dipyrone*
Doxycycline
Erythromycin
Ethambutol
Ferrous salts = Ferrous sulphate
Ferrous sulphate + Folic acid
Flubendazole
Folic acid
Furosemide = Frusemide
Griseofulvin
Halofantrine*
Hydralazine
Hydrochlorothiazide
Hyoscine butylbromide
Ibuprofen
Indometacin
Iron salts
Isoniazid = INH
Isoniazid + Thiacetazone
Ivermectin
Levamisole
Loperamide
Mebendazole
Mefloquine
Metamizol*
Methyldopa
Methylprednisolone
Metoclopramide
Metrifonate
Metronidazole
Multivitamins
Niclosamide
Nitrofurantoin
Noramidopyrine*
Noscapine
Nystatin
Oral rehydration salt = O.R.S.
Oxamniquine
Oxytetracycline
Paracetamol
Phenobarbitone = Phenobarbital
Phenoxymethyl penicillin = Penicillin V
Phenylbutazone*
Phenytoin
Piperazine
Potassium chloride
Praziquantel
Prednisolone- Prednisone
Probenecid
Proguanil
Promethazine
Propanthelin
Propranolol
Pyrantel
Pyrazinamide
Pyridoxine
Quinine salts
Reserpine
Retinol
Rifampicin
Salbutamol
Sulfadimidine
Sulfadoxine + Pyrimethamine
Sulfaguanidine*
Tetracycline
Theophylline
Thiabendazole
Thiamine
Tolbutamide
Vitamin A
Vitamin B1
Vitamin B6
Vitamin C
Vitamin B Complex

* The use of this drug is not advised.

ACETYL SALICYLIC ACID = A.S.A.

(Aspirin)

Health post

Therapeutic action

- Analgesic
- Antipyretic
- Anti-inflammatory

Indications

- Headache, toothache
- Fever
- Joint or muscular pain

Preparation

- Tablets of 75 mg, 100 mg, 300 mg and 500mg

Dosage

- Child: 50 mg/kg/d divided in 3 doses
- Adult: 1-3 g/d divided in 3 doses
- In case of joint pain, double the dose.

FIGURE

Duration: depending on clinical progress, 1-3 days

Contra-indications, side-effects, precautions

- Do not administer:

· in cases of heartburn, alcoholism, haemorrhage, asthma.
· children under one year (preferably use paracetamol when available).

- If heartburn or allergic reaction, stop treatment and give paracetamol.
- Do not combine with probenecid.
- Pregnancy: avoid if possible (preferably use paracetamol especially in the third trimester of pregnancy)
- Lactation: avoid if possible (preferably use paracetamol)

Remarks

- Take during meals, preferably",with a lot of water.
- Storage: keep cool if possible
- Do not use if the tablets have a strong unusual smell (acid or vinegar). A slight acetic acid smell is always present.

ALUMINIUM HYDROXIDE [with or without magnesium salts]

Health post

Therapeutic action

- Antacid
- Protects digestive mucosa

Indications

- Heartburn after or during meals (gastritis)
- Stomach ulcer

Preparation

- Tablet of 500 mg There are numerous preparations on the base of aluminium and/or magnesium hydroxide in varying dosages. Adapt dosage accordingly.

Dosage

- Child: rarely indicated. When necessary: 75 mg/kg/d
- Adult: 1.5 to 3 g/d divided in 3 doses after meals or at the time of extreme pain

FIGURE

Duration :5 days (longer if necessary)

Contra-indications, side-effects, precautions

- Frequent constipation (except when the tablets contain magnesium salts).
- Decreases the absorption of many drugs so avoid simultaneous administration especially with tetracycline. Separate the different drugs by one or two hours.
- Chew tablets.
- Besides this treatment, the patient should avoid taking alcohol, coffee, tea, coca-cola, carbonated drinks, spices and tobacco.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Storage: no special precautions

AMINOPHYLLINE (Euphyllin(R), Theodrox(R).) and THEOPHYLLINE (Nuelin(R).)

District hospital

Therapeutic action

- Bronchodilator

Indications PRESCRIPT/ONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION

- Asthma
- Severe respiratory problems combined with bronchopneumonia

Preparation

- Tablets of 100 mg and 200 mg

Dosage

- Child and adult:

· Aminophylline: 13 to 15 mg/kg/d divided in 3 doses
· Theophylline : 10 to 13 mg/kg/d divided in 3 doses

- For smokers, it is sometimes necessary to increase the dosage to 20 mg/kg/d.
- Aminophylline contains 85% of theophylline.

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Paediatrics:

· do not combine with erythromycin.
· the therapeutic dose is near the toxic dose.

- Toxic in case of overdose:

· early signs: vomiting, hyperthermia.
· signs of intoxication: convulsions.

When these symptoms appear, stop treatment and refer to a doctor as soon as possible.

- Lower the dosage in case of heart failure.
- Administer with care to children under one year.
- Avoid combination with phenobarbitone.
- Pregnancy: avoid (especially in the third trimester of pregnancy)
- Lactation :avoid

Remarks

- Storage: keep below 30°C

AMOXICILLIN (Amoxil(R), Clamoxyl(R).)

Health clinic

Therapeutic action

- Antibacterial (antibiotic) of the penicillin group

Indications

- Respiratory infections with fever in children under 5 years
- Prevention and treatment of secondary infections of whooping cough and measles
- Genito-urinary infections, especially in pregnant women

Preparation

- Tablets or capsules of 500 mg and 250 mg
- Syrup of 125 mg/5 ml = 1 teaspoon (tsp)

Dosage

- Child : 50 mg/kg/d divided in 2 doses
- Adult: 1 to 2 g/d divided in 2 doses
- In case of severe infections, use the maximum dosage in 3 doses/day.
- Treatment of genito-urinary infections in pregnant women: 1 g/d divided in 2 or 3 doses for 10 days.

FIGURE

Duration

- Minimum 5 days
- 10 days in case of genito-urinary infections in pregnant women

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 without medical advice.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Amoxicillin is used for the same indications as ampicillin but, because of its better intestinal absorption, only half the dose is required by oral administration.
- Storage: keep cool if possible.
Once prepared, the syrup should be kept cool, and will only last for 1 week.

AMPICILLIN (Amfipen(R), Penbritin(R).)

Health clinic

Therapeutic action

- Antibacterial (antibiotic) of the penicillin group

Indications

- Respiratory infections with fever in children under 5 years
- Prevention and treatment of secondary infections of whooping cough and measles
- Genito-urinary infections, especially in pregnant women

Preparation

- Tablets or capsules of 500 mg and 250 mg - Syrup of 125 mg/5 ml = 1 teaspoon (tsp)

Dosage

- Child: 100 mg/kg/d divided in 2 doses
- Adult: 2 to 4 g/d divided in 2 doses
- In case of severe infections, use the maximum dosage in 3 doses/day.
- Treatment of genito-urinary infections in pregnant women: 1 g/d divided in 2 or 3 doses for 10 days.

FIGURE

Duration

- Minimum 5 days
- 10 days in case of genito-urinary infections in pregnant women

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 without medical advice.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Avoid to take ampicillin during meals.
- Amoxicillin is used for the same indications as ampicillin but, because of its better intestinal absorption, only half the dose is required by oral administration.
- Storage: keep cool if possible.

Once prepared, the syrup should be kept cool, and will only last for 1 week.

ASCORBIC ACID = VITAMIN C (Redoxon(R).)

District hospital

Therapeutic action

- Vitamin

Indications

- Treatment and prevention of scurvy

Preparation

- Tablets of 50 mg and 250 mg

There are also tablets of 500 mg and 1 g. Adapt dosage accordingly.

Dosage

- Treatment:

child: 100 to 300 mg/d divided in 3 doses
adult: 500 mg to 1 g/d divided in 3 doses

- Prevention:

child: 50 to 100 mg/d
adult: 50 to 100 mg/d

FIGURE

Duration

- Treatment: 1 to 2 weeks until symptoms improve, followed by a maintenance dose for 2 weeks (preventive dose).
- Prevention: as long as the situation requires (e.g. insufficient supply in the food rations of displaced population).

Contra-indications, side-effects, precautions

- Well tolerated.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- High doses of vitamin C can interfere with the measurement of glucose in urine.
- This supplement is rarely necessary when the food intake contains enough fruit and vegetables.
- Storage: keep below 30°C

ATROPINE Sulphate
HYOSCINE BUTYLBROMIDE = BUTYLSCOPOLAMINE (Buscopan(R).) PROPANTHELIN (Probanthine(R).)

District hospital

Therapeutic action

- Antispasmodic

Indications

- Spasms of the digestive and uro-genital tract

Preparation

- Atropine sulphate : tablet of 1 mg
- Hyoscine butylbromide: tablet of 10 mg
- Propanthelin : tablet of 15 mg

Dosage

- Child: avoid
- Adult:
atropine sulphate : 3 mg/d divided in 3 doses
hyoscine butylbromide: 30 to 60 mg/d divided in 3 doses
propanthelin : 45 to 90 mg/d divided in 3 doses
- Butylhyoscine or propanthelin are to be preferred since their side-effects are less pronounced than those of atropine.

FIGURE

Duration: depending on clinical progress, maximum 1 to 4 days

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· urinary retention,
· cardiac problems,
· glaucoma.

- May cause:

· dry mouth,
· constipation,
· dizziness, headache.

- Do not combine with chlorpromazine or promethazine.
- Pregnancy: avoid, particularly in the third trimester of pregnancy, NO PROLONGED TREATMENTS
- Lactation: avoid, NO PROLONGED TREATMENTS

Remarks

- Do not use for convenience.
- Storage:

CHARCOAL

District hospital

Therapeutic action

- Absorbent

Absorbs toxic substances of certain plants and drugs and those produced by some microbes.

Indications

- Intoxication after taking drugs in higher doses than normal (A.S.A., paracetamol, chloroquine, quinine, barbiturates, indometacin, phenytoine, digoxine, tolbutamide, theophylline...)
- Poisoning by plants

Preparation

- Tablet of 125 mg

There are different strengths. Adapt dosage accordingly.

Dosage

- Child and adult: 6 to 24 tablets in a single dose
- In case of severe overdose: 30 tablets in a single dose.

FIGURE

Duration: single dose; repeat if necessary.

Contra-indications, side-effects, precautions

- Do not administer after ingestion of caustic products.
- Constipation possible after treatment.
- Black colouring of faeces.
- Do not administer with other drugs, because of its absorbing properties.
- Pregnancy: no contra-indication (avoid prolonged use)
- Lactation: no contra-indication

Remarks

- Charcoal DOES NOT CURE DIARRHOEA. It does not correct dehydration. It can only relieve a blown up stomach.
- To make this drug easier to take, crush the tablets.
- Storage: no special temperature requirements

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

District hospital

Therapeutic action

- Antibacterial (antibiotic)

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

- Typhoid fever
- Meningitis
- Bronchopneumonia

Preparation

- Tablet or capsule of 250 mg
- Syrup of 125 mg/5 ml

Dosage

- Child under 2 months: 25 mg/kg/d divided in 3 doses
- Child above 2 months: 50 to 100 mg/kg/d divided in 3 doses
- Adult :1 to 3 g/d divided in 3 doses

FIGURE

- Typhoid: refer to national protocol. In other cases, start the first day with a half dose and increase gradually.
- For indications other than typhoid, do not exceed the total dose of 26 g for adults.
- Can be used for immediate treatment of gonorrhoea: 2 to 3 g once daily for 2 days.

Duration

- 5 days minimum
- Typhoid fever: continue the antibiotic therapy 15 days after the fever has gone.

Contra-indications, side-effects, precautio- In newborn babies, administer only for cases of typhoid or meningitis.

