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Tonsillopharyngitis - Acute (1 of 10)

Tonsillopharyngitis - Acute (1 of 10)

Tonsillopharyngitis - Acute (1 of 10)

1 Patient presents w/

2

EVALUATION Yes EXPERT Are there signs of REFERRAL ?

No

3 4 EVALUATION Is Group A Beta-hemolytic Yes DIAGNOSIS Streptococcus (GABHS) • Rapid antigen detection test suspected? (RADT) • roat culture

No

TREATMENT EVALUATION No A Supportive management Is GABHS confi rmed? B Pharmacological therapy (Non-GABHS)

Yes

5 TREATMENT A EVALUATE RESPONSEMIMS Supportive management TO THERAPY C Pharmacological therapy • Poor/No Good D Surgery, if recurrent or complicated response response

REASSESS PATIENT COMPLETE THERAPY & REVIEW THE DIAGNOSIS©

Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS.

B269 © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS • • • ofComplications Management • • • • • Obstruction Airway ofUpper Signs • • • • • • ofSore &Symptoms Signs w/Complications roat • • • • • • • • • • • • ofaViral Suggestive &Symptoms Signs Etiology • • • • • Infection ofGABHS Suggestive &Symptoms Signs • • • • Acute tonsillectomy without prior incision Acute prior tonsillectomy without Tonsillectomy ofrecurrent ifpatient ahistory has drained shouldbe All abscesses Cyanosis Toxic appearance distress Respiratory Air hunger Stridor displacement palate ofthe &forward soft Asymmetry ofuvula Deviation Peritonsillar edema or drooling salivation Increased liquids Inability toswallow Trismus obstruction airway ofupper forsigns Examine abscess or retropharyngeal peritonsillar Patients throat w/ sore including , may have deep throatSore isthe common most inolder presenting children symptom etc) (infl &viral etc) pathogens , , adenovirus, uenza, infl streptococcus, Aβ-hemolytic Etiologies include (group bacterial Fusobacterium sp, uenzae, Infl ammation ofthe tonsils& Muscle &joint pain ulceration Oropharyngeal Diarrhea ©Conjunctivitis Hoarseness Symptoms inapatient 5-15years aged hoarseness ofcough, rhinorrhea, conjunctivitis, Lack <38ºCinchildren old) fever <3years Fever >38ºC(low-grade nodes Swollen anterior cervical throat/tonsillarSore swelling/ 100% inchildren ofage <3years Viral pathogens accounting inchildren, are more frequent &almost than bacteria, 70-90%ofcases forabout tests laboratory by &supported grounds &epidemiological onclinical suspected should be infection GABHS isthe common most pathogen bacterial GABHS ofATP treatment &warrants ofcontagiousness period (PANDAS) infection &decrease w/ streptococcal syndrome, autoimmune disorders associated neuropsychiatric pediatric glomerulonephritis, (ARF), acute rheumatic fever ofcomplications risk like todecrease diagnosis after possible as soon as infection &treat GABHS Identify 3 2 EVALUATION FOR GABHS INFECTION 1 EVALUATION FOR COMPLICATIONS Tonsillopharyngitis -Acute(2of10) ACUTE TONSILLOPHARYNGITIS

