Commonly used drugs in children

1. Dr Sachin Rathod
Email:- drsachin.rathod@yahoo.com

2. Analgesics in Pediatric Dentistry
 Concepts About Pain in Children.
1. Children have higher tolerance to pain.
2. Pain perception is low because of biologic
immaturity.
3. Little or no memory of a painful experience.
4. More sensitive to side-effect of analgesics.
5. Special risk for addiction to narcotics.

3. Classification of Analgesics
 Centrally acting (narcotic)
 Peripherally acting (non-narcotic)

4. Centrally Acting Analgesics
 These are more effective against acute
pain. But have a greater incidence of
adverse effect.
 They usually are administered parenterally
and are devoid of anti-inflammatory and
antipyretic effect.
 Recent Opioid Analgesics
1. Alfentanil
2. Remifentanil
3. Tramadol

5. Alfentanil & Remifentanil
Mechanism of action
• Rapid onset (within 1-1.5 min)
• Metabolized in liver
• Half-life is 1-2 hours
Uses
• Short , pain full procedures requiring intense
analgesia and blunting of stress responses.
• Remifentanil for longer neurosurgical procedures
where rapid emergence from anesthesia is
important.
Commercial forms
• ALFENTA (Alfentanil)
• ULTIVA (Remifentanil)

6. Tramadol
Mechanism of action
• Weak agonist at all type of opioid receptors with
some selectivity for µ receptors.
Uses
• Mild to moderate pre-and postoperative pain.
• Severe acute or chronic pain, cancer pain
Commercial forms
• CONTRAMAL
• CONTRAAL DT
• DOLOMED
• DOLOTRAM
• TRAMOL

7. Peripherally acting Analgesics
 These are less effective against severe pain.
But have a lower incidence of adverse effects.
 They usually are administered orally and are
used for chronic low grade pain.
 Some possess anti-inflammatory and antipyretic
effect.
• Ibuprofen
• Diclofenac
• Nimesulide
• Paracetamol.

8. Combination therapy for pain
 Ibuprofen & Paracetamol.
 Diclofenac sodium & Paracetamol.
 Nimesulide & Paracetamol.
 Mefenamic & Paracetamol.

9. Dose Calculation for Children
1. Clark’s rule
child’s weight in Ib
X adult dose = child’s dose
150
2. Young’s rule
Age of child
X adult dose = child’s dose
Age + 12

10. Commonly used
Antibiotics in children

11.  AMOXICILLIN
 Action: interferes with cell wall replication of
susceptible organisms, the cell wall rendered
osmatically instable, swells & bursts from
osmatic pressure .
 Dose: 20-40 mg/kg/day 3 divided doses
 Adverse reaction: increased thirst, nausea,
vomiting, diarrhea, pruritus urticaria, angione-
urotic edema, bronchospasm, anaphylaxis.
 Contra- indication: Hypersensitivity to penicillin,
neonates.

12.  AMOXICILLIN + CLAVUNATE POTASSIUM
 Action: interferes with cell wall replication of
susceptible organisms, the cell wall rendered
osmatically instable, swells & bursts from
osmatic pressure .
 Dose: 20-40 mg/kg/day 3 divided doses
 Adverse reaction: Discolored
tongue,glossititis,increased thirst, nausea,
vomiting, diarrhea, pruritus,urticaria,
bronchospasm, anaphylaxis.
 Contra- indication: Hypersensitivity to
penicillin, neonates.

13.  AMOXICILLIN + CLOXACILLIN
 Action: interferes with cell wall replication of
susceptible organisms, the cell wall rendered
osmatically instable, swells & bursts from
osmatic pressure .
 Dose: 50-100 mg/kg/day 3 divided doses
 Adverse reaction: increased thirst, nausea,
vomiting, hyperkalemia, pruritus,urticaria,
bronchospasm, anaphylaxis.
 Contra- indication: Hypersensitivity to penicillin.

