PRESUMPTIVE TREATMENT (PT):

Age in                          Low Risk Area             High Risk Area

Years               - —————————————————————————————————————————-

0 –1                               75                  75         75        37.5                               -

1-  4                             150                  150      150        75                                7.5

4 – 8                            300                  300      300      150                              15.0

8 – 14                          450                  450      450      225                              30.0

> 14                             600                  600      600      300                              45.0

 RADICAL TREATMENT (RT)

 Age in                          P.vivax                                     P.falliparum

Years       

—————————————————————————————-

0 –1                   75                    -           -          -                        75                 -

1-  4                 150                  5           5          2.5                 150                 10.0

4 – 8                300                  10        10        5                     300                 20.0

8 – 14              450                  20        20        10                    450                 30.0

   > 14              600                  30        30        15                    600                 45.0

                                                                       STANDARD TREATMENT OF LEPRUSY

For paucibacillary patients (PB) :

                                                                                    Adult    children

                                                                             ——————————————-

Monthly treatment

                        Day 1               Rifampicin        600 mg 450 mg 300 mg

                                                Dapsone           100 mg   50 mg    25 mg

Daily treatment

                        Day 2 –28        Dapsone           100 mg   50 mg    25 mg

Duration of treatment                                        6 months course to be taken within a

maximum period of 9 months    .

 For multibacillary patients (MB):

                                                                                     Adult    children

                                                                             ——————————————-

 Monthly treatment

                         Day 1               Rifampicin        600 mg             450 mg             300 mg

                                                Clofazimine       300 mg            150 mg            100 mg

                                                Dapsone           100 mg             50 mg               25 mg

Daily treatment

                        Day 2 –28        Clofazimine       50 mg               * 50 mg            * * 25 mg

Dapsone           100 mg             50 mg               25 mg

 Duration of treatment                                        12 months course to be taken within a

maximum period of 18 months  .

                                                                        ———————————————————————-

 *    -  on alternative days ; ** - twice a week.

 For Single lesion paucibacillary patients (SLPB) :

                                                                         Adult                            Children

                                                                                                            6 –1 4 yrs.

 Single dose                   Rifampicin                    600 mg             300 mg

                                    Ofloxacine                    400 mg             200 mg

                                    Minocycline                  100 mg                         50 mg

 STANDARD TREATMENT OF TUBERCULOSIS:

 ESSENTIAL                                                    Recommended Dose

Anti – TB Drug                         —————————————————————————————                                                    Daily                            Intermittent

                                                                                    ————————————————————

 Isoniazid                                   5 mg / kg                      10 mg/kg                      15 mg/kg

                                                (4-6 mg/kg)                  (8 – 12 mg/kg)             (13 –15 mg/kg).

Rifampicin                                10 mg / kg                    10 mg/kg                      10 mg/kg

                                                (8-12 mg/kg)                (8 – 12 mg/kg)             (8 –12 mg/kg).

Pyrazinamide                            25 mg / kg                    35 mg/kg                      50 mg/kg

                                                (20-30 mg/kg)              (30 – 40 mg/kg)           (40 –60 mg/kg).

Streptomycin                            15 mg / kg                    15 mg/kg                      50 mg/kg

                                                (12-18 mg/kg)              (12 –18mg/kg)             (12 –18 mg/kg).

Ethambutol                               15 mg / kg                    30 mg/kg                      45 mg/kg

                                                (15-20 mg/kg)              (25 – 35 mg/kg)           (40 –50 mg/kg).

 Treatment of Tuberculosis in children:

             2 HRZ/4 HRZ                                      For primary TB and TB

            2 EHRZ/4 HR                                      Lymphadenitis

                        1

                        5

             2 EHRZ/10 HR                                    TBM and miliary TB and disseminated

TB along with steroids

                        1

             9 HR                                                    primary complex without any other

Systemic complication.