B270 MIMS © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS • • • Alternative erapy • • • • Measures General • • Centor Criteria • • • Culture Swab roat • • • Test Detection Antigen Rapid (RADT) • • • • • FeverPAIN Score which warrants reassessment which warrants Persistence 48 beyond hours may ordevelopment indicate of suppurative alternative causes complications 24-48hours within isusuallyevident response Clinical ofacupunture use ere are &herbal notenough studies tosupport treatments fortonsillopharyngitis Remain at homeuntil received 24 hoursofantibiotic therapy been has confiElimination contact ifpatient ofclose orvisitors members been w/family has tohave GABHS rmed Warm 8oz ofwater) ofsaltper glass salinegargle (¼teaspoon Adequate fluid intake Fever (>38 - signs/symptoms: the following utilizing system apoints Uses antibiotic tostart treatment inthe may decision assist Results - onthe patient’s based the infection ofpatients susceptibility toGABHS toassess ageUsed &symptoms antibiotics &before are started ofsymptoms timeforcollection isat onset Optimal wall pharyngeal tonsils&posterior both from roat swabs - ofdelay (18-24hours) butnotdoneroutinely inresults (90-95%sensitivity) because Highly sensitive Confi result RADT anegative after rmation w/culture isnotnecessary lymph nodes Positive ofthe &tenderness forswelling anterior cervical - Age >15years - offever History - Presence oftonsillarexudates/swelling - Absence ofcough - Children w/throat are toundergo recommended painw/≥2ofthe following RADT: minutes (within versus 48hoursforculture) &specifiAdvantage ofspeed city (≥95%)forGABHS excluded be cannot whenFor GABHS tests diagnostic patients ofage, 3-15years perform Tests infection forpatients features donotsuggest GABHS whose notneeded Modifi ontotalATP based totalrisk ed score: (-1) Age >44years - (0) Age 15-44years - (1) Age 3-14years - Tonsillar /swelling (1) - Tender (1) node anterior cervical - Absence ofcough (1) - High results may indicate streptococcal infection; results should be correlated shouldbe w/Centor score results criteria may infection; indicateHigh results streptococcal ofthroat antibiotic tostart treatment pain the well the severity as need as toassess used May be GABHS infection &symptomatic patients infection at forrheumatic highrisk fever GABHS recurrent , ofcontact w/GABHS w/symptomatic persons w/history forthose Recommended Total score Risk ofGABHS Risk Total score ≤0 ≥4 1 2 3 o © (1) C) Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not 11-17% 28-35% 51-53% Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing 1-2.5% 5-10% A Tonsillopharyngitis -Acute(3of10) 5 SUPPORTIVE MANAGEMENT RESPONSE TO THERAPY 4 DIAGNOSIS

B271 MIMS © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS •  Lozenges/Gargle/Spray roat • • • Anti-inflNonsteroidal (NSAIDs) Drugs ammatory • • Analgesics/Antipyretics Simple • TreatmentSymptomatic • • • • • Cephalosporins • • • • Macrolides • • Amoxicillin • • • • Penicillin • • • • • • Antimicrobial erapy • • TreatmentSymptomatic May be helpful especially in those w/signifi inthose especially helpful May be cant throat painordiscomfort w/signifi are associated NSAIDs As their isnotrecommended routine use ofGIbleeding, cant risk ATP by paincaused foragainst Diclofenac used may be also Ibuprofen isasafe&eff alternative &antipyrexia foranalgesia ective duetothe ofReye’s risk syndrome isnotrecommended Paracetamol ofchoice isthe drug throat insore foranalgesia Symptomatic treatment isimportant inthe management ofchildren throat w/sore reasonable alternative &Penicillin to macrolides reasonable toClindamycin isolates are resistance generally ofGABHS &thus low considered mayReported a stillbe whoare Penicillin-allergic both forthose used &Erythromycin-intolerantMay be Studies that show a5-day toa10-day treatment course issuperior w/Penicillin w/acephalosporin inrecurrent cases Alternative especially toAmoxicillin forthe eradication infection ofstreptococcal Eg Cefaclor, Cefdinir, Cefadroxil, Cefi Cephalexin Cefpodoxime, xime, forErythromycin-intolerant patients used may be orCephalexin Azithromycin antibiotic inPenicillin-allergic patients inthe included consideration &shouldbe geographically foranalternative resistance patterns vary Local forpatients w/Penicillin used May be allergy Eg Clarithromycin, Roxithromycin Azithromycin, Erythromycin, patients2nd linetoPenicillin preference duetotaste inpediatric tolerated than PenicillinBetter compliance ifpoor advisable mayIM penicillin be isaconcern Full 10-day course oftreatment fororalmedications Proven effi cost &low safety cacy, spectrum, narrow ofchoiceDrug course Appropriate antibiotics ARF, prevent clinical &shorten infectivity suppurative prevent decrease complications, empirically,If antibiotics are started are the &culture negative, discontinued antibiotic results shouldbe empiric taken starting antibiotics orthroat before shouldbe swab A RADT systems w/ elaborate even clinical scoring accuracy diagnostic Empiric treatment is discouraged due to poor of GABHS Follow-up isnotpossible - Patient istoxic-looking - suspected isclinically GABHS - empirically if: antibiotics started may be constraints, topractical Due Treatment infection GABHS onlyfordocumented started infection fornon-GABHS Same as Important inthe management ofchildren throat w/sore B PHARMACOLOGICAL INFECTION THERAPY - NON-GABHS C

