Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit

ANTIBIOTICS
A soft copy of this
document is available as
Ampicillin (a broad spectrum antibiotic, first line to treat neonatal sepsis)
a pdf on the computer in
the intern’s room, and
Dose: Neonates less than 7 days old: 50mg/kg every 12 hours. on the flash on the
Neonates 8 days to 28 days old: 50mg/kg every 8 hours intern’s room keyring
Older babies and children: 50mg/kg 6 hourly.

Preparation: 500mg powder in vial. Add 5 mls of water for injection to get a total of 500mg in 5mls
solution. This is equal to 100mg in 1ml.
Final preparation gives:
500mg ampicillin powder
1ml = 100mg
+ 5mls water for injection

= 500mg ampicillin in 5mls total solution

Ampiclox (an antibiotic containing ampicillin and cloxacillin combined)

Dose: Neonate: 75mg 8 hourly IV. 1 year to less than 2 years: 250mg 6 hourly IV or po.
2 to 10 years: 250 – 500mg 6 hourly IV or po. More than 10 years: 500mg – 1g 6 hourly IV or po

IV Preparation: Take vial of 500mg ampiclox (=250mg ampicillin + 250mg cloxacillin). Add 5mls of
water for injection to make a total solution of 500mg in 5mls.
Final preparation gives:
500mg ampiclox powder
1ml = 100mg
+ 5mls water for injection

= 500mg ampiclox in 5mls total solution

X Pen = Benzylpenicillin (an antibiotic) NB Be careful! iu / mega units / mg are NOT the same

Dose: 50,000 iu / kg 6 hourly (standard dose) = 0.05 mega units/kg 6 hourly = 30mg/kg 6 hourly.
(NB in severe infection the dose can be increased to 100,000 iu / kg 6 hourly)

Preparation: Using a one Mega Unit vial, add 2mls water for injection to make a total solution of
1,000,000 iu (1 mega unit) in 2 mls

600mg = I mega Unit vial Final preparation gives:

1ml = 500 000 iu (units)
+ 2 mls water for injection
1ml = ½ mega unit
= 1, 000, 000 units penicillin in 2mls total solution 1ml = 300mg
= 1 mega unit penicillin in 2mls total solution
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
ANTIBIOTICS
Ceftriaxone (a broad spectrum antibiotic used to treat meningitis and severe pneumonia)

Dose: 100mg/kg once a day IV or IM

Preparation: To make IV – take 1g ceftriaxone Preparation: To make IM – take

vial. Add 10mls of water for injection to 1g ceftriaxone vial. Add 4 mls of
make a total solution of 1g in 10mls. water for injection to make a total
solution of 1g in 4mls

1gram ceftriaxone 1gram ceftriaxone

+ 10mls water for injection + 4 mls water for injection

= 1gram ceftriaxone in 10mls total solution = 1 gram cef in 4 mls solution

Final IV preparation gives: Final IM preparation gives:
1ml = 100mg 1ml = 250mg

Chloramphenicol (broad spectrum antibiotic)

Dose: 12.5mg /kg 6 hourly, doubled to 25mg/kg 6 hourly in sepsis/meningitis/epiglottitis

Most commonly chloramphenicol is available in a big vial containing 1 gram chloramphenicol.

Large vial (1 gram of chloramphenicol)

Final preparation
+ 10 mls water for injection gives:
1ml = 100mg
= 1gram chloramphenicol in 10mls solution
Rarely, chloramphenicol comes in a small vial which cannot fit 10mls of water for injection inside. In this case, add 5 mls
of water for injection to give a final concentration of 1ml = 200mg chloramphenicol.

Ciprofloxacin (antibiotic) Ready made preparation gives:

Dose: 10mg/kg 8 hourly IV 1ml = 2mg

IV Preparation: Already in solution of 200mg / 100mls

Give as an IV infusion slowly over 60 minutes

 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
ANTIBIOTICS
Cloxacillin (a broad spectrum antibiotic used to treat meningitis, severe skin infections, second line
for neonatal sepsis)

Dose: Neonatal sepsis: 50mg/kg every 12 hours.