 SEXUALLY TRANSMITTED DISEASE 

TREATMENT OF GONORRHOEA: 

                                                                  Ciprofloxacin 500 mg orally in a single dose  (contraindicated in pregnancy). 

                                                                      TREATEMETN OF CHLAMYDIA INFECTION : 

                                                                 Doxycycline 100 mg orally 2 times daily for 7 days or Erythromycin 500 mg

     orally 4 times daily for 7 days (pregnant woman). 

                                                                     TREATMENT FOR TRICHOMONIASIS AND BACTERIAL VAGINOSIS

                                                                            Metronidazole 400 mg orally twice daily for 7 days or 2 gm orally as a single dose.

    Note : metronidazole should not be given during the first trimester of pregnancy. 

TREATMENT OF CANDIDIASIS

     Clotrimazole 200 mg intravaginally once daily for 3 days. 

TREATMENT FOR SYPHILIS :

     Benzathing penicillin 2.4 million units IM in 2 injections (equally divided after intradermal sensitivity test for penicillin.

For men and non-pregnant women sensitive to penicillin :

Doxycycline 100 mg orally 2 times daily for 15 days.           

For pregnant women sensitive to penilillin.

Erythromycin stearate 500 mg orally 4 times daily for 15 days  advice those women to bring the child within 7 days of birth for screening). 

TREATMENT FOR CHANCROID

Erythromycin stearate 500 mg orally 4 times daily for 7 days or ciprofloxacin 500 mg orally as a single dose (do not give to pregnant women). 

TREATMENT FOR HERPES

            First episode : Acylovir 200 mg orally 5 times daily for 7 days.

            Recurrent episode : acyclovir 200 mg orally 5 times daily for 5 days. 

ACUTE RESPIRATORY INFECTIONS: 

Case management:

      ·    Infants aged 0-2 months, with a respiratory rate of 60 per minute or more.

Co-trimoxazole (paediatric) 3 tablet twice a day for 5 days. 

      ·    Children 2-12 months of age with respiratory rate of 50 per minute or faster, with no signs of respiratory distress (e.g. chest in drawing).

Co- trimoxazole (paediatric) 2 tablets twice a day for 5 days. 

      ·    Children 1 – 5years of age with a respiratory rate of 40 per minute or greater, and no signs of respiratory distress.

Co-trimoxazole (paediatric) 3 tablets twice daily for 5 days. 

SEVERE PNEUMONIA 

      ·    Refer URGENTLY to hospital

      ·    Give first dose antibiotic (co-trimoxazole).

      ·    Treat fever, if present (if referral is not feasible, treat with antibiotic and follow closely).

      ·    Keep the baby warm. 

PNEUMONIA 

      ·    Advise mother to give home care

      ·    Give antibiotic  (co-trimoxazole).

      ·    Treat fever, if present

      ·    Advise mother to return with child in 2 days for reassessment or earlier if the child is getting worse.

      ·    Keep the baby warm. 

NO PNEUMONIA: COUGH OR COLD 

      ·    If coughing more than 30 days, refer for assessment

      ·    Assess and treat other problems.

      ·    Advise mother to give home care.

      ·    Treat fever, if present. 

            (Reassess in 2 days a child who is taking an antibiotic for pneumonia.) 

TREATMENT OF DIARRHOEAL DISEASES: 

1.   TREATMENT DIARRHOEA AT HOME (Plan A) 

1.   Give the child more fluid then usual to prevent dehydration

2.   Give the child plenty of food to prevent malnutrition.

3.   Take the child to the HEALTH WORKER. If the child does not get better in 3 days or develops any of the following. 

       ·    Many watery stools                                    eating or drinking poorly.

       ·    Repeated vomiting                          fever

       ·    Marked thirst                                              blood in the stool 

THE CHILD SHOULD BE GIVEN ORS SOLUTIONS AS PER THE FOLLOWING SCHEDULE:

 Age                        Amount of ORS to give            Amount of ORS to provide

                              After each loose stool               for use at home

 Less than

24 months                          50 – 100 ml                              500 ml/day.

