Padeatrics Case No 4.Dysentery

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Padeatrics Case No 4.Dysentery

ফাতিহা;বয়স ১.৫বছর,আপনার কাছে আসলো। ওজন ১২ কেজি৷। তার মা বল্লো,ফাতিহার পাতলা পায়খানা,পায়খানার সাথে আম যায়,বমি করে।ফাতিহার ট্রিটমেন্ট কি?

তাহলে Chief complain:

loose motion.

আম যায় মানে Mucous যাচ্ছে,

তাহলে Dx হবে most provably Dysentery..

কারণ কি হতে পারে-

১–

ব্যাকটেরিয়াল ইনফেকশন হতে পারে, কমন হচ্ছে ই-কোলাই

অন্যান্য গ্রাম নেগেটিভ এন্টারোব্যাক্টেরিয়েসিও হতে পারে-

২৷ ভাইরলা ইনফেকশন রোটা ভাইরাস থেকেও এমন হতে পারে-

৩৷ .food poisoning এই ক্ষেত্রেও ই-কোলাই কমন।

৪। প্যারাসাইটিক ইনফেকশন ও হতে পারে

উপসর্গ-

পাতলা পায়খানা হবে,

বমি হবে,।

জ্বর আসতে পারে

পেট ব্যাথা করতে পারে

যদিও বাচ্চাদের অধিকাংশ ডায়েরিয়া রোটা ভাইরাস দিয়ে হয়, তথাপি অনেকের ক্ষেত্রে ব্যাকটেরিয়া দিয়েও হতে পারে।

ব্যাকটেরিয়া হলে E coli infection হওয়ার সম্ভাবনা ৯০%, সাথে anaerobic infection হতে পারে.আমাদের GIT তে অ্যানারোবিক অর্গানিজম গুলি normal flora থাকে;যা শরীরের জন্য উপকারী। কিন্তু abnormal condition হলে উপকারী ব্যাকটেরিয়া গুলো নিজ জায়গা থেকে

স্থানান্তরিত হয়ে infection হয়।

Dx:

ব্যাকটেরিয়াল ডায়রিয়া সাধারণত ২ধরনের ব্যাক্টেরিয়া দিয়ে বেশি হয়,

১.ই কোলাই(গ্রাম নেগেটিভ ব্যাক্টেরিয়া)

২.এনেরোবিক ব্যাক্টেরিয়া

Rx:

তাই ডায়রিয়া চিকিৎসায় সাধারণত ২ধরনের এন্টিবায়োটিক ইউজ হয়।অর্থাৎ gram negative and anerobic coverage দিতে হবে।

তাহলে gram(-ve) এর জন্য Ciprofloxacin আর

Anaerobic এর জন্য metronidazole

(পায়খানার সাথে রক্ত গেলেও এগুলি দিতে হবে)

ডায়রিয়াতে zinc loss হয়।তাই জিংক সিরাপ দিতে হবে।

ডোজঃ Cipro : 10 kg তে আধা চামচ দিন দুইবার

★syrup cipro(1/2 TSF দিনে ২বার——৭দিন)

★syrup metro (1/2TSF দিনে ৩বার)

ওজন বেশি হলে ডোজ একটু বাড়াবে,

যথা

age more than ২ year (wt 15-20kg)———-১চামচ করে দিনে

Xinc সিরাপের ডোজ এক বছরের নিছে হলে৷ ১/২ চামচ করে দিন ২ বার, ১ বছরের উপরে হলে

১ চামচ করে দিনে ২ বার

বমির জন্য,(ondansetron)

Syrup 1.Anset 4mg/5ml 50ml bottle (AS A ondansetron Anti-emetic drugs) (1/2 চামচ করে দিনে ৩বেলা)

Indications of Syrup 1.Anset 4mg/5ml 50ml bottle (AS A ondansetron Anti-emetic drugs).

Anset is a serotonin subtype 3 (5-HT3) receptor antagonist indicated:

Prevention of nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy.
Prevention and treatment of post-operative nausea and vomiting.
Prevention of radiotherapy-induced nausea and vomiting.