All children except neonates: 50mg/kg every 6 hours

Preparation: 500mg cloxacillin vial of powder. Add 5 mls water for injection to make a total solution
of 500mg in 5 mls.

500mg cloxacillin Final preparation gives:

1ml = 100mg
+ 5mls water for injection

= 500mg cloxacillin in 5mls total solution

Gentamicin (a broad spectrum antibiotic, first line to treat neonatal sepsis)

Dose: Preterm / low birth weight of less than 2.5kg: 3mg / kg od IV or IM.
Term neonate: 5mg / kg once a day IV/IM.
Older babies and children: 7.5mg/kg once a day IV / IM

Preparation: NEONATES – AMPOULE NEEDS TO BE DILUTED. Take the 80mg in 2ml ampoule, add
8 mls of water for injection to get a total of 80mg in 10mls solution. This is equal to 8mg in every 1ml.

80mg gentamicin in 2mls solution

Final preparation gives:
+ 8mls water for injection 1ml = 8mg

= 80mg gentamicin in 10mls total solution

Preparation: Older babies and children: use ready made

Final preparation gives:
preparation in the ampoule which is already in solution of 80mg
1ml = 40mg
gentamicin in 2mls.

Metronidazole (an antibiotic that covers anaerobic bacteria. Used in tetanus)

Ready made preparation gives:
Dose: 7.5mg/kg every 8 hours.
1ml = 5mg
Preparation: 500mg metronidazole is already in solution of 100mls.
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
ANTIMALARIALS
Artesunate (an antimalarial, first line in severe / complicated malaria)

Dose: Weight <20kg: 3.0mg/kg at 0,12,24 hours. Weight>20kg: 2.4mg/kg at 0,12,24 hours.
Give 3 IV / IM doses over 24 hours irrespective of patient’s ability to tolerate oral treatment.
If unable to take oral medication, continue parenteral treatment (IV/IM) once a day for a
maximum of 7 days. NB Must be followed by 3 day course of oral Coartem.
Preparation: 30mg and 60mg vials available. See also Job Aid poster
30mg vial – IV preparation 30mg vial – IM preparation

+ 0.5 sodium bicarbonate (must add this FIRST) + 0.5ml sodium bicarb (must add this FIRST)

Then +2.5 mls Normal saline Then + 1mls Normal saline

Gives 30mg in 3mls = 1ml is 10mg 30mg in 1.5mls = 1ml is 20mg

Final preparation gives: Final preparation gives:

1ml = 10mg 1ml = 20mg

60mg vial – IV preparation 60mg vial – IM preparation

+ 1ml sodium bicarbonate (must add this FIRST) + 1ml sodium bicarbonate (must add this FIRST)

Then +5 ml Normal saline Then + 2mls Normal saline

Gives 60mg in 6mls = 1ml is 10mg Gives 60mg in 3mls = 1ml is 20mg

Quinine (second line anti-malarial for severe malaria, only give if artesunate not available)

Dose: 10mg/kg 8 hourly IV or IM. Each IV dose (10mg/kg) of quinine should be mixed with 5 –
10ml/kg of glucose 5% and run as an IV infusion over a 4 hour period. Continue IV/IM for a minimum
of 24 hours (3 doses). If able to take oral medications after 24 hours change to oral quinine 10mg/kg
every 8 hours and continue quinine treatment for at least 72 hours. After 72 hours if able to take oral
medication, stop quinine and give Coartem 3 days course, or if unable to take orally, continue with IV
quinine to complete a full 7 days quinine treatment (from start of IV quinine).
Ready made IV
IV Preparation: Ampoule of 600mg in 2 mls already in solution. preparation gives:
10mg/kg quinine + (5-10mls/kg 5% dextrose) 1ml = 300mg
IM preparation: Dilute to 100mg/ml (2mls of 600mg quinine solution + 4 mls of water for injection)
and inject into anterior thigh. If volume is >3 mls, split the volume and give half in the left anterior
thigh and half in the right anterior thigh.
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
RESUSCITATION / RESPIRATORY DRUGS
Adrenaline (stimulant for resuscitation if pulse absent)
Dose: In resuscitation: GIVE INTRAVENOUSLY 0.1mls / kg of 1:10,000

Preparation: Ampoules contain 1mg adrenaline in 1 ml solution = 1:1000 strength. Take 1ml of 1:1000
adrenaline and add 9mls of N/Saline to make a solution of 1:10,000 strength adrenaline to use IV.