- If treatment causes anaemia, stop treatment and refer to a doctor.
- Do not combine with other antibiotics without medical advice.
- As far as possible, limit the use of chloramphcol to serious infections.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks

- In spite of a rare severe haematological toxicity, the use of chloramphenicol is justified because of its effective treatment of the above mentioned severe infections. Another advantage is the low price.
- The oral treatment is more effective than the injected (I.M.), as the blood- and tissue concentrations are better.
- Storage: keep below 30°C if possible-

Once prepared, the syrup should be kept cool, and will only last for 1 week.

CHLOROQUINE Phosphate or Sulphate (Nivaquine(R), Resochin(R).)

Health post

Therapeutic action

- Antimalarial

Indications

- Malaria

· Treatment of a malaria attack (in areas without chloroquine resistance)
· Prophylaxis for pregnant women, malnourished children and non-immune individuals in areas without chloroquine resistance

Preparation

- Tablet of 100 mg of chloroquine base
- Tablet of 150 mg of chloroquine base

IMPORTANT: THE DOSE WRITTEN ON THE LABELS IS SOMETIMES IN CHLOROQUINE SALT AND SOMETIMES IN CHLOROQUINE BASE WHICH LEADS TO FREQUENT CONFUSION. WHO RECOMMENDS PRESCRIPTIONS AND LABELS IN CHLOROQUINE BASE.

Equivalence for salt and base: 130 mg sulphate = 150 mg phosphate or diphosphate = 100 mg base 200 mg sulphate = 250 mg phosphate or diphosphate = 150 mg base

Dosage

PREVENTIVE TREATMENT

When there is no national protocol, apply one of the following schemes, depending on local practice:

FIGURE

CURATIVE TREATMENT

When there is no national protocol, administer in the following way:

- Child and adult: 10 mg base/kg, D1 and D2 5 mg base/kg, D3, D4 and D5
- When treatment schedule must be very simple, it is possible to give 10 mg base/kg/d for 3 days.
- When using injectable chloroquine, never forget that the therapeutic oral dose is equivalent to a toxic dose when injected.

FIGURE

Duration: curative treatment: 5 or 3 days

Contra-indications, side-effects, precautions

- Vomiting and frequent headaches.
- Pruritis, cutaneous eruptions possible, most of them occurring in areas of endemic filariasis. These are not allergic reactions and treatment should not be stopped.
- Do not come near the toxic dose:

· child: 25 mg base/kg in one dose 2 g base in one dose
· adult: 2 g base in one dose

Intoxication is severe.

- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

PREVENTIVE TREATMENT

- The prevention of malaria in areas with high prevalence of chloroquine resistance is often debated. In this case, chloroquine has to be combined with proguanil or replaced by a different drug.
- Travellers only have to start treatment on the day of their arrival in affected areas. Treatment must be continued for 6 weeks after leaving the area.

CURATIVE TREATMENT

- When it is not possible to take two doses on the first day, give the total dose of the first day at once, 15 mg base/kg.
- If the patient vomits within one hour of medication being given, repeat the dose.
- Some national guidelines recommend to give only the first dose of treatment (conservation of natural immunity of population).
- It is advisable to use tablets of 150 mg base (= 250 mg of phosphate) in english speaking countries and 100 mg base (= 150 mg of phosphate) in french speaking countries to mountain local practice and to avoid mistakes in dosage.
- Storage: no special temperature requirements -

CHLORPHENIRAMINE = CHLORPHENAMINE (Teldvin(R).)

District hospital

Therapeutic action

- Antihistamic

Indications

- Allergic reactions due to:

· contact, seasons.
· drugs, insect bites, food.

- Dry cough of allergic origin

Preparation

- Tablet of 4 mg

Dosage

- Child (above 2 years): 1 to 4 mg/d divided in 2 or 3 doses
- Adult: 8 to 12 mg/d divided in 2 or 3 doses

FIGURE

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

Contra-indications, side-effects, precautions

- Do not administer to children under 2 years.
- Risk of drowsiness, use with care when driving.
- Risk of increased sedation when combined with alcohol and other drugs that act on the central nervous system: diazepam (Valium(R)), phenobarbitone (Gardenal(R)) and chlorpromazine (Largactil(R)).
- Avoid alcoholic drink during the treatment.
- Pregnancy: avoid
- Lactation : avoid

Remarks

- Dexchlorpheniramine (Polaramine(R) has the same indications but: 2 mg of dexchlorpheniramine has the same effect as 4 mg of chlorpheniramine.
- Storage: keep below 30°C

CHLORPROMAZINE (Largactil(R).)

District hospital

Therapeutic action

- Sedative neuroleptic
- Major tranquillizer

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

- Acute psychosis with agitation
- Chronic psychosis, hallucinations and schizophrenia

Preparation

- Tablet of 25 mg

There are also tablets of 50 and 100 mg. Adapt dosage accordingly.

Dosage

Varies from one person to another, doses have to be progressive.

- Child: 1.5 mg/kg/d divided in 3 doses
- Adult: 50 to 100 mg/d divided in 3 doses

FIGURE

- Do not exceed indicated doses.
- Lower the dose for elderly patients.

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· barbiturate or alcoholic coma,
· Parkinson's disease,
· renal or liver failure (risk of overdose).

- If patient becomes febrile, interrupt the treatment. It could be a case of malicious neuroleptic syndrome.
- Risk of extrapyramidal manifestations, orthostatic hypotension and photosensitization to the sun.
- Refer in case of acute intoxication.
- If prolonged treatment, check blood regularly (risk of agranulocytosis).
- 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: CONTRA-INDICATED (in case of psychosis, stop treatment one week before delivery if possible)
- Lactation: avoid

Remarks

- Storage: keep below 30°C

CIMETIDINE (Tagamet(R).)

District hospital

Therapeutic action

- Healing of ulcers

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

- Active duodenal and gastric ulcers and prevention of relapses.
- esophagitis caused by gastro-esophageal reflux unresponsive to other treatments.

Preparation

- Tablets of 200 mg, 400 mg and 800 mg

Dosage

- Newborn and child: 10 to 20 mg/kg/d divided in 4 to 6 doses
- Adult :800 mg/d once daily (evening)

FIGURE

Duration :4 to 6 weeks

Contra-indications, side-effects, precautions

- Do not administer treatments over long periods.
- Do not administer an antacid (aluminium hydroxide) for 2 hours before or after taking cimetidine.
- May cause: diarrhoea, dizziness, rash, fever.
- Association with other drugs not advised (phenytoine), or to be monitored (propanolol theophylline...).
- Reduce dosage in case of severe hepatic or renal failure.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks

- To prevent relapses of duodenal ulcers, reduce the dosage by half.
- Expensive treatment.
- Storage: keep below 30°C

CLOFAZIMINE (Lamprene(R).)

Special department

Therapeutic action

- Antibacterial, active against the leprosy bacillus

Indications

- Multibacillary leprosy, in association to other "anti-leprosy" medication
- Leprotic reaction: erythema nodosum leprosum

Preparation

- Capsules of 50 mg and 100 mg

Dosage

According to national protocol. For information:

- Multibacillary leprosy: 300 mg once a month under surveillance and 50 mg/d taken by patient at home. Must be combined with rifampicin and dapsone.
- Leprotic reaction: 100 to 300 mg/d

Duration

- 6 months or 2 years depending on the type of leprosy.
- Leprotic reaction :3 months, then decrease dosage progressively.

Contra-indications, side-effects, precautions

- Do not administer doses of 300 mg/d or over for more than 3 months.
- Administer with care in cases of liver or renal failure.
- Occasionally causes nausea and/or abdominal cramps.
- Orange red colouring of the skin, mucosa and skin lesions, which continues a long time after the end of treatment.
- Orange colouring of the urine, faeces and secretions.
- Should be combined with other "antileprotics".
- Pregnancy: avoid (if necessary may be used under medical supervision)
- Lactation: avoid (if necessary may be used under medical supervision)

Remarks

- The action on the tuberculoid type is quite slow, about 2 to 6 weeks.
- Only prescribe "anti-leprotics" in the content of an organised leprosy program.
- Storage: no special precautions.

CLOXACILLIN (Orbenin(R).)

District hospital

Therapeutic action

- Antibacterial (antibiotic) of the penicillin group, acting specifically against penicillinase producing staphylococci

Indications PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE

UNDER MEDICAL SUPERVISION

- Staphylococci infections resistant to other antibiotics: chronic osteomyelitis, pulmonary staphylococci of the newborn.

Preparation - Capsules of 250 mg and 500 mg

Dosage

- Child: 50 mg/kg/d divided in 3 doses
- Adult: 1 to 2 g/d divided in 3 doses
- In case of a severe infection, the dose can be doubled.

FIGURE

Duration: minimum 7 days

Contra-indications, side-effects, precautions

- Do not administer if known allergy to penicillin.
- If allergic reactions, stop treatment and refer to a doctor.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Cloxacillin, oxacillin and dicloxacillin are equivalent products: same indications and same doses, except for dicloxacillin (25 mg/kg/day).
- Storage: keep cool if possible

COTRIMOXAZOLE = Sulfamethoxazole (SMX) + Trimethoprim (TMP) (Bactrim(R), Cotrim(R), Eusaprim(R), Septrim(R).)

Health post

Therapeutic action

- Combination of 2 antibacterials including a sulfonamide (active during maximum 12 hours)

Indications

- Respiratory infections with fever
- Urinary infections
- Bacillary dysentery
- Otitis
- Gonorrhoea

Preparation

- Tablet of 400 mg sulfamethoxazole (SMX) + 80 mg trimethoprim (TMP)
- Syrup of 200 mg SMX + 40 mg TMP / 5 ml = 1 teaspoon

There are also tablets of 800 mg SMX + 160 mg TMP (named cotrimoxazole "forte") and paediatric tablets of 100 mg SMX + 20 mg TMP. Adapt dose accordingly.

Dosage

- Child : 1/2 to 2 tab of 400 mg + 80 mg/kg/d divided in 2 doses
- Adult: 4 tab of 400 mg + 80 mg/d divided in 2 doses

FIGURE

- To treat:

· gonorrhoea: 10 tabs of 400 mg + 80 mg/d once daily for 3 days
· urinary infections: 4 tabs of 400 mg + 80 mg in a single dose

- In case of acute respiratory infections in children under 5 years, double the dose:

· from 2 months to 1 year: 1/2 tab x 2
· from 1 to 5 years : 1 tab x 2

Duration: minimum 5 days

Contra-indications, side-effects, precautions

- Do not administer to children under 2 months.
- Frequent digestive problems.
- Allergic reactions mostly benign but sometimes severe (generalised bullous eruptions, agranulocytosis). In this case, stop treatment and refer to a doctor.
- Do not combine with other antibacterials.
- Drink a lot of liquid during treatment.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks

- Storage: no special precautions.

Once prepared, the syrup can be kept for up to 1 week if kept cool.

DAPSONE (Avlosulfon(R).)

Special department

Therapeutic action

- Antibacterial, active against the leprosy bacillus

Indications

- Leprosy, in association to other "anti-leprosy" medication

Preparation

- Tablets of 50 mg and 100 mg

There are different strengths. Adapt dosage accordingly.

Dosage

According to national protocol.

For information:

- Child : 1 to 2 mg/kg/d once daily
- Adult: 100 mg/d once daily

FIGURE

Duration

- Multibacillary leprosy: 2 years or more, depending on the progress
- Paucibacillary leprosy: 6 months

Contra-indications, side-effects, precautions

- Do not administer if allergy or intolerance to sulfonamides.
- Avoid in case of liver failure.
- If severe anaemia or leucopenia develops, stop treatment and replace dapsone with another "antileprotic".
- Pregnancy: avoid (if necessary may be used under medical supervision)
- Lactation: avoid (if necessary may be used under medical supervision)

Remarks

- Warning: antileprotic treatment should only be prescribed in the context of an organised program.
- Dapsone should not be used alone, but in combination with other "antileprotic" drugs to avoid development of resistance.
- Storage: keep below 30°C

DIAZEPAM (Tensium(R), Valium(R).)