Pharmacology Syrup 1.Anset 4mg/5ml 50ml bottle (AS A ondansetron Anti-emetic drugs)

Ondansetron is a potent, highly selective 5HT₃ receptor-antagonist. Its precise mode of action in the control of nausea and vomiting is not known. Chemotherapeutic agents and radiotherapy may cause release of 5HT in the small intestine initiating a vomiting reflex by activating vagal afferents via 5HT₃ receptors. Ondansetron blocks the initiation of this reflex. Activation of vagal afferents may also cause a release of 5HT in the area postrema, located on the floor of the fourth ventricle, and this may also promote emesis through a central mechanism. Thus, the effect of ondansetron in the management of the nausea and vomiting induced by cytotoxic chemotherapy and radiotherapy is probably due to antagonism of 5HT₃ receptors on neurons located both in the peripheral and central nervous system. The mechanisms of action in post-operative nausea and vomiting are not known but there may be common pathways with cytotoxic induced nausea and vomiting.

তাহলে,In case of Fatiha:

Syrup2. Cipro 250mg/5ml 60 ml bottle (AS A ciprofloxacin As a 4-Quinolone preparations, Anti-diarrhoeal Antimicrobial drugs).

Indications of Syrup Cipro 250mg/5ml 60 ml bottle (AS A ciprofloxacin As a 4-Quinolone preparations, Anti-diarrhoeal Antimicrobial drugs).

Cipro is indicated for the treatment of single infection or mixed infections caused by two or more susceptible organisms. It can also be used for infections caused by organisms resistant to other antibiotics including Aminoglycosides, Penicillins and Cephalosporins.

As antibacterial concentrations of Cipro are obtained in serum and body tissues as well as in the urine following administration by mouth, Cipro has been suggested for use in the treatment of a wide range of infections caused by susceptible organisms including infections of the urinary, respiratory and gastrointestinal tracts, gonorrhoea and septicaemia. The extensive tissue penetration of Cipro combined with its enhanced antibacterial activity (including antipseudomonal activity), enables Cipro to be used alone (pending sensitivity results) or in combination with an Aminoglycoside or with beta lactam antibiotics for instance when severe neutropenia is present or with an antibiotic active against anaerobes where the presence of bacteroides fragilis is suspected. Cipro is indicated for the treatment of the following infections caused by sensitive bacteria:

Severe systemic infections: e.g. septicaemia, bacteraemia, peritionitis, infections in immunosuppressed patients with haematological or solid tumors and in patients in intensive care unit with specific problems such as infected burns.
Respiratory tract infections: Lobar and bronchopneumonia, acute and chronic bronchitis, acute exacerbation of cystic fibrosis, bronchiectasis, empyema.
Urinary tract infections: Uncomplicated and complicated urethritis, cystitis, pyelonephritis, prostatitis, epididymitis.
Skin and soft tissue infections: e.g. infected ulcers, wound infections, abscesses, cellulitis, otitis externa, erysipelas, infected burns.
Gastro-intestinal infections: e.g. enteric fever, infective diarrhea.
Infection of the biliary tract: e.g. cholangitis, cholecystitis, empyema of the gall bladder.
Intra abdominal infections: e.g. peritonitis, intra abdominal abscesses.
Bone and joint infection: Osteomyelitis, septic arthritis.
Pelvic infections: e.g. salpingitis, endometritis, pelvic inflammatory diseases.
Eye, ear, nose and throat infections: e.g. otitis media, sinusitis, mastoiditis, tonsillitis.
Gonorrhoea: Including urethral, rectal and pharyngeal gonorrhoea caused by beta-lactamase producing organisms or organisms moderately sensitive to penicillin.

Pharmacology Syrup Cipro 250mg/5ml 60 ml bottle (AS A ciprofloxacin As a 4-Quinolone preparations, Anti-diarrhoeal Antimicrobial drugs).

Ciprofloxacin is a synthetic quinolone anti-infective agent. Ciprofloxacion has broad spectrum of activity. It is active against most gram negative aerobic bacteria including Enterobacteriaceae and Pseudomonas aeruginosa. Ciprofloxacin is also active against gram-positive aerobic bacteria including penicillinase producing, non penicillinase producing, and methicillin resistant staphylococci, although many strains of streptococci are relatively resistant to the drug. The bactericidal action of Ciprofloxacin results from interference with the enzyme DNA gyrase needed for the synthesis of bacterial DNA. Following oral administration it is rapidly and well absorbed from the G.I. tract. It is widely distributed into the body tissues and fluids. The half life is about 3.5 hours. About 30% to 50% of an oral dose of Ciprofloxacin is excreted in the urine within 24 hours as unchanged drug and biologically active metabolites.