1mg adrenaline in 1ml solution Final IV preparation gives:

+ 9mls normal saline 1ml = 0.1mg

= 1mg adrenaline in 10mls total solution

CAREFUL! What condition
are you treating?
Adrenaline (stimulant for anaphylaxis) Adrenaline is given in
Dose: GIVE INTRAMUSCULARLY different ways depending
Age <6 years: 0.15mls /kg of 1:1000 IM on what condition you are
Age 6 – 12 years: 0.3mls/kg of 1:1000 IM treating.
Age above 12 years: 0.5mls/kg of 1:1000 IM

Preparation: USE UNDILUTED READY MADE 1:1000 STRENGTH SOLUTION. Inject intramuscularly into
buttock or thigh.
Ready made
preparation gives:
Adrenaline (bronchodilator for severe croup)
1ml = 1mg
Dose for severe croup: 0.4mg/kg of 1:1000 (= 1mg in 1ml)
GIVE IT BY NEBULISER. May be repeated after 30 minutes.

Preparation: USE UNDILUTED READY MADE 1:1000 STRENGTH SOLUTION. Add additional saline to
make total volume at least 3 mls. NEBULISE and monitor closely.

Adrenaline (bronchodilator for severe asthma)

Dose for severe asthma: 0.01ml/kg of 1:1000 solution (=1mg in 1ml)
SUBCUTANEOUSLY (up to a maximum of 0.3ml). Can be repeated
once after 15 mins if no improvement

Preparation: USE UNDILUTED READY MADE 1:1000 STRENGTH SOLUTION.

Use accurate 1ml syringe to give
Ready made preparation gives:
subcutaneously
1ml = 1mg
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
RESUSCITATION / RESPIRATORY DRUGS
Aminophylline (a respiratory stimulant, can be used for apnoea of prematurity and also
asthma)

Dose: All ages: Loading dose (oral or IV) 6mg/kg (maximum 300mg)

Dose: Neonates: Maintain on 2.5mg/kg 12 hourly.

Older babies and children: Maintenance dose (oral or IV) 5mg/kg every 6 hours

IV Preparation: Ampoule contains 250mg in 10mls. Take 2mls solution from the ampoule =
50mg. Add this to 8mls of water for injection to make a total solution of 50mg in 10mls. Give
by slow IV push to reduce side effects – e.g. give loading dose over 20 minutes and
maintenance doses over 5 minutes.

50mg Aminophylline in 2mls solution

Final preparation gives:
+ 8mls Water for injection 1ml = 5mg

= 50mg Aminophylline in 10mls solution

Atropine (an antimuscarinic agent which inhibits the parasympathetic nervous system, used to
counteract organophosphate poisoning)

Dose: 20 micrograms / kg per dose, repeat doses every 15 - 30 minutes until atropinisation
(pupil dilatation, hot dry skin, dry mouth, fast pulse)

IV Preparation: Ampoule of 1mg / 1ml Ready made

already in solution preparation gives:
1ml = 1mg
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
RESUSCITATION / RESPIRATORY DRUGS
Salbutamol nebulisers (a bronchodilator for wheeze)

Dose: Children aged less than 5 years: 2.5mg. Children aged 5 years and over: 2.5 to 5mg
Can repeat up to every 10 minutes maximum (usual dose 1 nebuliser every 1 to 6 hours).

Nebuliser preparation: take 2.5 or 5mg salbutamol and place into nebuliser chamber. Add 3 mls of
normal saline. Attach oxygen at a flow rate of 6 L/min. Usually takes about 10 minutes to give dose.

