ឪសថ Azithromycin

Therapeutic action

 – Macrolide antibacterial Indications 

– Trachoma, conjunctivitis due to Chlamydia trachomatis 

– Cervicitis and urethritis due to Chlamydia trachomatis (in combination with a treatment for gonorrhoea),donovanosis, chancroid, early syphilis 

– Cholera (if the strain is susceptible), yaws 

– Pertussis, pneumonia due to Mycoplasma pneumoniae and Chlamydophila pneumoniae 

– Streptococcal tonsillitis, acute otitis media, in penicillin-allergic patients only

Presentation 

– 250 mg and 500 mg capsules or tablets 

– 200 mg/5 ml powder for oral suspension, to be reconstituted with filtered water 

Dosage and duration 

– Trachoma, cholera, cervicitis and urethritis due to C. trachomatis, chancroid, early syphilis

Child: 20 mg/kg as a single dose (max. 1 g) 

Adult: 1 g as a single dose (2 g as a single dose in early syphilis) 

– Yaws 

Child and adult: 30 mg/kg as a single dose (max. 2 g) 

– Conjunctivitis due to C. trachomatis

Child: 20 mg/kg once daily for 3 days (max. 1 g/day) 

Adult: 1 g once daily for 3 days 

– Donovanosis (granuloma inguinale)

Adult: 1 g on D1 then 500 mg/day until healing of lesions 

– Pertussis, pneumonia due to M. pneumoniae and C. pneumoniae

Child: 10 mg/kg once daily for 5 days (max. 500 mg/day) 

Adult: 500 mg on D1 then 250 mg from D2 to D5 

– Streptococcal tonsillitis, only in penicillin-allergic patients

Child: 20 mg/kg once daily for 3 days (max. 500 mg/day) 

Adult: 500 mg once daily for 3 days 

– Acute otitis media, only in penicillin-allergic patients

Child: 10 mg/kg once daily for 3 days (max. 500 mg/day) 

Contra-indications, adverse effects, precautions 

– Do not administer to patients with allergy to azithromycin or another macrolide, and to patients with severe hepatic impairment. 

– May cause: gastrointestinal disturbances, heart rhythm disorders (QT prolongation), allergic reactions sometimes severe. In the event of allergic reaction, stop treatment immediately. 

– Do not administer simultaneously with antacids (aluminium or magnesium hydroxide, etc.). Administer 2 hours apart. 

– Avoid combination with drugs that prolong the QT interval (amiodarone, chloroquine, co artemether, fluconazole, haloperidol, mefloquine, moxifloxacin, ondansetron, pentamidine, quinine, etc.). 

– Administer with caution and monitor use in patients taking digoxin (increased digoxin plasma levels).

 – Pregnancy and breast-feeding: no contra-indication 

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ឪសថ AUGMENTIN

Therapeutic action 

– Combination of two antibacterials. The addition of clavulanic acid to amoxicillin extends its spectrum of activity to cover beta-lactamase producing Gram-positive and Gram-negative organisms, including some Gram-negative anaerobes. 

Indications 

– Animal bites, if antibiotic therapy or antibiotic prophylaxis is clearly indicated 

– Second line treatment of acute otitis media and acute bacterial sinusitis, when amoxicillin alone given at high dose failed 

– Acute uncomplicated cystitis (no systemic signs) in girls > 2 years 

– Postpartum upper genital tract infection 

– Severe pneumonia: parenteral to oral switch therapy in patients treated with ceftriaxone +cloxacillin

Presentation 

– The ratio of amoxicillin and clavulanic acid varies according to the manufacturer:

Ratio 8:1 – 500 mg amoxicillin/62.5 mg clavulanic acid tablet

​​​​​​​​​​​​​​​​​– 500 mg amoxicillin/62.5 mg clavulanic acid/5 ml powder for oral suspension

Ratio 7:1 – 875 mg amoxicillin/125 mg clavulanic acid tablet

– 400 mg amoxicillin/57 mg clavulanic acid/5 ml, powder for oral suspension

Ratio 4:1 – 500 mg amoxicillin/125 mg clavulanic acid tablet

– 125 mg amoxicillin/31.25 mg clavulanic acid/5 ml, powder for oral suspension

Also comes in formultions with a ratio amoxicillin/clavulanic acid of 16:1, 14:1, 6:1, 2:1.

Dosage (expressed in amoxicillin) 

– Animal bites; second line treatment of acute otitis media and acute sinusitis

• Child < 40 kg: 45 to 50 mg/kg/day in 2 divided doses (if using ratio 8:1 or 7:1) or in 3 divided doses (if using ratio 4:1) Note: the dose of clavulanic acid should not exceed 12.5 mg/kg/day or 375 mg/day.

• Child ≥ 40 kg and adult: 1500 to 2000 mg/day depending on the formulation available: 

Ratio 8:1: 2000 mg/day = 2 tablets of 500/62.5 mg 2 times per day 

Ratio 7:1: 1750 mg/day = 1 tablet of 875/125 mg 2 times per day 

Ratio 4:1: 1500 mg/day = 1 tablet of 500/125 mg 3 times per day 

Note: the dose of clavulanic acid should not exceed 375 mg/day. 

– Acute uncomplicated cystitis in girls > 2 years

25 mg/kg/day in 2 divided doses (if using ratio 8:1 or 7:1 or 4:1) 

Note: the dose of clavulanic acid should not exceed 12.5 mg/kg/day or 375 mg/day. 

– Postpartum upper genital tract infection; parenteral to oral switch therapy in severe pneumonia

Use formulations with a ratio 8:1 or 7:1:

• Child < 40 kg: 80 to 100 mg/kg/day in 2 or 3 divided doses 

Note: the dose of clavulanic acid should not exceed 12.5 mg/kg/day or 375 mg/day.