District hospital

Therapeutic action

- Anxiolytic
- Anticonvulsive, muscle relaxant

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

- Muscular contractions
- Agitation and anxiety

Preparation

-Tablet of 5 mg

There are also tablets of 2 mg and 10 mg. Adapt dosage accordingly.

Dosage

- Child: 0.5 mg/kg/d divided in 3 doses
- Adult: 5 to 15 mg/d divided in 3 doses

FIGURE

- Do not exceed indicated doses.
- Signs of overdose: muscular weakness, ataxia.
- Signs of intoxication (5 times the therapeutic dose): hypothermic coma.
- The dose should be halved for elderly patients.
- Should only be used exceptionally and with great care for children.

Duration: depending on clinical progress

Contra-indications, side-effects, precautions.

- Do not administer in cases of respiratory depression.
- Risk of drowsiness, use with care when driving.
- Addiction will occur in case of prolonged use (average 12 days). Reduce the dosage gradually to wean the patient off the drug.
- Risk of causing 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)).
- Pregnancy: avoid
- Lactation :avoid

Remarks

- Do not use as an easy remedy.
- Storage: no special precautions

DIETHYLCARBAMAZINE (Banacide(R), Hetrazan(R), Notezine(R).)

Special department

Therapeutic action

- Filaricide

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

- Lymphatic filariasis (Wuchereria bancrofti)
- Onchocerciasis (Onchocerca volvulus)
- Loiasis (Loa-loa)

Preparation

- Tablets of 50 mg and 100 mg

Dosage

According to national protocol.

For information:

- Lymphatic filariasis and onchocerciasis

· Child : build up dose progressively (over 4 days) 6 mg/kg/d divided in 2 doses
· Adult: build up dose progressively (over 4 days) 400 mg/d divided in 2 doses start the first day with 25 to 50 mg divided in 2 doses

- Loiasis
Adapt dosage to the parasite-load of the patient

· Child and adult: build up progressively (over 5 to 8 days) to 6 mg/kg/d divided in 2 doses start the first day with 3 mg/kg/d divided in 2 doses

- In West Africa, every treatment should start with 3 mg/d because of the risk of possible combination of loiasis with other filariasis.

Duration: 21 days

Contra-indications, side-effects, precautions

- Allergic reactions: pruritus, Iymphangitis, risk of shock due to the microfilaria lysis
(loiasis and onchocerciasis).
- Risk of lethal encephalitis; reactions are the most severe when the progressive protocol is not respected.
- Drowsiness, malaise, headache, nausea, vomiting.
- To prevent or decrease allergic reactions, administration of antihistamines is recommended.
- Pregnancy: avoid (in most cases, the treatment can wait until the end of the pregnancy)
- Lactation: avoid

Remarks - To treat onchocerciasis: ivermectin (Mectizan(R)), a single dose medication which is better tolerated, replaces diethylcarbamazine.

- An individual chemoprophylaxis against Loa-Loa is possible :100 mg once weekly.
- Storage: keep below 30°C

DIGOXIN (Lanoxin(R).)

District hospital

Therapeutic action

- Cardiotonic (reinforces the cardiac contraction, slows down and regulates the cardiac rhythm)

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

- Congestive heart failure, sinus arrhythmia (fibrillation, flutter, paroxysmal tachycardia) DIAGNOSED BY A DOCTOR.

Preparation

- Tablet of 0.25 mg (= 250 microgram = 250 mcg = 250 ug)

Dosage

- Child

· initial dose : 0.015 mg/kg (= 15 mcg/kg) x 3 to 4 doses the first day
· maintenance dose: 0.015 mg/kg/d once daily, 5 days in every 7

- Adult

· initial dose : 0.5 to 1 mg/d divided in 3 or 4 doses the first day
· maintenance dose: 0.25 mg/d divided in 1 or 2 doses, 5 days in every 7

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· bradycardia
· ill-defined heart rhythm disorders

- The surveillance of the pulse is vital at the beginning of the treatment.
- The therapeutic dose is near the toxic dose.
- Signs of overdose: digestive problems, visual problems, disorientation or confusion, arrythmia and problems of the atrio-ventricular conduction. In this case, reduce dosage or stop treatment. Nausea or vomiting are early signs of overdose.
- Higher risk of intoxication in cases of hypokalemia, especially if combined with a diuretic.
- Administer with care in cases of renal failure.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Storage: no special temperature requirements

ERYTHROMYCIN (Erythrocin(R), Ilotycin(R).)

District hospital

Therapeutic action

- Antibacterial (antibiotic)

Indications

- For upper and lower respiratory infections as a second choice and in case of allergy or resistance to penicillin

Preparation

- Tablets of 250 mg and 500 mg erythromycin (base)

Dosage

- Child : 30 to 50 mg/kg/d divided in 2 doses
- Adult: 1 to 3 g/d divided in 2 doses depending on the degree of infection
- In case of severe infections, it is recommended to give the dosage in 3 doses/day.

FIGURE

Duration: minimum 5 days

Contra-indications, side-effects, precautions

- Do not combine with ergotamine or aminophylline, especially in pediatrics.
- Allergic reactions, digestive problems possible.
- Administer with care in cases of liver failure.
- Transitory deafness at high doses.
- Pregnancy: no contra-indicafion
- Lactation: no contra-indication

Remarks

- Take before meals.
- Storage: no special precautions

ETHAMBUTOL (Myambutol(R).)

Special department

Therapeutic action

- "Antituberculous" antibacterial

Indications

- Only for tuberculosis, bacteriologically proven if possible

Preparation

- Tablets of 100 mg and 400 mg

There are also tablets of 250 mg and 500 mg. Adapt dosage accordingly.

Dosage

According to national protocol.

For information:

- Child above 5 years and adult: 20 mg/kg/d once daily

FIGURE

Duration: according to national protocol

Contra-indications, side-effects, precautions

- Do not administer in cases of severe renal failure or ocular disease.
- In case of inflammation of the optic nerve (problems of vision: colour and acuity), stop treatment and refer to a doctor.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Not recommended for children as the visual problems are hard to identify.
- Take in the morning before meal.
- 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).
- Ethambutol should not be used alone, but in combination with other "antituberculous" drugs to avoid development of resistance.
- Storage: no special precautions

Iron salts = FERROUS salts, fumarate, ascorbate, sulphate= FERROUS sulphate

Health post

Therapeutic action

- Essential to produce red blood cells

Indications

- Prevention of anaemia during pregnancy
- Treatment of anaemia due to lack of iron: insufficient intake, intestinal parasitic disease, blood loss

Preparation

- Tablet of 200 mg ferrous sulphate (containing 60 mg of the element iron)
Also available in different strengths. Adapt dosage accordingly.

Dosage (unit is ferrous salts)

- Prevention:

Child :6 mg/kg/d once daily
Pregnant women: 100 to 200 mg/d once daily

- Treatment :

Child: 15 to 30 mg/kg/d divided in 3 doses
Adult: 800 mg to 1.2 g/d divided in 3 doses

FIGURE

- Do not exceed indicated doses. Toxic dose: 100 mg/kg ferrous sulphate (= 30 mg/kg element iron).
- Signs of overdose: diarrhoea with blood, heart failure.

Duration

- Prevention: throughout the risk period (pregnancy, malnutrition)
- Treatment: 2 months minimum

Contra-indications, side-effects, precautions

- Do not combine with tetracycline as each drug prevents the other from being absorbed properly.
- Do not administer in cases of sickle cell anaemia.
- Can cause gastro-intestinal problems: gastric burning, diarrhoea or constipation.
- Black colouring of the stools.
- Do not exceed the recommended dose, especially in children.
- Pregnancy: no contra-indication (recommended to avoid anaemia)
- Lactation: no contra-indication

Remarks

- Take during meals to avoid digestive problems.
- If treatment requires the administration of ferrous salts, tablets containing both ferrous salts and folic acid are recommended.
- All ferrous salts are to be used in the same dose, e.g. ferrous fumarate, ascorbate
- Storage: no special precautions

FOLIC ACID

District hospital

Therapeutic action

- Vitamin necessary to produce red blood cells

Indications

- Anaemia caused by lack of folic acid: severe malnutrition, repeated attacks of malaria, intestinal parasites

Preparation

- Tablet of 5 mg. There are also tablets of 1 mg. Adapt dosage accordingly.

Dosage

- Child : 5 to 15 mg/d once daily
- Adult: 10 to 20 mg/d once daily
- In case of severe anaemia, it is recommended to double.

FIGURE

Duration :15 to 30 days

Contra-indications, side-effects, precautions

- Well tolerated.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Storage: no special temperature requirements

FERROUS Salt + FOLIC ACID (Fegal(R).)

Indications

- Prevention of lack of iron and folic acid, mainly during pregnancy

Preparation

- Tablet of 200 mg ferrous sulphate and 0.25 mg folic acid

Dosage

- Child: 1 tab/d
- Adult: 1 to 2 tab/d

Remarks

- This combination is not suitable for the treatment of folic acid deficiency because of its low dose (0.25 mg).
- Storage: keep below 30°C

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

District hospital

Therapeutic action

- Diuretic

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

- Oedema caused by renal, heart or liver failure, DIAGNOSED BY A DOCTOR

Preparation

- Tablet of 40 mg

Dosage

- Child: 0.5 to 1 mg/kg/d once daily
- Adult: 20 to 80 mg/d once daily

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Never administer for other types of oedema, particularly not for kwashiorkor.
- Risk of hypokalemia (increases the toxicity of digoxin when used together).
- Pregnancy:avoid
- Lactation: no contra-indication (but can reduce the milk production)

Remarks

- A lot of fruit should be eaten during the treatment (dates, bananas, tomatoes, mangos, oranges.), in order to supply additional potassium. Use potassium tablets as well if available.
- Storage: no special temperature requirements

GRISEOFULVIN (Fulcin(R), Grisavin(R).)

District hospital

Therapeutic action

- Antifungal

Indications

- Dermatophytosis: fungal infections of skin, scalp and nails (tinea)

Preparation

- Tablets of 125 mg and 500 mg

Dosage

- Child : 10 mg/kg/d divided in 2 doses
- Adult : 500 mg to 1 g/d divided in 2 doses

For scalp infection, there is a single dose treatment

- Child and adult :1.5 g in a single dose (3 tabs of 500 mg or 12 tabs of 125 mg). In this case, the administration of a spoonful of oil improves the effectiveness of the treatment.

FIGURE

Duration - Depending on clinical progress, minimum 10 days. Often needs to be extended over 1 month.

Contra-indications, side-effects, precautions

- Do not administer in cases of liver failure.
- May cause: frequent vomiting, diarrhea, stomach-ache, headache, dizziness, skin allergy and photosensitization, especially with the single dose treatment.
- Do not drink alcohol during treatment.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks

- Use gentian violet to dry the lesions.
- Has no effect on candidiasis or pityriasis versicolor.
- Storage: no special temperature requirements.

HALOFANTRINE (Halfan(R).)

The use of this drug is not advised:

- it is potentially dangerous; these severe adverse effects concerning the cardiac conductions are unforeseable even if an ECG has been done previously;
- it is not included in the WHO essential drug list;
- it is expensive.

Therapeutic action

- Antimalarial

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

- Curative treatment of a malaria attack with Plasmodium falciparum resistant to chloroquine.