2 upto 10 yrs.                     100 – 200 ml                            1000 ml/day.

10 years or

more                                  As much as wanted                   2000 ml/day.

 II.TREATMENT OF DEHYDRATION (Plan B)

 APPROXIMATE AMOUNT OF ORS SOLUTION BE GIVEN IN THE FIRST 4 HOURS:

 Age           Less than 4        4 – 11            12 –23            2 – 4                 5 – 14              15yrs.

                    Months           months            months            years                  years              or older

 Wt.        Less than 5 kg.   5 –7.9 kg       8 –10.9kg     11 –15.9 kg       16 –29.9kg        30 kg or

In ml.         200 –400        400-600         600-800       800-1200         1200-2200      2200-4000

       ·    Use the patient age only you do not know the weight . The approximate amount of ORS required (in ml) can also be calculated by multiplying the patient’s weight(in Kg) times 75. 

       ·    if the child wants more ORS than shown, give more.

       ·    Encourage the mother to continue breast  feeding.

       ·    For infants under 6 months who are not breast  fed, also give 100 –200 ml clean water during this period. 

III . TREAT SEVERE DEHYDRATION (Plan  C) 

Start IV fluids immediately. If the patient can drink , give ORS by mouth while the drip is set up. Give 100 ml /kg ringer’s lactate solution (or, if not available, normal saline), divided as follows :

 Age                              first give                                    The give

 infants                           1 hours                                     5 hours.

(under 12 months)

             Repeat once if radial pulse is still very weak or not detectable.

Reassess the patient every 1 – 2 hours . If hydration is not improving, give the IV drip rapidly.

Also give ORS (about 5 ml/kg/hour) as soon as the patient can drink : usually after 3 –4 hours
(infants ) or 1 –2 hours (older patients). 

After 6 hours (infants) or 3 hours (older patients), evaluate the patient using the assessment chart. Then choose the appropriate plan (A,B,C) to continue treatment.

 Treatment of Dysentery: 

( Diarrhoea with blood in stool )

                        |

Treat with co- trimoxazole

                        |

Treat fever with paracetamol

                        |

Give ORS and early feeding

                        |

Child well or definitely improving

                                                      |                                      |

                                                   Yes                                 NO

                                                      |                                      |

                                         Continue therapy       monitor weight response

                                                      |                                      |

                                   Monitor weight response     if no response Refer 

1.Co –trimoxazole : 

Adult: 2 tab. (160 mg. TMP + 800 mg SMX) 2 times a day x 5 days

Children: 5 mg  TMP+25 mg of SMX per kg 2 times a day  5 days 

Treatment of cholera: 

1.   Doxycycline 100 mg tab/cap.

Adult : 300 mg single dose.

Children: not used for children below 12 years. 

       2.   Co-trimoxazole : 

Adult: 2 tab. (160 mg TMP + 800 mg SMX 2 times a days 3.

Children: pediatric tab. (20 mg  TMP + 100 mg SMX).

            5 mg of TMP+25mg of SMX /kg) 2 times a day x 3 days

            Syrup (40 mg TMP+200 mg SMX in 5 ml).

       3.   Furazolidone 100 mg tab. 

Adult:  100 mg 4 times a day x 3 days.

Children : 1.25 mg/kg 4 times a day x 3 days. 

Treatment of parasitic diarrhoea : 

Intestinal Amoebiasis : 

Metronidazole 200 mg tab. 

          Adult    :           400 – 600 mg 3 times a day x 5 days.

                                  (10 days for severe disease).

Children         :           10 mg/kg 3 times a day x 5 days

                                  (10 days for severe disease)> 

Giardiasis : 

Metronidazole 200 mg tab. 

          Adult    :           200 –400 mg 3 times a dayx 5 days.

Children           :           5 mg/kg 3 times a day x 5 days.