© INFECTION -GABHS THERAPY PHARMACOLOGICAL Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Tonsillopharyngitis -Acute(4of10)

B272 MIMS © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS • toTonsillectomyContraindications • • orQuinsy • • • TonsillitisRecurrent forTonsillectomyIndications • Treatment Goal © Velopharyngeal insufficiency, etc) infection &presence (anemia, oflocal hematologic factors Tonsillectomy toappropriate antibiotics &/orincision&drainage response ifwithout drained shouldbe All abscesses Symptoms interfere w/patient’s dailyfunction normal infection Positive forGABHS test - Tonsillar exudate - adenopathy Cervical - Temperature >38.3°C(101°F) - throat ofsore w/documentation &≥1ofthe 3years following: in the episode foreach past 2 or ≥3episodes/year intheyears past or≥5episodes/year a12-month oftonsillitisover period ≥7 episodes throatSore duetoinflammation oftonsils health w/tonsillectomy inoccurrence aimsforreduction throat ofsore surgery general &improved For recurrent tonsillopharyngitis, Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Tonsillopharyngitis -Acute(5of10) D SURGERY

B273 MIMS © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS Cefpodoxime 8-10 mg/kg/day PO in 2 divided doses doses in2divided 8-10mg/kg/day PO Ceftibuten Cefpodoxime Cefi xime Cefdinir Cefditoren pivoxil  Generation ird Cefuroxime Cefprozil Cefaclor Generation Second (Cephalexin) Cefalexin Cefadroxil First Generation (Acetaminophen) Paracetamol Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © 400mg/day dose: Max 24hrly >6 mth:9mg/kgPO 200mg/day dose: Max 24hrly 12hrly or400mgPO 200mgPO >12 yr: 24hrly PO 12hrly or200-300mg 100-150mgPO 7-12 yr: 24 hrly 12hrly or100-200mgPO 50-100mgPO 3-6 yr: Max dose:100mg/day 24hrly 12hrly or50-100mgPO PO 24hrly or25-50mg 8mg/kgPO >6 mth-2yr: 600mg/day dose: Max hrly ordivided 12 hrly PO24 mg/kg/day 14 12hrly x10days 200mgPO ≥12 yr: ≥40 kg: 12hrly 12hrly or125mgPO 10mg/kgPO <40 kg: 500mg/day dose: Max 12hrly 7.5 mg/kgPO 8hrly 250mgPO >5 yr: 8hrly 125mgPO 1-5 yr: 8hrly 62.5mgPO <1 yr: 1g/day dose: Max 8hrly divided >1 mth:20-40mg/kg/day PO hrly POdivided6 mg/kg/day 25-50 30 mg/kg/day PO 12hrly 24 hrly ordivided 4doses/day dose: Max 4-6hrly 250-500mgPO 6-12 yr: 4-6hrly 120-250mgPO 1-5 yr: 4-6 hrly 60-120mgPO 3 mth-1yr: 4-6hrly <3 mth:10mg/kgPO Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not ANALGESICS (NON-OPIOID)&ANTIPYRETICS ANALGESICS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing 250 mg PO 12hrly 250mgPO Tonsillopharyngitis -Acute(6of10) Dosage Dosage Guidelines CEPHALOSPORINS Dosage