Preparation

- Tablet of 250 mg
- Oral suspension 45 ml to 20 mg/ml (1 measuring spoon=1 m.s. = 5 ml = 100 mg)

Dosage

- Child and adult: 24 mg/kg divided in 3 doses to be taken every 6 hours
- Do not exceed indicated doses

FIGURE

Duration: 3 doses, taken every 6 hours

Contra-indications, side-effects, precautions

- Do not administer in case of congenital or acquired prolonged QT interval of the electrocardiogram.
- Avoid in case of severe electrolytic disorders and in thiamin (vitamin B1) deficiency.
- Do not associate with drugs predisposing to the occurrence of "torsades de pointes": antiarrhythmic drugs (quinidine, disopyramide, sotalol), drugs inducing hypokaliemia (diuretics, glucocorticoids).
- May induce arrhythmias: prolongation of QT interval and severe, eventually fatal, ventricular arrhythmias ("torsades de pointes").
- May cause diarrhoea (occasionally), abdominal pain, nausea and vomiting.
- Do an ECG before giving the treatment in case of history of unexplained syncope or malaise.
- Pregnancy: CONTRA-INDICATED
- Lactancy: CONTRA-INDICATED

Remarks

- Administer away from the meals.
- The QT prolongation is more marqued in case of recent treatment with mefloquine.
- Do not use as a preventive treatment because of rapid elimination.
- If the patient has not had a previous malaria attack repeat the treatment after one week.
- Since this treatment is expensive, and to avoid emergence of resistant strains, use, instead sulfadoxine-pyrimethamine or quinine if possible, depending on the local situation and protocol.
- Storage:

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

District hospital

Therapeutic action

- Antihypertensive drug with vasodilatory action

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

- Moderate or severe arterial hypertension when thiazide diuretics or beta-blockers on their own are ineffective

Preparation

- Tablets of 25 mg and 50 mg

Dosage

- Initial dose: adult: 25 to 50 mg/d divided in 2 or 3 doses
- Raise the dose progressively over 2 weeks until the optimal dose of 100 mg/d in 2 or 3 doses is reached.
- When the hypertension is under control, decrease the dose progressively. Stopping suddenly can provoke a hypertensive crisis.
- Do not exceed indicated doses. Maximum dose : 200 mg/d.

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of coronary insufficiency or a recent myocardial infarction.
- Administer with care to elderly patients or those with a history of cerebrovascular accidents.
- Tachycardia reflex, headache.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Hydralazine and dihydralazine are used for the same indications at the same dosage.
- Storage: keep below 30°C

HYDROCHLOROTHIAZIDE (Dochlotride(R), Esidrex(R), HydroSaluric(R).)

District hospital

Therapeutic action

- Diuretic

Indications

- Moderate or severe arterial hypertension
- Oedema caused by renal, heart or liver failure, DIAGNOSED BY A DOCTOR

Preparation

- Tablet of 50 mg

There are also tablets of 25 mg. Adapt dosage accordingly.

Dosage

- Œdema

· Child : 1 mg/kg/d divided in 2 doses
· Adult: 50 to 100 mg in the morning, every 2 days

- Hypertension

· Adult: 25 to 50 mg/d divided in 2 doses

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of severe renal failure, allergy to sulfonamides or kwashiorkor oedema.
- May cause: orthostatic hypotension, photosensitization, disturbance of electrolytes, skin allergies.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks

- Often used in association with other antihypertensive drugs.
- A lot of fruit should be eaten during the treatment (dates, bananas, tomatoes, mangos, oranges.), in order to supply additional potassium. Use potassium tablets as well if available.
- Storage: no special temperature requirements

IBUPROFEN (Brufen(R), Fenbid(R), Motrin(R).)

District hospital

Therapeutic action

- Non-steroidal anti-inflammatory
- Analgesic, antipyretic

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

- Rheumatic diseases

Preparation

- Tablets of 200 mg and 400 mg

Dosage

- Adult: 1200 mg/d divided in 3 doses
- A dose of 2400 mg/d may be used at the beginning of treatment of rheumatoid arthritis.

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of gastroduodenal ulcer and severe renal or liver failure.
- Do not prescribe for children.
- May cause: gastrointestinal problems, allergic reactions.
- Do not combine with other anti-inflammatory drugs (aspirin, indometacin).
- Use with care for infectious diseases: can mask the usual symptoms of the infection.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks

- Take with meals.
- Ibuprofen has less anti-inflammatory activity than indometacin, but is better tolerated in the long term.
- Only prescribe for severe cases which do not improve by ASA (aspirin).
- Storage: no special precautions

INDOMETACIN (Artracin(R), Indocid(R).)

District hospital

Therapeutic action

- Non-steroidal anti-inflammatory drug
- Analgesic, antipyretic

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

- Rheumatic diseases
- Gout

Preparation

- Tablet of 25 mg

Dosage

- Adult :50 to 150 mg/d divided in 3 doses

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· gastroduodenal ulcer,
· severe renal or hepatic failure,
· asthma.

- Do not prescribe for children.
- May cause: headache, dizziness, digestive problems, gastric ulcer.
- Use with care for elderly patients.
- Do not combine with ASA (aspirin) and corticosteroids.
- Pregnancy :avoid
- Lactation :avoid

Remarks

- Take with meals.
- Only prescribe for severe cases which are not improving with ASA (aspirin).
- Storage: no special temperature requirements.

ISONIAZID = INH (Rimifon(R).)

Special department

Therapeutic action

- "Antituberculous" antibacterial

Indications

- Only for tuberculosis, bacteriologically proven if possible

Preparation

- Tablets of 100 mg, 150 mg and 300 mg

There are also tablets of isoniazide + rifampicine.

Dosage

According to national protocol.

For information:

- Child: 10 to 20 mg/kg/d once daily
- Adult: 5 mg/kg/d once daily

FIGURE

Duration: according to national protocol

Contra-indications, side-effects, precautions

- Do not administer in cases of liver failure or epilepsy.
- Do not combine with niridazole: severe mental problems.
- If the patient complains about a prickling feeling in the fingers and toes, or presents signs of liver intoxication (jaundice), stop the treatment and refer to a doctor.
- To avoid polyneuritis, give vitamin B6 with this treatment :10 to 25 mg/d.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Take in the morning before eating.
- 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).
- Isoniazid should not be used alone, but in combination with other "antituberculous" drugs to avoid development of resistance.
- Storage: no special temperature requirements

ISONIAZID + THIACETAZONE = INH + THIACETAZONE (Thiazine(R).)

Special department

Therapeutic action

- Combination of two "antituberculous" antibacterial drugs

Indications

- Only for tuberculosis, bacteriologically proven if possible

Preparation

- Tablets of 100 mg INH + 50 mg thiacetazone and 300 mg INH + 150 mg thiacetazone

Dosage

According to national protocol.

For information:

- Child: 10 to 20 mg/kg/d INH + 50 to 100 mg/d thiacetazone, once daily
- Adult: 5 mg/kg/d INH + 150 mg/d thiacetazone, once daily

FIGURE

Duration: according to national protocol.

Contra-indications, side-effects, precautions

- Do not administer in cases of liver failure or epilepsy.
- Do not combine with niridazole: severe mental problems.
- If the patient complains about a prickling feeling in the fingers and toes, or presents signs of liver intoxication (jaundice), stop the treatment and refer to a doctor.
- In case of intolerance to thiacetazone: skin reactions, haematological disorders, signs of haemolysis, reduction of polynuclear cells or cerebral oedema, stop treatment and refer to a doctor, even if reaction is only moderate.
- If available, give vitamin B6 with this treatment :10 to 25 mg/d.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Take in the morning before eating.
- 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).
- Intolerance to thiacetazone varies genetically, and is notably more common in Asia.
- Warning: thiacetazone is not vitamin B1.
- At the beginning of treatment, INH + thiacetazone should be accompanied by another "antituberculous" drug.
- Storage: no special temperature requirements.

IVERMECTIN (Mectizan(R).)

Special department

Therapeutic action

- Antifilaria

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

- Onchocerciasis with O. volvulus

Preparation

- Divisible tablet of 6 mg

Dosage

- Child and adult :150 to 200 microgrammes/kg (= 0.200 mg/kg), single dose, to be taken on an empty stomach

FIGURE

Duration: single dose

Contra-indications, side-effects, precautions

- Do not administer to children under 5 years.
- May cause passing allergic reactions: pruritus, lymphangitis, fever, œdema, tachycardia, drowsiness.
- Mild, passing digestive problems.
- Benign ophthalmic effects.
- Do not eat within 2 hours after taking the medicine.
- Pregnancy: avoid during first trimester
- Lactation: avoid until the breastfed infant is 3 months of age.

Remarks

- Ivermectin is much better tolerated than diethylcarbamazine in the treatment of onchocerciasis.
- Ivermectin is given free of charge by the manufacturer as part of the campaign against onchocerciasis.
- Storage: no special precaution

LEVAMISOLE (Tramisol(R).)

Health clinic

Therapeutic action

- Anthelminthic

Indications

- Ascariasis
- Hookworm (ankylostomiasis)

Preparation

- Tablet of 40 mg and 150 mg levamisole (base)

Dosage

Child and adult: 2.5 mg/kg

FIGURE

Duration

- Ascariasis : single dose
- Hookworm: repeat treatment after 7 days

Contra-indications, side-effects, precautions

- May cause: nausea, vomiting.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Effectiveness in treatment of hookworm is 75 to 95%.
- Advice on sanitation should be given with the treatment.
- Storage: no special precautions

LOPERAMIDE (Imodium(R), Inosec(R).)

District hospital

Therapeutic action

- Antidiarrhoeal

Indications

- Symptomatic treatment of persistent diarrhoeas, primarily for adults with AIDS, with rehydration.

Preparation

- Capsule of 2 mg

Dosage

- Adult: 2 cap at once, then 1 cap 1 to 3 times per day
- Maximum dosage :8 cap/d

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer to children.
- Risk of constipation.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- The classical treatment of diarrhoea is based on oral rehydration. It is also possible to associate a treatment with traditional herbs (for example infusions of guava leaves.). Loperamide is necessary only for AIDS-patients.
- Storage: keep below 30°C

MEBENDAZOLE (Vermox(R).)

Health post

Therapeutic action

- Anthelminthic

Indications

- Hookworm (ankylostomiasis)
- Ascariasis
- Enterobiasis (pinworm)
- (Tapeworms and strongyloidiasis: second choice)

Preparation

- Tablet of 100 mg

There are also tablets of 500 mg. Adapt dosage accordingly.

Dosage

- Child above 2 years and adult

· Hookworm : 200 mg/d divided in 2 doses for 3 days
· Ascariasis : 500 mg in a single dose
· Enterobiasis 100 mg in a single dose, repeat after 2 or 3 weeks

FIGURE

Duration

- Hookworm : 3 days
- Ascariasis : single dose
- Enterobiasis: single dose, repeat treatment after 2 or 3 weeks

Contra-indications, side-effects, precautions

- Do not administer to children under 2 years.
- Pregnancy: avoid (in most cases, the treatment can wait until the end of the pregnancy)
- Lactation: no contra-indication

Remarks

- In cases of endemic hookworm, it is recommended to prescribe at the same time an antianaemic treatment with ferrous sulphate (if possible combined with folic acid).
- For the systematic elimination of parasites, a single dose scheme of 600 mg can be used.
- Flubendazole has the same indications and dosage.
- Albendazole (Zentel(R)) has the same indications and dosage as mebendazole: 400 mg (2 tab of 200 mg), single dose.
- Advice on sanitation should be given with the treatment.
- Storage: no special precautions

MEFLOQUINE (Lariam(R).)

District hospital

Therapeutic action

- Antimalarial

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

- Curative treatment of a malaria attack with Plasmodium falciparum resistant to chloroquine.

Preparation

- Divisible tablet of 250 mg
- Tablet of 50 mg

FIGURE

Dosage

- Curative treatment :25 mg/kg (person with no immunity)
- Preventive treatment for travellers with no immunity in areas with resistance to chloroquine: 4 mg/kg/week

A weekly dose is necessary: start 1 week before departure and continue for one month after return. Do not take during more than 15 weeks.