1. Attach the oxygen hose to chamber / machine 2. Open nebuliser chamber, add drug + saline

3. Attach mouthpiece / mask to chamber 4. Put mask on, switch on, keep chamber vertical

Salbutamol inhaler with “Volumatic” spacer device (A bronchodilator for wheeze)

Dose: Child less than 5 years: 6 to 10 puffs. More than 5 years of age: 12 puffs. Give each puff then
wait for child to breath 5 times before giving next puff. Can be repeated several times an hour until
improvement. Can use a plastic bottle if a spacer is not available. 10 puffs = similar effect to nebuliser
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
IV FLUIDS
10% Dextrose (D10) (an IV fluid used to treat low blood sugar levels)

Dose: 5mls / kg of 10% dextrose

Preparation: - two methods:

Using a 10ml syringe, take 8mls water for Using a 5ml syringe, take 4mls water for
injection OR saline, add 2 mls of 50% injection OR saline, add 1ml of 50%
dextrose to get a solution of 10% dextrose dextrose to get a solution of 10% dextrose

8mls water for injection / saline OR 4mls water for injection / saline

+ 2mls 50% dextrose + 1mls 50% dextrose

= 10mls 10% dextrose = 5mls 10% dextrose

Ringer’s Lactate with 5% dextrose (an IV fluid used as maintenance if at risk of hypoglycaemia)

Dose: As prescribed – e.g. at maintenance rate

Preparation: Take 500mls of Ringer’s lactate and discard 50 mls from the bottle. 24 hour fluid
Add 50 mls of 50% dextrose. This gives you Ringer’s lactate with 5% dextrose. maintenance by
weight
500mls Ringer’s lactate
2kg 200mls
- 50mls from the bottle 4kg 400mls
6kg 600mls
+ 50mls 50% dextrose
8kg 800mls
= 500mls of Ringer’s Lactate with 5% dextrose 10kg 1000mls
12kg 1100mls
IV fluids maintenance for children: 14kg 1200mls
16kg 1300mls
- give 100mls for every kg up to the first 10kg bodyweight 18kg 1400mls
- then give 50mls for every kg between 10 and 20kg bodyweight 20kg 1500mls
- then give 25mls for every kg above 20kg. 22kg 1550mls
24kg 1600mls
Eg for a 34kg child give (100mls x 10) + (50mls x 10) + (25mls x 14) = 26kg 1650mls
1850mls IV fluid is required every 24 hours as “maintenance”. 28kg 1700mls
30kg 1750mls
Paediatric
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
ANTICONVULSANTS / TETANUS TREATMENTS
Chlorpromazine (CPZ) (a sedative used for tetanus patients) The ready made solution
for IM use gives:
Dose: All ages: 12.5 to 25mg every 6 hours IV/IM/PO/NGT
1ml = 25mg
(alternate with diazepam so one sedative is given every 3 hrs)
Preparation for IM use: Ampoule is already in solution of 50mg in 2mls. To use IM do not dilute.
Preparation for IV use: Dilute solution to make final concentration of
After dilution for IV use:
1mg in 1ml. Give slowly, have patient lying down to minimise
1ml = 1mg
hypotension.
For an IV dose of 12.5mg – take 0.5mls from For an IV dose of 25mg – take 1ml from
the ampoule (=12.5mg CPZ), add 12mls of the ampoule (=25mg CPZ), add 24mls of
normal saline to get 12.5mg CPZ in 12.5mls. normal saline to get 25mg CPZ in 25mls.
0.5mls from CPZ ampoule OR 1ml from CPZ ampoule

+ 12mls normal saline + 24mls normal saline

= 12.5mg CPZ in 12.5 mls solution = 25mg CPZ in 25mls solution

Diazepam (anti convulsant and sedative used in tetanus)

Dose: Rectal suppository for convulsions: 0.5mg/kg rectally.