B274 MIMS • Instructions Special • • Reactions Adverse dysfunction Use w/caution inpatients w/renal orhepatic agranulocytosis) pancytopenia, leucopenia, (thrombocytopenia, Hematologic eff reported have been ects reactions &usuallymild;RarelyRare hypersensitivity • • • Instructions Special • • Reactions Adverse renal impairment Use w/ caution inpatients w/ sensitivity 10%chancebe ofcross allergic toPenicillin, there may Use w/ caution inpatients distress gastric decrease to taken w/food May be occurred (encephalopathy, convulsions); effw/ CNS ects associated may be High doses infections) colitis); effOther (Candidal ects diarrhea/ antibiotic-associated N/V,(diarrhea, rarely occur); GIeffcan ects anaphylaxis eg reactions severe rash, pruritus, (urticaria, reactions Hypersensitivity Hepatic &renalHepatic eff have ects Rarely hematologic eff ects; Remarks Remarks © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS Clarithromycin 24hrly x 10mg/kgPO ≥6mth/<15kg: Azithromycin 8-12hrly x divided 50-75mg/kg/day PO Macrolides Advanced 12hrly divided 5-8mg/kg/day PO Spiramycin 6-8hrly divided 30mg/kg/day PO Roxithromycin 12hrly divided 30-50mg/kg/day PO Midecamycin Erythromycin Ibuprofen Diclofenac Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products NONSTEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDs) placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed 6-8 hrly 200mgPO 8-12 yr: 6-8 hrly 100mgPO 3-7 yr: 6-8 hrly 50mgPO 1-2 yr: 8hrly PO 50mg >6 mth-1yr: 8 hrly 3-6 mth:5mg/kgPO day 150mg/ dose: Max in2-3doses divided 75-100mgPO ≥14 yr: © 12hrly x10days PO 12hrly or250mg divided 15 mg/kg/day PO 24hrly x3days 500mgPO >45 kg: 500mg/day dose: Max 24hrly x4days 5 mg/kgPO by 24hrly x1day10 mg/kgPO followed 3 days or 5 days Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Dosage Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Tonsillopharyngitis -Acute(7of10) Dosage Dosage Guidelines • • • Instructions Special • • Reactions Adverse • Instructions Special • Reactions Adverse MACROLIDES cardiac dysfunction cardiac Use w/caution inpatients renal, hepatic w/hypertension, or orany other Aspirin NSAID by precipitated orrhinitis have been urticaria angioedema, of , including inwhomattacks orany those otherAspirin NSAID Avoid ulceration, inpatients to w/peptic hypersensitivity prevent GIeff ects To milkorantiulcer to food, drugs w/orafter administered be effHematological (inhibitionofplatelet aggregation) ect &ulcers) GI bleeding GI eff of including risk diarrhea, nausea, (GIdiscomfort, ects orany other Aspirin NSAID by precipitated have been or urticaria angioedema, inwhomattacksthose ofasthma, including orany other toAspirin NSAID hypersensitivity renal failure, orcardiac hepatic, severe perforation, orintestinal ulcer/bleeding/ patients w/activegastric of pregnancy, inwomen trimester Contraindicated inthe last transaminases) (increased eff vertigo, , tinnitus); Hepatobiliary (dizziness, ect fl pain,, abdominal dyspepsia, effatulence); CNS ects GI eff N/V, (GIulceration/bleeding/perforation, ects diarrhea,