Contra-indications, side-effects, precautions

- Not advised for children under 15 kg.
- Digestive problems, dizziness, headache.
- May cause neuropsychopathic problems at curative dosage.
- Bedrest under medical supervision for 24 hours after treatment.
- Do not use at the same time as quinine.
- Pregnancy: CONTRA-INDICATED
- Lactation: avoid

Remarks

- Because of the secondary reactions, the cost of the treatment, and to avoid the spread of resistance, treatment with mefloquine is prescribed as a last resort. Use, instead, sulfadoxine-pyrimethamine or quinine, depending on the local situation and protocol.
- Storage: keep below 30°C

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

The use of this drug is not advised:

- 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.

Therapeutic action

- Analgesic
- Antipyretic

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

- Severe pains
- High fever

Preparation

- Tablet of 500 mg

Dosage

- Child (above 5 years): 250 mg to 1 g/d divided in 3 doses
- Adult: 500 mg to 3 g/d divided in 3 doses

FIGURE

Duration: depending on clinical progress, 1 to 3 days

Contra-indications, side-effects, precautions

- Do not administer in cases of gastric ulcer.
- Severe and lethal cases of agranulocytosis have been found. Use only when other antipyretics and analgesics (e.g. acetyl salicylic acid and paracetamol) are not effective.
- Pregnancy: avoid
- Lactation: avoid

Remarks

- Storage: no special precautions

METHYLDOPA (Aldomet(R), Medomet(R).)

District hospital

Therapeutic action

- Central acting antihypertensive drug without a diuretic effect

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

- Arterial hypertension if no improvement is seen using only diuretics or if beta-blockers are contra-indicated

Preparation

- Tablet of 250 mg

Dosage

- Child: 10 mg/kg/d divided in 3 doses
- Adult: 750 mg/d divided in 3 doses; may be increased progressively up to 1,500 mg/d
- Maximum dosage :2.5 g/d (10 tab)

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· angina pectoris,
· renal or liver failure,
· depression.

- May cause: orthostatic hypotension, dry mouth, sedation, mental or hormonal problems.
- Don't stop the treatment suddenly; reduce the daily doses progressively.
- Pregnancy: no contra-indication
- Lactation: avoid

Remarks

- Storage: keep below 30°C

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
- Nausea
- Hiccups

Preparation

- Tablet of 10 mg

Dosage

- Newborn: 0.5 mg/kg/d divided in 3 doses
- Child : 0.3 to 0.4 mg/kg/d divided in 3 doses
- Adult : 5 to 10 mg/kg/d divided in 3 doses

FIGURE

Duration: depending on clinical progress, as short as possible

Contra-indications, side-effects, precautions

- Contra-indicated in case of haemorrhage, gastro-intestinal obstruction or perforation.
- When elevated doses are given or when treatments are prolonged, extrapyramidal disorder can occur (agitation and spasms), specially in young patients.
- Increased risk of crisis with epileptics and those suffering from Parkinson's disease.
- Reversible methaemoglobinemia in newborns.
- Association with propantheline, 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

METRIFONATE (Bilarcil(R))

Special department

Therapeutic action

- Schistosomicide

Indications

- Urinary bilharzia (Schistosoma haematobium)

Preparation

- Tablet of 100 mg

Dosage

- Child : 10 mg/kg in a single dose
- Adult: 400 mg in a single dose; if the weight of the patient is known, adapt dosage (10 mg/kg)
- Do not exceed indicated doses.

FIGURE

Duration: single dose

Contra-indications, side-effects, precautions

- Risk of overdose: abdominal cramps, bronchospasms, sweating, salivation. In this case, inject an ampoule of atropine SC or inject slowly intravenously.
- Pregnancy: avoid (in most cases the treatment can wait until the end of the pregnancy)
- Lactation: avoid

Remarks

- Repeat treatment after 15 days if the patient leaves the endemic area.
- This drug should be preferred to niridazole (Ambilhar(R)). Niridazole is more expensive and less well tolerated.
- In an endemic area, antibilharzia treatment will only be effective if preventive measures exist to avoid continuous reinfection.
- Advice on sanitation should be given with the treatment.
- Storage: keep below 30°C

METRONIDAZOLE (Flagyl(R)), Metrolyl(R), Zadstat(R).)

Health clinic

Therapeutic action

- Anti-protozoal, antibacterial

Indications

- Amoebiasis, trichomoniasis, giardiasis (= lambliasis)
- Certain anaerobic infections (Bacteroides fragilis, Clostridium perfringens)

Preparation

- Tablet of 250 mg

There are also tablets of 200 mg. Adapt dosage accordingly.

Dosage

- Amoebic dysentery:

Child: 30 to 50 mg/kg/d divided in 3 doses
Adult: 1.5 g/d divided in 3 doses

- Giardiasis:

Child : 15 mg/kg/d divided in 3 doses
Adult: 750 mg/d divided in 3 doses

- Trichomoniasis :

Adult: 2 g in a single dose

- Metronidazole can be used as an antibiotic, under medical supervision, with the same dose used for amoebiasis treatment and combined with penicillin or ampicillin for 6 to 10 days.

FIGURE

Duration

- Amoebic dysentery: 7 days
- Giardiasis : 7 days; repeat treatment after one week
- Trichomoniasis : single dose

Contra-indications, side-effects, precautions

- May cause digestive problems.
- Do not drink alcohol during treatment.
- Pregnancy: a teratogenic effect is not proven, Metronidazole treatment is possible in pregnant woman and it is justified to treat amoebiasis with clinical signs. Nevertheless, try to avoid in the first trimester of pregnancy.
- Lactation: avoid (passes into the breast milk)

Remarks

- In case of trichomoniasis, the partner has to receive oral treatment as well.
- The metronidazole pessaries are not recommended for vaginal trichomoniasis. Treatment should be oral.
- The mere presence of amoeba cysts in the stools is not a sufficient reason to administer metronidazole.
- In mass-treatment of amoebiasis, single dose treatment can be used:

· child: 4 tab from 5 to 15 years; 2 tabs from 1 to 5 years; 1 tab from 1 month to 1 year
· adult: 8 tab (in case of vomiting, give in 2 doses/day)

- Storage: keep below 30°C

MULTIVITAMINS VITAMIN B COMPLEX

Health post

Therapeutic action

- Vitamin supplement

Indications

- Only a few indications: this drug has no effect in cases of real vitamin deficiency, but it will help prevent deficiency in people at risk (pregnant women, malnourished persons).

Preparation

- Tablet and syrup

Composition of tablets varies in quality and quantity, depending on the manufacturer.

Example of composition per tablet(1):

(1) IDA catalogue, 1991

Dosage

- Child and adult: see table below

FIGURE

Duration: depending on situation

Contra-indications, side-effects, precautions

- Pregnancy: no contra-indicafion
- Lactation: no contra-indication

Remarks

- This drug has no impact on sexual activity.
- Multivitamins can be used as a placebo as they are both safe and inexpensive. Their composition is generally similar to the preventive treatment of avitaminoses and has no contra-indication.
- It is not included in the WHO Essential drug list.
- Storage: keep cool if posible.

NICLOSAMIDE (Tredemine(R), Yomesan(R).)

Health clinic

Therapeutic action

- Anthelminthic

Indications

- Tapeworms: Taenia saginata (beef), Taenia solium (pork), Hymenolepsis nana

Preparation

- Tablet of 500 mg

Dosage

- Taenia saginata and Taenia solium

· Child: 30 mg/kg in a single dose, on an empty stomach
· Adult: 2 g in a single dose, on an empty stomach

- Hymenolepsis nana

· Child: 30 mg/kg once daily for 5 days
· Adult: 2 g once daily the first day, then 1 g/d for 6 days

FIGURE

Duration

- Taenia saginata and Taenia solium: single dose
- Hymenolepsis nana : 7 days

Contra-indications, side-effects, precautions

- Frequent digestive problems (stomach pain).
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- The evening before, take a liquid meal. Take the drug in the morning before eating. CHEW THE TABLETS WELL. WAIT TWO HOURS BEFORE TAKING FOOD.
- In case of vomiting, the single dose treatment should be split into two doses, taken with an interval of one hour.
- Niclosamide kills the worm. You do not have to wait to see the worm complete in the stools because it is killed and partially digested.
- Advice on sanitation should be given with the treatment.
- Storage: no special temperature requirements.

NITROFURANTOIN (Furandantin(R), Urantoin(R).)

District hospital

Therapeutic action

- Antibacterial

Indications

- Infections without complications of the lower urinary tract (without fever or lumbar pain).

Do not confuse with gonorrhea (urethral discharge in the morning)

Preparation

- Tablets of 50 mg and 100 mg

Dosage

- Child (above one year): 5 mg/kg/d divided in 3 doses
- Adult: 300 mg/d divided in 3 doses

FIGURE

Duration: minimum 10 days

Contra-indications, side-effects, precautions

- Do not administer to children under 1 year.
- Do not administer in cases of renal failure.
- Dizziness can be a side-effect: stop treatment immediately and refer to a doctor.
- Do not drink alcohol during the treatment.
- Pregnancy: CONTRA-INDICATED at the end of the pregnancy
- Lactation :avoid

Remarks

- If possible, take with meals.
- Cotrimoxazole is generally more active in cases of urinary infections.
- Storage: no special temperature requirements.

NOSCAPINE

District hospital

Therapeutic action

- Antitussive

Indications

- Dry cough

Preparation

- Tablet of 15 mg
- Syrup of 15 mg/5 ml = 1 teaspoon

Dosage

- Child (above 30 months): 4 mg/kg/d divided in 3 doses
- Adult :45 to 90 mg/d divided in 3 doses
- Do not exceed indicated doses.

FIGURE

Duration: maximum 5 days

Contra-indications, side-effects, precautions

- Do not administer in cases of productive cough (sputum).
- Avoid using in children under 30 months.
- May cause: headache, constipation.
- Pregnancy:avoid
- Lactation: avoid

Remarks

- Using traditional anti-cough plants in the form of an infusion or syrup is often recommended.
- Codeine is a similar product with the same indications, but taken in smaller doses.
- Storage: no special precautions.

NYSTATIN (Mycostatin(R), Nystan(R).)

District hospital

Therapeutic action

- Antifungal: candidiasis

Indications

- Digestive candidiasis
- Candidiasis of the mucosa of the mouth and vagina

Preparation

- Tablet of 100,000 IU; for oral and gynaecological use

There are also tablets of 500,000 IU. Adapt dosage accordingly.

Dosage

- Digestive candidiasis Child and adult :4 to 5 tab/d to be sucked
- Candidiasis of the mouth. Child and adult: 1 to 2 tab/d to be sucked or put in the mouth after being crushed
- Vaginal candidiasis. Adult: 1 to 2 tab/d (wet the tablet before introducing it into the vagina)

Duration

- Candidiasis of the mouth: 8 to 10 days
- Vaginal candidiasis : 10 to 20 days

Contra-indications, side-effects, precautions

- The drug is well tolerated.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Has no effect on other types of fungi.
- Oral candidiasis can also be treated with the application of gentian violet or mouth washes with a base of lemon juice or sodium bicarbonate.
- THE GYNAECOLOGICAL TABLETS CAN ALSO BE USED FOR TREATMENT OF ORAL CANDIDIASIS.
- The tablets of 500,000 IU are meant to be swallowed (candidiasis of the digestive tube), but they can be sucked in case of oral candidiasis.
- For vaginal candidiasis, administer orally at the same time as vaginal applications. Do not interrupt treatment during menstruation. Sexual activity is not a contra-indication.
- Storage: keep below 30°C.

ORAL REHYDRATION SALT = ORS (Oralit(R).)