• Child ≥ 40 kg and adult: 2500 to 3000 mg/day in 3 divided doses. 

Depending on the formulation available: 

Ratio 8:1: 3000 mg/day = 2 tablets of 500/62.5 mg 3 times per day 

Ratio 7:1: 2625 mg/day = 1 tablet of 875/125 mg 3 times per day 

Note: the dose of clavulanic acid should not exceed 375 mg/day.

Duration 

– Animal bites: 5 to 7 days; otitis media: 5 days; sinusitis: 7 to 10 days; cystitis: 3 days; upper genital tract infection: 7 days; parenteral to oral switch therapy in severe pneunonia: to complete a total of 10 to 14 days of treatment. 

Contra-indications, adverse effects, precautions 

– Do not administer to penicillin-allergic patients and patients with history of hepatic disorders duringa previous treatment with co-amoxiclav. 

– Administer with caution to patients allergic to cephalosporins (cross-sensitivity may occur). 

– Administer with caution to patients with hepatic impairment; reduce dosage and give every 12 to 24 hours in patients with severe renal impairment. 

– May cause: gastrointestinal disturbances (mainly diarrhoea); allergic reactions sometimes severe (stop treatment immediately); jaundice and cholestatic hepatitis in the event of prolonged treatment (> 10 to 15 days). 

– Pregnancy: no contra-indication 

– Breast-feeding: no contra-indication Remarks

 – High doses of co-amoxiclav (80-100 mg/kg/day or 2.5-3 g/day) cannot be administered when using formulations of amoxicillin/clavulanic acid in a ratio of 4:1 (the content in clavulanic acid is too high). The maximum dose (expressed in amoxicillin) that can be given with these formulations is 50 mg/kg/day, without exceeding 1500 mg/day. 

– Take with meals. – Storage: below 25°C – –

ឪសថ Aspirin

ACETYLSALICYLIN ACIDE = ASPIRIN

Therapeutic action 

– Analgesic, antipyretic, non steroidal anti-inflammatory (NSAID) 

– Platelet antiaggregant (at low dose) Indications

 – Mild pain, fever 

– Secondary prevention of severe pre-eclampsia

Presentation 

– 300 mg and 500 mg tablets 

– 75 mg enteric coated tablet 

Dosage and duration 

– Pain and fever

Adolescent over 16 years and adult: 300 mg to 1 g every 4 to 6 hours, without exceeding 4 g/day, for 1 to 3 days 

– Prevention of pre-eclampsia 75 mg once daily from the 12th to the 32nd week of gestation 

Contra-indications, adverse effects, precautions 

– Do not administer to patients with allergy to aspirin and NSAID, peptic ulcer, coagulation disorders,

hemorrhage, severe renal, hepatic or cardiac impairment. 

– Do not administer to children for pain or fever (use paracetamol). 

– Administer with caution to elderly patients or patients with asthma. 

– Do not exceed indicated doses, particularly in elderly patients. Intoxications are severe, possibly fatal. 

– May cause:

• allergic reactions, epigastric pain, peptic ulcer, haemorrhage;

• dizziness, tinnitus (early signs of overdose);

• Reye’s syndrome in children (encephalopathy and severe hepatic disorders). 

For all cases above, stop aspirin. 

– Do not combine with methotrexate, anticoagulants and NSAID. 

– Monitor combination with insulin (increased hypoglycaemia) and corticosteroids. 

– Pregnancy:

• pain and fever: avoid. 

Contra-indiCated from the beginning of the 6th month. Use paracetamol.

• prevention of pre-eclampsia: do not exceed 75 mg/day. 

– Breast-feeding: avoid. Use paracetamol. Remarks 

– Take during meals, preferably with a lot of water. 

– Do not crush enteric coated tablets. 

– Aspirin may be administered in secondary prevention of atherosclerosis, at a dose of 75 to 300 mg

Prescription under medical supervision

ឪសថ Albendazole

Therapeutic action 

– Anthelminthic Indications – Ascariasis (Ascaris lumbricoides), enterobiasis (Enterobius vermicularis), hookworm infections (Ancylostoma duodenale, Necator americanus)

– Trichuriasis (Trichuris trichiura), strongyloidiasis (Strongyloides stercoralis) 

– Trichinellosis (Trichinella spp)

Presentation 

– 400 mg tablet 

Dosage and duration 

– Ascariasis, enterobiasis, hookworm infections

Child over 6 months and adult: 400 mg as a single dose Child over 6 months but under 10 kg: 200 mg as a single dose In the event of enterobiasis, a second dose may be given after 2 to 4 weeks. 

– Trichuriasis, strongyloidiasis

Child over 6 months and adult: 400 mg once daily for 3 days Child over 6 months but under 10 kg: 200 mg once daily for 3 days 

– Trichinellosis

Child over 2 years: 10 mg/kg/day in 2 divided doses for 10 to 15 days Adult: 800 mg/day in 2 divided doses for 10 to 15 days 

Contra-indications, adverse effects, precautions 

– Do not administer to children under 6 months. 

– Do not administer to patients with ocular cysticercosis. 

– May cause:

• gastrointestinal disturbances, headache, dizziness;             

• neurological disorders (headache, seizures) in patients with undiagnosed neuro cysticercosis.

– Pregnancy: avoid during the first trimester 

– Breast-feeding: no contra-indication

Remarks – Tablets are to be chewed or crushed: follow manufacturer's recommendations. 

– In the treatment of strongyloidiasis, ivermectin is more effective than albendazole. 

– Albendazole is also used in the treatment of cutaneous larva migrans (Ancylostoma braziliense and caninum), larval cestode infections (hydatid disease, certain forms of neurocysticercosis) and in mass treatment for lymphatic filariasis.