B275 MIMS • • Instructions Special • • • Reactions Adverse dysfunction Use w/caution inpatients w/hepatic distress gastric todecrease May take w/food Erythromycin GIdisturbances less cause than &ClarithromycinAzithromycin tend to macrolides w/some have loss occurred hearing tinnitus/ Dose-related hepatotoxicity; rarely Rarely anaphylaxis); cardiotoxicity, rash, pruritus, uncommon (urticaria, are reactions Hypersensitivity diarrhea/colitis); antibiotic-associated &other diarrhea GIdisturbances, GI eff (N/V,ects discomfort, abdominal Other effOther infections) (Candidal ect Remarks Remarks © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS 1 agents throat ese are foundinvarious &mouth preparations throughout different countries. paints, are lozenges, available as ey , mouth gel & oral soln. Please see the forspecifi latest MIMS see mouth gel Please &oralsoln. mouthwashes, c formulations. sidoides Pelargonium catarrhalis N viridans, & S pyogenes S aureus, & ozaenae, K pneumoniae D pneumoniae, H infl uenzae, of lysates bacterial Lyophilized Lincomycin 6hrly 3-6mg/kgPO Clindamycin Lincosamides ymol benzoate Sodium (Lysozyme) Muramidase Menthol Eucalyptol Borax acid Benzoic Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed OTHER DRUGSACTINGONTHERESPIRATORY SYSTEM 20 mg PO 8hrly 20mgPO >12 yr: 12hrly 20mgPO 6-12 yr: 8hrly : 2.5mlPO 1-5 yr 24hrly x10days PO 3.5mg treatment: Acute days/mth for3mth 24hrly x10 3.5 mgPO treatment: Preventive 6 mth-12yr: infections kg/day formore severe to60mg/ May increase 6-8hrly divided PO >1 mth:30mg/kg/day 8hrly PO 37.5kg or≤10kg: <1 yr © Drug Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Dosage Dosage Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Tonsillopharyngitis -Acute(8of10) Dosage Guidelines OTHER ANTIBIOTICS ORAL CARE • • • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse • • • Instructions Special • • Reactions Adverse antibacterial properties has Preservative; present insaliva normally Mucopolysaccharidase etc ofsinusitis, symptoms torelieve Used Counter irritant bacteriostaticproperties weak Has antibacterial properties has Preservative; additional 2days patient advise tocontinue for subsides, use symptoms After patients takinganticoagulants Use w/caution inpatients w/hematologic disorders &in impairment, pregnant&breastfeedingwomen Contraindicated inpatientsw/severerenal &hepatic pruritus) urticaria, (rash, reactions Hypersensitivity GI eff (N/V, bleeding); ects mildgingival diarrhea, problems orrespiratory gastrointestinal Withdraw treatment orpersistence ifw/skinreactions of mth <6 Contraindicated in children To taken onanempty be stomach allergic reactions) eczema, fever, rash, dyspnea, cough, tiredness, asthma, GI eff (N/V,ects pain);Other eff abdominal (headache, ects Discontinue occurs ifdiarrhea hepatic impairment Use w/caution inatopic patients &inpatients w/renal or ofcolitis history w/ especially Use w/caution inpatients w/GIdisease (polyarthritis) multiforme, exfoliative&vesiculobullousdermatitis); Severe dermatologiceff ects haveoccurred(erythema N/V,nous colitis, taste); pain,metallic abdominal GI eff antibiotic-related severe pseudomembra- (diarrhea, ects Hematologic &hepaticHematologic eff effOther have occurred; ects ect H ypersensitivity reactions (rash, urticaria, rarely anaphylaxis) urticaria, (rash, reactions ypersensitivity B276 MIMS 1 Indications Remarks Remarks © MIMS Pediatrics 2020 TONSILLOPHARYNGITIS 1 agents throat ese are foundinvarious &mouth preparations throughout different countries. paints, are lozenges, available as ey mouthwashes, mouth gel & oral soln. Please see the forspecifi latest MIMS see mouth gel Please &oralsoln. mouthwashes, c formulations. Ampicillin/sulbactam) (Sultamicillin: of Pro-drug Ampicillin/sulbactam Ampicillin clavulanate) 8hrly divided 20-40mg/kg/day PO (Co-amoxiclav, Amoxicillin/ Amoxicillin/clavulanic acid Amoxicillin (Amoxycillin) Inhibitors Beta-lactamase w/ orwithout Aminopenicillins (Penicillin V) Phenoxymethyl penicillin G) penicillin (Benzathine benzylpenicillin Benzathine Aminoacridine () Aminoacridine Biclotymol chloride Benzalkonium Azulene Amylocaine All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. stated. otherwise otherwise unless unless function function &hepatic &hepatic renal renal w/ w/ normal normal children children for for are are recommendations recommendations dosage dosage All All Drug Drug PREPARATIONS FORORALULCERATION &INFLAMMATION Products listed above may not be mentioned in the disease management chart but have been been been have have but but chart chart management management disease disease the the in in mentioned mentioned be be not not may may above above listed listed Products Products placed here based on indications listed in regional manufacturers’ product information. information. product product manufacturers’ manufacturers’ regional regional in in listed listed indications indications on on based based here here placed placed © Not all products are available or approved for above use in all countries. countries. all all in in use use above above for for approved approved or or available available are are products products all all Not Not Specifi c prescribing information may be found in the latest MIMS. MIMS. latest latest the the in in found found be be may may information information SpecifiSpecific prescribing c prescribing 375-750 mg PO 12hrly 375-750mgPO >30 kg: onAmpicillin 12 hrly based divided 25-50mg/kg/day<30 kg: PO 2-4g/day dose: Max 6hrly divided 50-100 mg/kg/day PO 12hrly PO 8hrly or625mg 375mgPO >12 yr: 12 hrly divided <3 mth:30mg/kg/day PO 8 hrly divided 20-40mg/kg/day<40 kg: PO 6hrly 250mgPO 6-12 yr: 6hrly 125mgPO 1-5 yr: 6hrly 62.5mgPO <1 yr: single dose a 900,000-1,200,000uIMas >27.3 kg: asingledose IM as 300,000-600,000u &Infants: ≤27.3 kg Tonsillopharyngitis -Acute(9of10) Antiseptic anti-inflLocal effammatory ect Antiseptic anesthetic Local Antiseptic Antiseptic antibiotic Local anti-inflLocal effammatory ect anesthetic Local Antiseptic Antiseptic Dosage Guidelines PENICILLINS Dosage