Health post

Therapeutic action

- Provide salts and sugar

Indications

- Prevention and treatment of dehydration in case of diarrhoea and/or vomiting

Preparation

- Sachet of powder to be diluted in one litre of clean, cooled boiled water

Composition:

· sodium chloride (NaCl) 3.5 g
· potassium chloride (KCl) 1.5 g total = 27.9 g
· trisodium citrate 2.9 g
· glucose (dextrose) 20.0 g

Dosage

According to national protocol.

For information:

- Child : 1 to 2 sachets/d given during the whole day = 1 to 2 litres
- Adult: 3 to 4 sachets/d given during the whole day = 3 to 4 litres
- Do not exceed indicated doses.

FIGURE

Duration: as long as the diarrhoea and signs of dehydration continue

Contra-indications, side-effects, precautions

- If oedema develops, reduce the quantities.
- In case of vomiting, give the liquid frequently in very small amounts; do not stop the rehydration.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- If the child cannot swallow, use a (naso-) gastric tube if necessary.
- Signs of improvement: the patient begins to urinate again.
- When the patient improves, you can give ORS and clean water alternately.
- If no ORS is available, you can use a sugar and salt solution: 2 pinches of salt (3 g), 4 tablespoons of sugar (40 go), added to some fruit juice, diluted in one litre of clean, cooled boiled water.
- Storage: no special temperature requirements. Do not use the powder if it has turned into a yellow-brown sticky substance.

ONCE MADE UP, THE SOLUTION MUST BE USED THE SAME DAY.

OXAMNIQUINE (Mansil(R), Vansil(R).)

Special department

Therapeutic action

- Schistosomicide

Indications

- Intestinal bilharzia (Schistosomia mansoni)

Preparation

- Tablet of 250 mg

Dosage

- Child : 20 to 40 mg/kg in a single dose
- Adult: 1 g in a single dose

FIGURE

Duration: single dose

Contra-indications, side-effects, precautions

- Do not administer in cases of renal or heart failure, or epilepsy.
- May cause: nausea, some dizziness, drowsiness, headache.
- Colours the urine red.
- Pregnancy: avoid (in most cases, treatment can wait until the end of the pregnancy)
- Lactation: avoid

Remarks

- Take with evening meal to avoid side-effects.
- Treatment with praziquantel, which is just as effective and well tolerated, and 3 times as cheap (IDA 1991).
- This drug is less dangerous than niridazole (Ambilhar(R)).
- The impact of the antibilharziosis treatment will be negligible if there are no parallel preventive measures to avoid the recurrence of the disease in endemic areas.
- Advice on sanitation should be given with the treatment.
- Storage: no special precautions

PARACETAMOL=ACETAMINOPHEN (Doliprane(R), Panadol(R), Tylenol(R).)

Health post

Therapeutic action

- Analgesic
- Antipyretic

Indications

- Headache, toothache or joint pain
- Fever

Preparation

- Tablets of 100 mg and 500 mg

Dosage

- Child : 20 to 30 mg/kg/d divided in 3 doses
- Adult: 2 to 3 g/d divided in 3 doses

FIGURE

Duration

- Depending on clinical progress, 1 to 3 days.
- Do not continue treatment for an extended period without medical advice.

Contra-indications, side-effects, precautions

- Do not administer in cases of liver disease (hepatitis) or alcoholism.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Paracetamol is recommended for patients who are allergic to A.S.A. (aspirin), those with stomach problems and for children under one year.
- IT HAS NO ANTI-INFLAMMATORY PROPERTIES.
- Storage: keep below 30°C.

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

District hospital

Therapeutic action

- Anticonvulsive, sedative and hypnotic

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

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

Preparation

- Tablets of 30 mg, 50 mg and 100 mg

Dosage

According to national protocol.

For information:

- Child : 3 to 5 mg/kg/d once daily or divided in 2 to 3 doses
- Adult: 150 to 200 mg/d once daily or divided in 2 to 3 doses

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of respiratory depression or porphyria.
- Risk of drowsiness and depression of the central nervous system.
- Do not stop the treatment suddenly.
- 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
- Lactation: avoid

Remarks

- For convulsions, in cases of extreme agitation and in emergencies, it is better to use diazepam (Valium(R)).
- Plasma-concentrations are stable after 2 to 3 weeks. Beware of accumulation.
- If necessary, a treatment with phenytoin may be used with this treatment.
- Storage: no special precautions.

PHENOXYMETHYL PENICILLIN=PENICILLIN V (Crystapen V(R), Stabillin V-K(R), V-Cil-K(R).)

Health clinic

Therapeutic action

- Antibacterial (antibiotic)

Indications

- Tonsillitis
- Pneumopathy
- Dental abscess
- Extensive impetigo with or without general signs

Preparation

- Tablets of 125 mg (200,000 IU) and 250 mg (400,000 IU)
- Syrup of 125 mg/5 ml (200,000 IU/5 ml) = 1 teaspoon (1 tsp)

There are also other presentations and strengths. Adapt dosage accordingly.

Dosage

- Child: 150,000 IU/kg/d divided in 3 doses
- Adult: 1.5 to 3 MIU/d divided in 3 doses

4 doses/day are more effective, but to ensure that the treatment is likely to be followed correctly, we recommend 3 doses/day.

FIGURE

Duration :5 to 8 days

Contra-indications, side-effects, precautions

- Do not administer in cases of known allergy to penicillin.
- If allergic reactions: stop treatment and refer to a doctor.
- Do not combine with other antibiotics.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Do not use orally in case of:

· meningitis or gonorrhoea (use injections of procaine penicillin or PPF);
· syphilis (use injections of benzathine penicillin).

- Storage: keep below 30°C.

Once prepared, the syrup must be kept cool and will only last for one week.

PHENYLBUTAZONE (Butazolidin(R).)

The use of this drug is not advised:

- it is potentially dangerous;
- it is not included in the WHO essential drug list;
- its marketing is forbidden in several countries.

Therapeutic action

- Non steroidal anti-inflammatory

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

- Ankylosing spondilitis, gout, resistant to other anti-inflammatory drugs

Preparation

- Tablet of 200 mg

Dosage

- Adult: 300 to 600 ma/d divided in 3 doses

FIGURE

Duration: as short as possible, depending on clinical progress

Contra-indications, side-efects, precautions

- Do not administer in case of:

· peptic ulcer,
· liver failure,
· known allergy to phenylbutazone.

- Risk of severe sometimes fatal agranulocytosis.
- Should only be used as an analgesic if all other analgesics are ineffective.
- Do not combine with anticoagulants, digitalis, phenytoin or other anti-inflammatory drugs (including aspirin).
- Pregnancy: avoid
- Lactation: avoid

Remarks

- Take with meals.
- Storage: keep below 30°C

PHENYTOIN (Di-hydan(R), Dilantin(R), Epanutin(R).)

District hospital

Therapeutic action

- Anticonvulsive

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

- Epilepsy, except absence seizure (petit mal)

Preparation

- Tablet of 100 mg

There are also tablets of 25 mg and 50 mg. Adapt the dosage accordingly.

Dosage

- Child : 3 to 8 mg/kg/d divided in 2 or 3 doses
- Adult: 2 to 6 mg/kg/d divided in 2 or 3 doses

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in case of known allergy.
- Risk of digestive problems: gingival hypertrophy, nausea, vomiting.
- If prolonged usage, risk of haematologic problems. Monitor peripheric blood count if possible and administer folic acid.
- Risk of neurological problems: dizziness, visual problems, mental confusion.
- Allergic reactions: cutaneous eruptions, fever, adenopathy.
- Pregnancy: avoid
- Lactation: avoid

Remarks

- It is not advised to associate phenytoin with oral contraceptives, sulfamides, or chloramphenicol. Combination with other drugs must be closely monitored (diazepam, phenobarbital, barbiturates, digoxin, corticosteroids.).
- Storage: keep below 30°C.

Never use expired phenytoin (risk of under dosage).

PIPERAZINE (Antepar(R), Pripsen(R).)

District hospital

Therapeutic action

- Anthelminthic

Indications

- Ascariasis
- Enterobiasis (pinworm)

Preparation

- Tablets of 300 mg and 500 mg
- Syrup of 750 mg/5 ml = 1 teaspoon

Dosage (expressed in piperazine hydrate)

- Ascariasis : Child: 75 mg/kg, in a single dose Adult :3 to 4 g, in a single dose
- Enterobiasis: Child: 50 mg/kg/d for 5 days Adult: 3 to 4 g/d for 5 days
- Do not exceed indicated doses.

FIGURE

Duration

- Ascariasis : single dose
- Enterobiasis: 1 course of 5 days

Contra-indications, side-effects, precautions

- Do not administer in case of epilepsy, renal or liver failure.
- Risk of overdose and neurological toxicity: dizziness, problems of vision and/or consciousness.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- This drug is still frequently used but considering its ineffectiveness on hookworm and its side-effects, it is often replaced by more broad-spectrum anthelmintic drugs (mebendazole), which are more effective for general deworming.
- 100 mg piperazine hydrate = 120 mg adipate = 125 mg citrata = 104 mg phosphate.
- Advice on sanitation should be given with the treatment.
- Storage: no special temperature requirements.

POTASSIUM Chloride

District hospital

Therapeutic action

- Potassium supplement

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

- Hypokalemia:

· following diuretic treatment with thiazides
· of other origin (dehydration.)

Preparation

- Tablet of 8 mmol (mEq) of K+ = 600 mg
- Tablet of 6.7 mmol (mEq) of K+ = 500 mg

WARNING, DOSES VARY DEPENDING ON SUPPLIER. Adapt dosage accordingly.

Dosage

- Adult: 7 to 15 mmol/d or 0.5 to 1 g/d
- Do not exceed indicated doses.
- Use slow release tablets.

FIGURE

Duration: depending on clinical progress and duration of diuretic treatment

Contra-indications, side-effects, precautions

- May cause: nausea, vomiting.
- Risk of intestinal ulcers and heartburn, in particular when using quick dissolving tablets.
- Do not combine with spironolactone and other similar diuretics.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- If tablets are not available, a lack of potassium can be corrected by a diet rich in dates, bananas, mangos, oranges, tomatoes.
- One ORS sachet contains 1,5 g of potassium chloride.
- Storage:

PRAZIQUANTEL (Biltricide(R).)

Special department

Therapeutic action

- Schistosomicide, also active on distomiasis

Indications

- Bilharziasis:

· S. haematobium (urinary bilharzia)
· S. mansoni and S. intercalatum (intestinal bilharzia)
· S. japonicum and S. mekongi (hepato-splenic bilharzia)

- Distomiasis: Opisturchis felinus, Clonorchis sinensis, Paragonimum westermani, Fasciola hepatica

Preparation

- Tablet of 600 mg

Dosage

- Bilharziasis S. haematobium, S. mansoni, S. intercalatum
Child and adult :40 mg/kg in a single dose
- Bilharziasis S. japonicum, S. mekongi
Child and adult :60 mg/kg divided in 3 doses in 1 day
- Distomiasis
Child and adult: 75 mg/kg/d divided in 3 doses

FIGURE

Duration

- Bilharziasis S. haematobium, S. mansoni, S. intercalatum: single dose
- Bilharziasis S. japonicum, S. mekongi :3 doses, 1 day
- Distomiasis: Opisturchis felinus, Clonorchis sinensis, Paragonimum westermani :2 to 3 days

Fasciola hepatica :5 to 7 days

Contra-indications, side-effects, precautions

- Risk of allergy.
- May cause: nausea, vomiting, headache.
- Pregnancy: avoid (in most cases, treatment can wait until the end of the pregnancy)
- Lactation :avoid

Remarks

- In an endemic area, antibilharzia treatment will only be effective if preventive measures exist to avoid continuous reinfection.
- Advice on sanitation should be given with the treatment.
- Storage:

PREDNISOLONE (Codelsol(R), Deltastab(R), Prednesol(R).) and PREDNISONE (Decortisyl(R), Econosone(R).)