১চামচ দিনে ২বার ৭দিন

2.syrup metro

১চামচ দিনে ৩বার

3.syrup Anset

১/২ চামচ দিনে ৩বার

4.syrup. Zinc

১চামচ করে দিনে ২বার

Same problem

In case of adult:.

1.cap. Cipro 500mg

1+0+1

Tablet 3. Metro 400mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Indications of Tablet 3. Metro 400mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metro is indicated in the treatment of following diseases:

The prevention of post-operative infections due to anaerobic bacteria (particularly species of bacteroides and anaerobic streptococci).
The treatment of septicaemia, bacteraemia, peritonitis, brain abscess, pelvic abscess, pelvic cellulitis and post-operative wound infections caused by anaerobes.
In the treatment of urogenital trichomoniasis.
Bacterial vaginosis (also known as non-specific vaginitis).
All forms of amoebiasis (intestinal, extra-intestinal disease and that of symptomless cyst passers).
Giardiasis.
Acute ulcerative gingivitis.
Anaerobically infected leg ulcers and pressure sores.
Acute dental infections due to anaerobic organisms.
Antibiotic associated pseudomembranus colitis.

Pharmacology of Tablet 3. Metro 400mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metronidazole is a member of the imidazole class of antibacterial drug and is classified therapeutically as an antiprotozoal agent. The 5-nitro group of Metronidazole is reduced by anaerobes metabolically. Studies have demonstrated that the reduced form of this drug interacts with DNA and gives bactericidal action of Metronidazole.

1+1+1

Tablet 4.Xinc- B AS A ((Vitamin B Complex +zinc) As a Specific mineral & vitamin combined preparations).

Indications of Xinc- B AS A ((Vitamin B Complex +zinc) As a Specific mineral & vitamin combined preparations):-

Xinc B is indicated for the treatment and prevention of zinc and vitamin B deficiencies.

Pharmacology of Xinc- B AS A ((Vitamin B Complex +zinc) As a Specific mineral & vitamin combined preparations):-

Zinc is vital for many biological functions such as immunity enhancement, wound healing, digestion, reproduction, physical growth and mental development. Zinc supports normal growth and development during pregnancy, childhood, and adolescence. Zinc also has some antioxidant properties. Zinc is used to treat ADHD (Attention Deficit Hyper-activity Disorder) in children. In adult, due to zinc deficiency loss of appetite, poor sense of taste and smell, tendency towards depression, white marks on fingernails, frequent infections, low fertility, prostate problems, mental problems, poor wound healing, a poor immune system, diarrhoea, mental lethargy, rough skin and weight loss may occur.

B-Vitamins are needed to release energy from food. They play an important role in ensuring healthy brain and nerve function, healthy red blood cells formation in children & adults. They are specially needed for healthy growth and development of children. B-Vitamin deficiencies in adult cause profound fatigue and various types of neurologic manifestations, which may include weakness, poor balance, confusion, irritability, memory loss, nervousness, tingling of the limbs and loss of coordination. Additional symptoms of vitamin B deficiency are sleep disturbances, nausea, poor appetite, frequent infections, and skin lesions.

1+0+1

4.tab anset 8mg

1+1+1 (খাবার আগে)

আর সাথে ওরস্যালাইন খাবে।

আরেকটা কথা..

ডায়েরিয়ার এখন একটা এক্সিলেন্ট ট্রিটমেন্ট হচ্ছে,

Azithromycin 500 mg 2 tab stat, একসাথে দুইটা খেলে খুব দ্রুত ডায়েরিয়া ভালো হয়,

প্রেগ্ন্যাসির ক্ষেত্রে Cipro ব্যবহার করা যাবেনা, সেই ক্ষেত্রে Azithromycin দিতে হবে।

General Quaries:-

1.শিশুদের ক্ষেত্রে ciprofloxacin কত বয়স থেকে দেয়া যায়?

Answer is:- ১ বছর থেকে সেইফলি দেওয়া যায়,

2:-azithromycin ২ tab stat পাওয়ার পর কি আর কোর্স কন্টিনিউ করবে?

Answer is:-

total 5 days complete korbe… 2 tab stat then 1 tab for 5days.

3.In case of child,Syp azithromycin kmn kaaj kore?cipro metro r poriborte kotota effective?

Answer is:-

valoi, stronger than cipro.

Reference:-

Raiyyan Tahsan Date:17-01-2025 Friday Time:-8-45-45 PM

Raiyyan Tahsan

Raiyyan Tahsan