B277 MIMS Indications • • Instructions Special • • Reactions Adverse renal impairment Use w/caution inpatients w/ allergy Avoid inpatients w/Penicillin (encephalopathy, convulsions) eff w/CNS associated ects may be Highdoses occurred; Renal &hepatic eff have ects Rarely hematologic eff ects; infections) colitis); effOther (Candidal ect diarrhea/ antibiotic-associated N/V,(diarrhea, rarely occur); GIeffcan ects anaphylaxis eg reactions severe pruritus, urticaria, (rash, reactions Hypersensitivity Remarks © MIMS Pediatrics 2020 1 TONSILLOPHARYNGITIS 1 agents throat ese are foundinvarious &mouth preparations throughout different countries. paints, are lozenges, available as ey mouthwashes, mouth gel & oral soln. Please see the forspecifi latest MIMS see mouth gel Please &oralsoln. mouthwashes, c formulations. Carbenoxolone salicylate Sodium acid Salicylic Povidone- (Lignocaine) Hydroxybenzoate Glycyrrhizin Enoxolone bromide Domiphen alcoholDichlorobenzyl () Dibucaine Choline salicylate Chlorobutanol chloride Cetylpyridinium bromide chloride Cetalkonium All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All PREPARATIONS FORORALULCERATION &INFLAMMATION (CONT’D) Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Please see the end of this section for reference list. reference for section this of end the see Please Tonsillopharyngitis -Acute(10of10) Local treatment ofinfections Local anti-infl analgesic, Local ammatory anti-infl analgesic, Local ammatory & Antiseptic Antiseptic &disinfectant Antiseptic antibiotic Local &preservative Antiseptic Antiseptic agent Bacteriocidal antibacterial agentLocal anti-inflLocal effammatory ect Treatment infl ofnon-infective disorders ofthe mouth, throatammatory Antiseptic Antiseptic anesthetic Local Antiseptic analgesic as Rubefacient used Antiseptic &disinfectant Antiseptic &disinfectant Antiseptic Antiseptic Antiseptic Antiseptic Antiseptic Mucosal protectant Dosage Guidelines

B278 MIMS Indications © MIMS Pediatrics 2020 1

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