District hospital

Therapeutic action

- Corticosteroid

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

- Symptomatic treatment:

· allergic diseases
· inflammatory diseases
· severe asthma

Preparation

- Tablet of 5 mg

Dosage

- Child: initial dose :1 to 2 mg/kg/d maintenance dose: 0.1 to 0.5 mg/kg/d
- Adult: initial dose :20 to 80 mg/d maintenance dose: 5 to 20 mg/d

FIGURE

- In case of prolonged treatment, do not stop the treatment suddenly. Decrease the dose by 5 mg each day.

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· peptic ulcer,
· fungal and/or viral infections (herpes), or bacterial infections not controlled by antibiotics.

- May cause: hypokalemia, osteoporosis if prolonged treatment.
- Risk of oedema and arterial hypertension as a result of sodium and water retention.
- Risk of adrenal suppression in case of prolonged treatment with daily doses of 15 to 20 mg.
- If daily administration of more than 20 mg, a salt-free diet and potassium supplement are recommended.
- If acute adrenal failure, prescribe hydrocortisone: 100 to 300 mg IV.
- Pregnancy: avoid in the first trimester
- Lactation :avoid

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

- Storage: keep below 30°C.

PROBENECID (Benemid(R).)

Health clinic

Therapeutic action

- Prolongs the action of penicillin and ampicillin
- (Anti-gout)

Indications

- In combination with procaine penicillin (or possibly with ampicillin or amoxycillin) in the treatment of gonorrhoea. Can be combined with other penicillin preparations. BENZATHINE PENICILLIN CAN NOT BE USED WITH PROBENEClD.

Preparation

- Tablet of 500 mg

Dosage

In conjunction with penicillin treatment:

- Child (above 2 years): 20 to 25 mg/kg/d
- Adult :1 g/d

FIGURE

Duration: depending on the penicillin treatment

Contra-indications, side-effects, precautions

- Do not administer in children under 2 years.
- Do not combine with acetyl salicylic acid (aspirin).
- Pregnancy :avoid
- Lactation :avoid

Remarks

- The combination of probenecid and procaine penicillin is always indicated for the treatment of gonorrhoea, except in pregnant women.
- Tablets can be taken at the same time as the injection, or preferably, 1/2 hour before.
- Storage: keep below 30°C.

PROGUANIL (Paludrine(R).)

District hospital

Therapeutic action

- Antimalarial

Indications

- Prevention of malaria in association with chloroquine in countries with rare or moderate resistance to chloroquine.

Preparation

- Tablet of 100 mg

Dosage

Conform to national protocol.

For information:

FIGURE

Duration

- Travellers must start to take proguanil associated with chloroquine 24 hours before departure, continue throughout their journey and for 4 to 6 weeks after return.

Contra-indications, side-effects, precautions

- Transitory digestive problems.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Take tablets with some water, every day, at the same time, after the meal.
- Storage: no special precaution.

PROMETHAZINE (Phenergan(R).)

District hospital

Therapeutic action

- Anti-emetic
- Antihistaminic
- Sedative

Indications

- Vomiting
- Allergic reactions due to:

· contact, seasons.
· drugs, insect bites, food.

- Dry cough of allergic origin

Preparation

- Tablets of 25 mg

Dosage

- Child: 1 mg/kg/d divided in 2 or 3 doses
- Adult: 25 to 50 mg/d divided in 2 or 3 doses

FIGURE

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

Contra-indications, side-effects, precautions

- Do not drink alcohol during treatment.
- In case of drowsiness, administer in the evening.
- 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).
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Chlorpheniramine is cheaper, but has no anti-emetic action.
- Storage: keep below 30°C.

PROPRANONOL (Angilol(R), Inderal(R).)

District hospital

Therapeutic action

Beta-blocker, used against hypertension, angina and arrhythmias

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

- Arterial hypertension
- Angina pectoris
- Arrhythmia diagnosed by a doctor (with ECG)

Preparation

- Tablets of 10 mg and 40 mg

Dosage

-Arterial hypertension
80 mg/d divided in 2 doses, to be increased progressively depending on clinical progress, maximum 320 mg/d
-Prophylaxis for angina pectoris
Initial dose: 30 to 60 mg/d divided in 3 doses, to be increased every 4 days up to a dose of 160 to 320 mg/d
-Prevention of arrhythmia after myocardial infarction
180 to 240 mg/d divided in 2 or 3 doses; start as of the 6th or 9th day after the infarction and continue for 18 months at a dose of 160 mg/d

Duration

- Depending on indication and clinical progress
- Do not stop abruptly.

Contra-indications, side-effects, precautions

-The drug should only be prescribed for patients who are following a prolonged treatment. The treatment should never be stopped suddenly.
- Do not administer in cases of:

· asthma,
· bradycardia below SO/min, bundle-branch block,
· heart failure (or a history of),
· arteritis of the lower limbs, Raynaud syndrome.

- Administer with care in cases of diabetes, digitalis treatment or emphysema, and in cases of renal or liver failure.
- Do not combine with aminophylline (reciprocal inhibition), digitalis (bradycardia), adrenaline (hypertension), curare, M.A.O. inhibitors.
- Pregnancy: no contra-indication
- Lactation :avoid

Remarks

- For the treatment of hypertension, may be combined with a diuretic.
- Storage: no special temperature requirements.

PYRANTEL (Combantrin(R).)

District hospital

Therapeutic action

- Anthelminthic

Indications

- Ascariasis
- Enterobiasis (pinworm)
- Hookworm (ankylostomiasis)

Preparation

- Tablet of 125 mg

There are also tablets of 250 mg. Adapt dosage accordingly.

Dosage

- Ascariasis, enterobiasis, hookworm caused by Ancylostoma duodenalis

Child and adult :10 mg/kg in a single dose

- Hookworm caused by Necator americanus

Child and adult :20 mg/kg/d once daily

FIGURE

Duration

- Ascariasis, enterobiasis, hookworm caused by Ancylostoma duodenalis: single dose
- Hookworm caused by Necator americanus: 3 days

Contra-indications, side-effects, precautions

- Administer with care in case of liver failure.
- May cause: digestive problems, headache, dizziness.
- Pregnancy: avoid (in most cases, the treatment can wait until the end of the pregnancy)
- Lactation: no contra-indication

Remarks

- Generally more expensive than mebendazole and levamisole.
- Sanitation advice should be given with the treatment.
- Storage: no special temperature requirements.

PYRAZINAMIDE (Zinamide(R).)

Special department

Therapeutic action

- "Antituberculous" antibacterial

Indications

- Only for tuberculosis, bacteriologically proven if possible

Preparation

- Tablet of 500 mg

Dosage

According to national protocol.

For information

- Child and adult :25 mg/kg/d maximum
- Can also be given in a dose of 40 mg/kg 2 times a week or 70 mg/kg once a week

Duration: according to national protocol

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· Iiver failure,
· history of allergy to ethionamide, isoniazid and nicotinamide.

- May cause: anorexia, nausea, vomiting, skin allergies, joint pains, gout.
- Pregnancy :avoid
- Lactation: avoid

Remarks

- 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).
- Pyrazinamide should not be used alone, but in combination with other "antituberculous" drugs to avoid resistance.
- Storage: keep below 30°C.

PYRIDOXINE = Vitamin B6

District hospital

Therapeutic action

- Vitamin

Indications

- Prevention and treatment of peripheral neuropathies, particularly if isoniazid (INH) has been prescribed

Preparation

- Tablets of 25 mg and 50 mg

Dosage

- Child: 25 to 50 mg/d once daily
- Adult: 50 to 150 mg/d once daily

FIGURE

Duration: depending on clinical progress or as long as the treatement with isoniazid (INH) continues

Contra-indications, side-effects, precautions

- No contra-indication.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- Storage: no special temperature requirements

QUININE Salts

District hospital

Therapeutic action

- Antimalarial

Indications

- Treatment of Plasmodium falciparum malaria resistant to chloroquine
- Follow up of injectable quinine given for cerebral malaria or chloroquine resistance

Preparation

- Tablets of 200 mg and 300 mg of quinine salts (generally sulphates or chlorhydrates)

There are also tablets of 100 mg, 250 mg and 500 mg. Adapt dosage accordingly.

Dosage

- Child : 25 to 40 mg/kg/d divided in 3 doses
- Adult: 1.5 to 2 g/d divided in 3 doses

Dosages and doses of the tablets are generally expressed in salts. They are all equal (formiate, sulphate, chlorhydrate, bi-chlorhydrate), except for bi-sulphate which is weaker and thus needs its own special dose.

FIGURE

Duration: 7 days

Contra-indications, side-effects, precautions

- Risk of toxicity in case of doses over 4 g: headache, disturbance of vision, abdominal pain, nausea, buzzing (tinitus) of ears.
- Possible allergic reactions.
- 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 and tetracycline (25 mg/kg/d) or doxycycline (200 mg/d) for 10 days is necessary because of resistance.
- Antacids, like aluminium hydroxide, can slow down the absorption of quinine.
- Storage: keep below 30°C.

RESERPINE (Decaserpyl(R), Rauwiloid(R), Serpasil(R).)

District hospital

Therapeutic action

- Antihypertensive

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

- Moderate arterial hypertension (in combination with a diuretic)

Preparation

- Tablets of 0.10 mg, 0.25 mg and 0.50 mg

Dosage

- Adult: 0.10 to 0.25 mg/d to be combined with a diuretic and to be adapted according to therapeutic progress

FIGURE

Duration: depending on clinical progress

Contra-indications, side-effects, precautions

- Do not administer in cases of:

· depression or history of depression,
· peptic ulcer,
· heart and/or severe renal failure,
· epilepsy.

- May cause: nausea, vomiting, gastritis, depression, anxiety, bronchial spasms.
- It has a slow but long lasting action: risk of accumulation.
- Avoid combination with digitalis, quinidine and other anti-arrhythmic drugs, alcohol and suppressors of the central nervous system: diazepam (Valium(R), phenobarbitone (Gardenal(R)) and chlorpromazine (Largactil(R)).
- Pregnancy : avoid
- Lactation: avoid

Remarks

- Storage: keep below 30°C.

RETINOL = VITAMIN A (Ro-A-Vit(R)..)

Health clinic

Therapeutic action

- Vitamin

Indications

- Prevention of vitamin A deficiency
- Treatment of xerophthalmia: reduced night vision, desiccation (drying) and ulceration of the cornea, Bitot's spots.
- Treatment of children specifically vulnerable for vitamin A deficiency: measles, malnutrition, respiratory infections.

Preparation

- Capsules of 50,000 IU and 200,000 IU

There are also capsules of 25,000 IU. Adapt dosage accordingly.

Dosage

- Prevention: Adult and Child above 1 year: 200,000 IU in a single dose every 6 months.

Child under 1 year: 100,000 IU in a single dose every 6 months

- Treatment: Adult and Child above 1 year: 1st, 2nd and 8th day, 200,000 IU once daily.

Child under 1 year : 1st, 2nd and 8th day, 100,000 IU once daily

- Do not exceed indicated doses.

For children under 1 year: when capsules of 50,000 IU are not available, pierce a capsule of 200,000 IU and give 3 drops.

FIGURE

Duration

- Prevention: single dose every 6 months
- Treatment: 1st, 2nd and 8th day; thereafter as for "prevention" if necessary

Contra-indications, side-effects, precautions

- Pregnancy: prevention: avoid, give a single dose just after delivery
treatment: do not exceed a dose of 10,000 Odd (risk of fetal malformation)
- Lactation: no contra-indication

Remarks

- The injectable form has no advantages.
- Food rich in vitamin A: dark green vegetables, palm oil, orange or red coloured fruits and vegetables, eggs, full-cream milk and meat.
- Storage: keep cool.