14.  AMPICILLIN
 Action: interferes with cell wall replication of
susceptible organisms, the cell wall rendered
osmatically instable, swells & bursts from
osmatic pressure .
 Dose: 50-100 mg/kg/day 3 divided doses
 Adverse reaction: Discolored tongue,
glossititis, rush, increased thirst, nausea,
vomiting, diarrhea, pruritus,urticaria,
glomerulonephritis, angioneurotic edema,
bronchospasm, anaphylaxis.
 Contra- indication: Hypersensitivity to
penicillin,

15.  CEPHALEXIN
 Action: inhibits bacterial cell wall synthesis,
rendering cell wall osmotically unstable.
 Doses: 50-100 mg/kg/day
 Adverse reaction: candidiasis, glossitis, nausea,
vomiting , diarrhea, anorexia, pseudomembranous
colitis, nephrotoxicity, urticaria, rash, anaphylaxis.
 Contraindications: hypersensitivity to penicillin,
pregnancy, infants < 1 month.

16.  COTRIMOXAZOLE
(sulfamethoxazole + trimethoprim )
 Action: sulfamethoxazole interferes with
bacterial biosynthesis of proteins by
competitive antagonism of PABA,
trimethoprim blocks synthesis of
tetrahydrofolic acid, this combination blocks 2
consecutive synthesis of essential nucleic
acids, proteins
 Doses: 8mg/kg/day
 Adverse reaction; candidiasis, stevens-
johnson syndrome, anaphylaxis, SLE,
nausea, vomiting, diarrhea, hepatitis,
enterocolitis, leukopenia, agranulocytosis,
renal failure.
 Contraindication : hypersensitivity to
trimethoprim or sulfame-thoxazole
megaloblastic anemia, infants < 2 months,

17.  ERYTHROMYCIN
 Action: binds to SDS ribosomal susceptible
bacteria and suppresses protein synthesis.
 Doses: 30-50 mg/kg/day
 Adverse reaction: candidiasis, rash, pruritus,
hypersensitivity, nausea, vomiting, diarrhea,
hepatotoxicity, abdominal pain,
pseudomembranous tinnitus.
 Contraindications: hypersensitivity to pre-
existing hepatic disease.

18.  METRONIDAZOLE
 Action: in anaerobic microorganisms
metronidazole is converted to active form
by reduction of its nitro group. This gets
bound to DNA and prevents nucleic acid
formation.
 Doses : 5 mg/ kg
 Adverse reaction ; dry mouth, furry tongue,,
bitter taste, metallic taste, leukopenia,
bone-marrow aplasia, rash, urticaria,
nausea, vomiting, diarrhea, abdominal
pain, nephrotoxicity.
 Contraindication: hypersensitivity to this
drug, renal disease, pregnancy, lactation,
hepatic disease, alcoholic patients.

19. Recent advanced in Antibiotics
Fourth generation Cephalosporins
 Cefepime
 Developed in 1990s
 Antibacterial spectrum similar to 3rd generation
 Resistance to β-lactamases
 Cefepirome
 Recently marketed in India.
 Used for treatment of serious hospital-based
infection
 Better penetration through gram-negative bacteria
 More potent than 3rd generation

20. Newer Macrolides

21.  ROXITHROMYCIN
 Semi-synthetic, long acting, acid–stable with anti microbial
spectrum resembling erythromycin.
Indication
 Respiratory infections
 ENT infections
 Skin & soft tissue infection
 Genital track infections
Dosage
 Adult 150 mg BD
 Children 2.5 -5 mg / kg BD
Commercial forms
 ROXID
 ROXEM
 ROXIBID
 150 mg & 50 mg kid tab.

22.  CLARITHROMYCIN
 Antimicrobial spectrum resembling
erythromycin
Indication
 First line drug in Mycobacterium avium
complex in AIDS patients.
Dosage
 250 mg BD for 7 days
 Severe cases 500 mg BD for 14 days
Commercial forms
 CLARIBID
 CELEX
 CLARIMAC

23.  AZITHROMYCIN
 Antimicrobial spectrum expanded as compared to erythromycin.
 Active against H.influenzae.
 High activity on respiratory pathogens
 Good activity against Mycobacterium avium complex in AIDS
patients.
Indication
 Pharyngitis
 Tonsillitis
 Sinusitis
 Staphylococcal & streptococcal skin & soft tissue infection
 MAC in AIDS patients
Dosage
 500 mg OD
 Children above 6 months 10 mg / kg of 3 days
Commercial forms
 ZITHROMAC
 AZITHRAL
 AZIWOK

24. Dr Sachin Rathod
Email:- drsachin.rathod@yahoo.com