NB It is safe and effective to give the undiluted IV solution
of diazepam by rectum. Can repeat after 10 mins if needed.
Dose: For convulsions: 0.2 – 0.3mg / kg IV given SLOWLY. The ready made IV /
If needed repeat after 10 minutes then PRN for a total maximum of IM solution gives:
3 doses (max 2 doses if also given phenobarbitone within 24 hours) 1ml = 5mg

Dose: For tetanus spasms: 0.2mg/kg IV 6 hourly given SLOWLY. Give IV until spasms mild/infrequent.
0.5 – 1mg/kg PO/NGT 6 hourly (alternate with CPZ so one sedative is given every 3 hours).
Preparation: Ampoule is already in solution of 10mg in 2ml (can use IV/IM).
GIVE IV DOSES SLOWLY OVER 5 MINS TO REDUCE RISK OF RESPIRATORY
ARREST – to make this easier, dilute the dose with N/Saline to make
5mls of solution then give this 5mls over 5 minutes.
NB Green’s Pharmacy on Main
Tetanus Antitoxin (Anti-Tetanus Serum = ATS) (Neutralises tetanus toxin) Street (next to Flavours coffee
shop) stocks ATS 1500 units – it
Dose: 1500 units initial dose - give IM split into 2 sites, or give slowly IV costs 60,000 shillings (July 2015).
Can repeat dose up to a total of 10,000 units (but this is expensive!) Global can sometimes help fund it

Note: Short half-life of 2 days, repeat doses may be needed

Best drug to neutralise toxin is TIG
Preparation: Already in solution. Have IM adrenaline ready (human immunoglobulin) but this is not
currently available in Jinja. TIG dose:
150 units/kg IM into 2 separate sites
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
ANTICONVULSANTS / TETANUS TREATMENTS
Phenobarbitone (used to stop convulsions that persist for more than 5 minutes, or multiple short
convulsions within 30 minutes. First line in neonatal convulsions. Can also be used for breakthrough
spasms in tetanus which persist despite regular diazepam / chlorpromazine.)

Dose: Neonate Loading dose (IM / IV) 20mg/kg. If convulsions do not stop
after 30 minutes can give further 10mg/kg. Max dose in 24 hours is 40mg/kg.

Dose: Paediatric Loading dose (IM / IV) 15mg/kg

Dose: Neonate and Paediatric Maintenance dose (oral / IV ) 5mg/kg once a day

CHILDREN Preparation: 200mg ampoule Phenobarbitone in 2mls solution. Add 3 mls water for
injection to make a solution of 200mg in 5mls.
Final
200mg Phenobarbitone in 2mls solution preparation

+ 3 mls water for injection CHILDREN gives:

1ml = 40mg
= 200mg Phenobarbitone in 5mls solution

NEONATES Preparation: BEWARE! PHENOBARBITONE MAY COME IN VIALS OF EITHER 1mls OR 2mls.
Either: Take ampoule of 200mg in 1ml, add 9mls of water to make a total solution of 200mg in 10mls.
Or, if ampoule contains 200mg in 2mls, add 8mls water to make a total solution of 200mg in 10mls.

NEONATES
200mg Phenobarbitone in 1ml solution 200mg Phenobarbitone in 2mls solution

+ 9 mls water for injection OR + 8mls water for injection

= 200mg Phenobarbitone in 10mls solution = 200mg Phenobarbitone in 10mls solution

Final preparation gives:

1ml = 20mg
 Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
OTHER DRUGS INCLUDING CARDIAC MEDS
Vitamin K (a vitamin which prevents haemorrhagic disease of the newborn)

Dose: 1mg for term babies. 0.5mg for preterm babies. Give by IM injection.

Preparation: 10mg in 1ml ampoule, add 9mls water for inj. to make a total of 1mg per 1ml solution.

10mg vitamin K in 1ml solution

Final preparation gives:
+ 9mls water for injection 1ml = 1mg
= 10mg vitamin K in 10mls total solution

Diclofenac (NSAID analgesia – NB do not give within 6 hours of ibuprofen)

Dose: IV/IM 2 years and over: 0.3 – 1mg /kg once daily or 12 hourly The ready made IV /IM
for max 2 days (max 150mg daily) solution gives:
1ml = 25mg
Preparation: IV/IM ampoule - already in solution of 75mg in 3 ml

Dose: Rectal suppository 6months and over: 0.3 – 1mg/kg three times daily
Preparation: 50mg or 100mg suppositories are available.