RIFAMPICIN (Rifadin(R), Rimactane(R).)

Special department

Therapeutic action

- "Antituberculous" and "antileprotic" antibacterial

Indications

- Tuberculosis, bacteriologically proven if possible
- Leprosy (Hansen's disease)

Preparation

- Tablets or capsules of 150 mg and 300 mg

Dosage

According to national protocol.

For information:

- Tuberculosis: 10 mg/kg/d
- Leprosy : 600 mg once every month

FIGURE

Duration: according to national protocol

Contra-indications, side-effects, precautions

- Do not administer if liver failure, porphyria or allergy for rifampicin.
- Risk of hepatotoxicity.
- May cause allergies.
- Urine, stools and secretions may turn red.
- Pregnancy: avoid
- Lactation: avoid

Remarks

- Warning: antituberculous and antileprotic treatments should only be prescribed in the context of an organised program (well established protocol, regular patient checks and the possibility of laboratory examination).
- Rifampicin should not be used alone, but in combination with other "antituberculous" or "antileprotic" drugs to avoid resistance.
- Rifampicin is an expensive antituberculous drug.
- Storage: no special temperature requirements

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

District hospital

Therapeutic action

- Bronchodilator
- Uterorelaxant

Indications

- Acute or chronic asthma (with continuous dyspnea).
- Bronchitis and obstructive pneumopathies with bronchospasm.
- Prevention of premature delivery: taking over treatment after emergency injectable treatment.

Preparation

- Tablets of 2 mg and 4 mg of salbutamol (in the form of sulphate)
- Syrup of 2 mg/5 ml

Dosage

- Asthma

· Child: 0.10 mg/kg/d divided in 3 doses
· Adult: 6 to 12 mg/d divided in 3 doses

Prevention of premature delivery: 1 tab of 2 mg 4 times a day

FIGURE

Duration: depending on clinical evolution

Contra-indications, side-effects, precautions

-Do not administer in cases of myocardial infarction or acute coronary insufficiency.
-Administer carefully if cardiac insufficiency, arrhythmia, hypertension, diabetes, hyperthyroidism.
-May cause: tachycardia, trembling, dizziness, headache.
-During the treatment, especially if the doses are taken too often, the bronchodilatory effect can decrease: stop treatment.
-Salbutamol is not very efficient for children less than 2 years.
-Pregnancy: no contra-indication
-Lactation: no contra-indication

Remarks

- Storage: keep below 30°C.

SULFADIMIDINE = SULPHADIMIDINE

District hospital

Therapeutic action

- Antibacterial (sulfonamide)

Indications

- Infections of the lower urinary tract without complications: without fever or lumbar pain.

Do not confuse with gonorrhoea (urethral discharge in the morning).

Preparation

- Tablet of 500 mg

Dosage

- Child (above 2 months): 100 to 250 mg/kg/d divided in 3 doses
- Adult: 2 to 6 g/d divided in 3 doses

FIGURE

Duration: minimum 7 days

Contra-indications, side-effects, precautions

- Do not administer:

· for children under 2 months,
· if known allergy to sulfonamides,
· if hematological disorder.

- Frequently causes digestive problems.
- Allergic reactions possible. Stop the treatment and refer to a doctor.
- DRINK A LOT during treatment to prevent kidney stones.
- Do not combine with other antibacterials.
- Pregnancy: CONTRA-INDICATED (use ampicillin if causative bacteria is sensitive)
- Lactation: CONTRA-INDICATED

Remarks

- For upper urinary tract infections and those with fever, cotrimoxazole is more effective.
- Sulfadimidine is nowadays usually replaced by cotrimoxazole.
- Storage: keep below 30°C.

SULFADOXINE + PYRIMETHAMINE (Fansidar(R).)

Special department

Therapeutic action

- Antimalarial

Indications

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

Preparation

- Tablet of 500 mg sulfadoxine + 25 mg pyrimethamine

Dosage

- Child: i/2 tab/10 kg, in a single dose
- Adult: 2 to 3 tab, in a single dose

FIGURE

Duration: single dose

Contra-indications, side-effects, precautions

- Do not administer if:

· allergy to sulfonamides,
· renal or liver failure.

- Do not combine with chloroquine.
- Do not administer at the same time as cotrimoxazole.
- May cause: gastro-intestinal problems, nausea, vomiting, cutaneous allergic reactions.
- If the attack is pernicious, treat with quinine.
- Avoid for children under 5 years.
- Pregnancy: CONTRA-INDICATED
- Lactation :avoid

Remarks

- Sulfadoxine + pyrimethamine as prophylaxis has been abandoned because of frequent serious side-effects.
- Warning: there is an increasing number of resistant strains.
- Storage: no special temperature requirements.

SULFAGUANIDINE (Ganidan(R).)

The use of this drug is not advised:

- it has no proven effectiveness;
- it is not included in the WHO essential drug list;
- its purchase is an useless expense.

Therapeutic action

- Antibacterial (sulfonamide)

Indications

- None. It has no effect on the treatment of bacterial diarrhoea : the pathogens have become resistant

Preparation

- Tablet of 500 mg

Dosage

It used to be given as follows:

- Child (above 2 months): 100 mg/kg/d, divided in 4 doses
- Adult: 12 g/d divided in 4 doses

Contra-indications, side-effects, precautions

- Do not administer:

· to children under 2 months,
· if known allergy to sulfonamides.

- Allergic reactions possible. Stop treatment and refer to a doctor.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDICATED

Remarks

- Storage: no special precautions.

TETRACYCLINE (Abfosan(R), Hexacycline(R), Tetramig(R).)

OXYTETRACYCLINE (Terramycine(R).)

DOXYCYCLINE (Doxy 100(R), Granudoxy(R), Spanor(R), Vibramycin(R).)

District hospital

Therapeutic action

- Antibacterials (of the cycline group)

Indications

- Cholera, brucellosis, borreliosis, rickettsiosis
- Gonorrhoea (if allergy or resistance to penicillin)
- Syphilis (if allergy or resistance to penicillin)
- Genital infections with Chlamydia
- Infections with Balantidium coli
- Atypical pneumopathy
- Chloroquine-resistant malaria, in association with quinine

Preparation

- Tetracycline: capsule or tablet of 25 mg
- Doxycycline: capsule or tablet of 100 mg

Dosage

- Tetracycline:

child above 8 years: 25 to 50 mg/kg/d divided in 3 doses
adult: 1 to 3 g/d divided in 3 doses

- Doxycycline:

child above 8 years :4 mg/kg/d once daily
adult: 200 mg/d once daily

- Cholera:

· tetracycline treatment 2 g/d divided in 4 doses for 3 days prophylaxis 1 to 1.5 g/d divided in 2 or 3 doses for 2 days to be repeated every 10 to 15 days
· doxycycline treatment and prophylaxis

child: 4 mg/kg in a single dose
adult: 300 mg in a single dose

Vibrio is increasingly resistant to cyclines.

FIGURE

Duration: 57days (tetracycline or doxycycline); Syphilis :14 days; Chlamydia: 21 days

Contra-indications, side-effects, precautions

- Do not administer:

· to children less than 8 years (colors teeth yellow)
· if renal diseases

- Do not give together with milk, iron or aluminium hydroxide.
- May cause: frequent digestive problems (diarrhoea.).
- Do not combine with other antibiotics.
- Pregnancy: CONTRA-INDICATED
- Lactation: CONTRA-INDlCATED

Remarks

- Take in-between meals.
- Treatments with doxycycline are cheaper and more efficient than those with tetracycline.
- Oxytetracycline has the same indications and doses as tetracycline.
- Storage: keep below 30°C.
Never administer expired tetracyclines or doxycycline

THIABENDAZOLE (Mintezol(R).)

District hospital

Therapeutic action

- Anthelminthic

Indications

- Strongyloidiasis
- Trichinosis
- Cutaneous larva migrans
- Hookworm (ankylostomiasis) and trichocephalosis: mebendazole preferred

Preparation

- Tablet of 500 mg

Dosage

- Strongyloidiasis Child and adult: 50 mg/kg in a single dose
- Trichinosis Child and adult: 50 mg/kg/d divided in 3 doses
- Cutaneous larva migrans Child and adult: 3 g in 30 g vaseline or antipruritic ointment, 3 applications per day during one week
- Chew tablets during the meal.

FIGURE

Duration

- Strongyloidiasis : single dose
- Trichinosis : 5 days
- Cutaneous larva migrans: 7 days

Contra-indications, side-effects, precautions

- Do not administer if allergy to thiabendazole, renal or liver failure.
- May cause: drowsiness, frequent dizziness, nausea, vomiting, diarrhoea.
- Allergic reaction can sometimes be very strong: Quincke oedema, Stevens Johnson syndrome.
- Pregnancy: avoid
- Lactation: avoid

Remarks

- Because of its limited indications, its price and side-effects, do not use for systematic elimination of parasites, but administer cheaper, broad-spectrum anthelminthic drugs.
- Storage: keep below 30°C.

THIAMINE = ANEURIN = VITAMIN B1 (Benerva(R), Bevitine(R).)

District hospital

Therapeutic action

- Vitamin

Indications

- Beri-beri: neurological or cardiac form
- Polyneuritis in alcoholics or due to nutritional deficiency

Preparation

- Tablet of 50 mg

There are also tablets of 10 mg, 25 mg, 100 mg and 250 mg. Adapt dosage accordingly.

Dosage

- Curative treatment

· Child: 10 to 30 mg/d
· Adult: 50 to 100 mg/d - up to 300 mg in case of severe deficiency to be taken once daily or divided in several doses

- Preventive treatment

· Child and adult :5 mg/d

Daily needs

child : 0.3 to 1 mg/d
adult and adolescent : 1.3 to 1.5 mg/d
pregnancy and lactation: 1.5 to 1.8 mg/d

FIGURE

Duration: at least one month for curative treatment

Contra-indications, side-effects, precautions

- No contra-indications, or side-effects with oral administration of vitamin B1.
- Pregnancy: no contra-indication
- Lactation: no contra-indication

Remarks

- The use of injectable vitamin B1 is only justified in exceptional cases (for example in cases of cardiac insufficiency or acute pulmonary oedema caused by an unbalanced diet).
- Storage: closed, non-metallic container.

TOLBUTAMIDE (Artosin(R), Dolipol(R), Rastinon(R).)

District hospital

Therapeutic action

- Sulfamide hypoglycemic agent wich stimulates the secretion of pancreatic insulin

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

- Diabetes of the adult, non acidocetosic, of insulin independent type and not balanced by a well followed diet

Preparation

- Tablet of 500 mg

Dosage

- Adult: 0.25 to 1.5 g/d at once during breakfast or divided in 3 doses before meals
- Adapt dosage progressively and with great care to elderly people.

FIGURE

Duration: depending on clinical progress and results of laboratory

Contra-indications, side-effects, precautions

- Do not administer to diabetic children under 16 years.
- Do not administer to an insulin-dependant diabetic, or to a patient with renal or hepatic failure.
- Do not administer to an alcoholic: antabuse reaction.
- Hypoglycemic problems to be treated with intake of oral sugar or IV injection if severe.
- Use with many associations to other drugs not advisable: sulfadimidine, prednisone, aspirin.
- Pregnancy :avoid
- Lactation :avoid

Remarks

- Chlorpropamide (Diabinese(R)) is an oral long acting antidiabetic of the same group, used at doses of i/2 to 2 tab/d once daily. Risk of hypoglycemia is higher.
- Another hypoglycemic sulfamide is glibenclamide (Daonil(R)), tablet of 5 mg: 1/2 to 3 tab/d.
- Use if failure of proper diet, and control glycemia regularly.
- Usage of oral antidiabetics does not mean dietetic measures should be cancelled.
- Storage: keep below 30°C.