Cardiac Meds
Furosemide (a diuretic for heart failure, or with blood transfusion to prevent heart failure if at risk)

Dose (IV): Neonate <1 month: 0.5 - 1mg/kg, 12 - 24 hourly. Ready made preparation
Older babies and children: 0.5 – 2mg/kg, 8 – 24 hourly gives:
1ml = 10mg
Preparation: Ampoule is already in solution of 20mg in 2mls

Digoxin (a weak inotrope used in heart failure)

Ready made preparation
Dose (IV): Load with 10micrograms / kg 8 hourly for 3 doses gives:
Maintain on 10 micrograms/kg daily 1ml = 250micrograms

Preparation: Ampoule is already in solution of 500 micrograms in 2 mls

Paediatric Formulary – Jinja Regional Referral Hospital Nalufenya Children’s Unit
ANALGESIA GUIDE

 Paracetamol
 NSAID (ibuprofen OR
 Paracetamol
diclofenac)
 NSAID (ibuprofen
 Morphine
OR diclofenac)

 Paracetamol (>3months) 15mg/kg 6 hourly* (max 20mg/kg 6 hourly in severe pain)

 Ibuprofen (>3months) 10mg/kg 8 hourly
 Diclofenac (>6months) 0.3 – 1mg/kg 8 hourly†
 Morphine (>6months) 0.2 – 0.3mg/kg 4 – 6 hourly
*Paracetamol 125mg rectal suppositories are available. Dose same as oral.
†Diclofenac 50mg / 100mg rectal suppositories are available. Dose same as oral.

A PAEDIATRIC PAIN SCALE

= mild pain = moderate pain = severe pain

 How to work out drug calculations
Dose = What you want × What it’s in = Dose you need (mg) x Volume meds are in

What you’ve got mg meds are in

E.g. We want to give 180mg cloxacillin. We have made up our solution as described above, to
give us 500mg cloxacillin in 5mls total solution

180mg cloxacillin x 5mls = 1.8 mls volume of the solution needs to be administered
500mg

Note: In order to use this formula, the units of measurement must be the same for ‘What
you want’ and ‘What you’ve got’; i.e. both mg or both micrograms etc.

Drug units – conversions Abbreviations for UNITS

units = u
1 Megaunit = 1,000,000 Units international units = iu

1 microgram = 0.001 mg 1 mg = 0.001 gram

100 microgram = 0.1 mg 0.1mg = 100 micrograms 100mg = 0.1 gram 0.1gram = 100mg
1000 microgram = 1 mg 1mg = 1000 micrograms 1000mg = 1 gram 1gram = 1000 mg

Abbreviations for frequency of drug dosing

OD: Once a day (24 hourly) TDS / TID: Three times a day (8 hourly) OM / Mane: Morning

BD / BID: Twice a day (12 hrly) QID / QDS: Four times a day (6 hourly) ON / Nocte: Bedtime

PRN: As required Stat: Immediately, as a one-off dose

 Working out the “drip rate”
To administer fluids at the correct rate as prescribed as mls / hour, you will need
to calculate the drip rate.

1) Find the mls/hour rate (e.g. if fluid is prescribed as 500mls to be given over
8 hours this gives a rate of 62.5mls per one hour). If the fluid is prescribed
as e.g. 32 mls/hr, you already have the mls/hour rate. Note – this figure of
15 is a constant
2) Calculate the drip rate using the following formula:
depending on the IV
fluid viscosity and
type of giving set.
Drip rate = Rate in mls per hour x 15
When giving blood,
3600 use 20 instead of 15
3) The drip rate tells you how many drips need to fall through the chamber of
the burette (or giving set) every second, in order to get the desired mls /
hour rate.
4) This drip rate is often less than one (e.g. 0.125). This means you need to
give 0.125 drops of fluid every second to get the desired mls / hour rate. To
make it easier to understand, use this formula:

1 ÷ drip rate = 1 drop should be given after every how many seconds
(i.e. how many seconds there should be between drops)

E.g. 1 ÷ 0.125 = there should be 1 drop every 8 seconds

(i.e. there should be 8 seconds between each drop)