Drug of choice for fever in children. Safe in neonates (lower dose: 7.5–10 mg/kg). Available as syrup (120 mg/5ml, 250 mg/5ml), suppository, IV. Do NOT exceed 5 doses/24h.

NOT recommended in dengue, chickenpox, or dehydration. Take with food to ↓GI side effects. Alternative to paracetamol; can alternate for refractory fever.

Max duration: 7 days. Available as 250 mg/5ml suspension, 250 mg & 500 mg capsules. Less preferred than paracetamol/ibuprofen for children.

⚠ IV must be given SLOWLY (>15 min) to prevent hypotension and anaphylactoid reactions — never bolus. Commonly used in Indonesian clinical practice for refractory fever. Available: 500 mg/ml drops, 500 mg tablet, 500 mg/ml injection. Not first-line — use paracetamol first. Banned in US/UK/Japan due to agranulocytosis risk.

Highly sedating — 1st generation. Not recommended for cold symptoms in children <2 years (FDA warning). Available as 2 mg/5ml syrup, 4 mg tablet. Also available as combination products (CTM + pseudoephedrine).

Non-sedating preferred for school-age children. Once daily dosing improves compliance. Available as 5 mg/5ml syrup, 10 mg tablet. Can use in renal impairment (every other day). Onset 1–3 hours.

Slightly more sedating than loratadine but still considered non-sedating. Dose reduce in renal impairment. Available: 5 mg/5ml syrup, 5 mg & 10 mg tablets. Rapid onset ~1 hour.

Dimenhydrinate = diphenhydramine + 8-chlorotheophylline salt (theophylline component reduces sedation slightly vs pure diphenhydramine). Give 30–60 min before travel for motion sickness prevention. Antimo (dimenhydrinate 50 mg) is the most recognisable brand in Indonesia — nearly OTC familiarity. Not recommended for children <2 years. Available: tab 50 mg; syrup 12.5 mg/5ml.

Tricyclic antihistamine — structurally different from ethanolamine antihistamines (CTM, diphenhydramine). Considered intermediate sedation (less than CTM, more than 2nd-gen). Popular in Indonesia for compounded paediatric powder prescriptions (puyer) — tab 50 mg commonly crushed and blended. Interhistin (mebhydroline napadisilate 50 mg) is the most widely dispensed brand. Onset ~1 hour, duration 6–8 hours. Available: tab 50 mg.

Very sedating. NOT first-line for anaphylaxis (epinephrine is). Paradoxical excitation common in children <6yr — warn parents. Available: 12.5 mg/5ml elixir, 25/50 mg capsules, 50 mg/ml injection. Avoid in children <2 years (FDA warning).

Appetite use is off-label with limited evidence: first exclude organic causes, review feeding practices, and treat worms, iron and zinc deficiency; combine with nutritional counselling and review weight gain after 2–4 weeks rather than continuing indefinitely. Give the larger share at bedtime to limit daytime sedation, and warn parents about drowsiness. Not for children under 2 years. Available: 4 mg tablet (Heptasan, generic); some products also come as 2 mg/5 ml syrup. For daytime allergy control, a 2nd-generation antihistamine (cetirizine, loratadine) is preferred.

Mucolytic/expectorant — only for productive (wet) cough. Should NOT be given for dry/non-productive cough. Encourage ↑fluid intake. Available as 100 mg/5ml syrup. Evidence for efficacy is limited in pediatrics.

Active metabolite of bromhexine. Better mucolytic than GG. Available: 15 mg/5ml syrup, 30 mg tablets, 7.5 mg/ml drops. May have surfactant-stimulating properties. Use only for productive cough.

Replenishes glutathione stores. As antidote: most effective within 8h of paracetamol ingestion. Available: 200 mg granules/effervescent, 100 mg/5ml syrup, 200 mg/ml IV. Foul taste/smell (sulfur).

Inhaled route preferred over oral. Use spacer device for MDI in children <8 years. Monitor K+ with high dose use. Short-acting (duration 4–6h). Onset inhaled: 3–5 min.

⚠ TDM MANDATORY for IV use. Target serum theophylline: 10–20 mcg/ml (bronchodilation); 7–12 mcg/ml (neonatal apnoea). Aminophylline = theophylline 80% + ethylenediamine 20% — dose as aminophylline salt. IV loading: infuse slowly over 20–30 min minimum — rapid infusion causes fatal arrhythmia. Do NOT give loading dose to patient already on theophylline. Check: heart rate (max 110 bpm during infusion), ECG, electrolytes (K⁺). Available: 250 mg/10ml injection (25 mg/ml); 100 mg, 200 mg tablet; 225 mg slow-release tablet. Widely used in Indonesian hospitals especially for acute asthma.

⚠ STRICT 3-DAY LIMIT — longer use causes rebound congestion (rhinitis medicamentosa) which can be worse than original symptoms. Counsel parents clearly. Use lowest effective concentration for age. In infants and toddlers: nasal saline drops are preferred first-line (safer, no rebound). Avoid in children <2 years entirely. Teach correct instillation technique: tilt head back, 1–2 drops per nostril, remain supine 1–2 minutes. Available: 0.125%, 0.25%, 0.5% nasal drops/spray; also in combination cold preparations (with antihistamines). Illiadin is the most recognised brand in Indonesia.

⚠ FDA (2008) and BPOM: OTC cold medicines including pseudoephedrine NOT recommended in children <2 years; use with caution in children <6 years. Evidence for efficacy of oral decongestants in children is limited — nasal saline remains first-line. Unlike topical decongestants, oral pseudoephedrine does NOT cause rebound congestion. Controlled substance precursor in many countries (meth precursor) — dispensing may be regulated. Short-term use only (max 7 days). Available: 30 mg/5ml syrup, 30 mg tablet; also widely available in combination products (Actifed, Rhinos SR) in Indonesia.

⚠ IMPORTANT SAFETY NOTE: PPA was withdrawn from the US market in 2000 (FDA) due to association with haemorrhagic stroke, particularly at high doses. However, it remains widely available in Indonesian OTC cold products (Decolgen, Contrex, Fludane, Mixagrip, Neozep). When prescribing or counselling patients on combination cold products in Indonesia, be aware of the PPA component. Counsel: use lowest effective dose, shortest duration (max 5–7 days), avoid in patients with hypertension or cardiovascular risk. In children, pseudoephedrine or phenylephrine are considered safer alternatives where available. Include in this reference as awareness card — physicians should recognise PPA content in combination products commonly dispensed in Indonesia.

⚠ DRY COUGH ONLY — counsel parents to distinguish dry vs productive cough before use; prescribing for wet/productive cough is inappropriate. Evidence for efficacy of cough suppressants in children is modest — reassure parents that most URTI coughs resolve without treatment in 1–2 weeks. Misuse/abuse risk: DXM at 5–10× therapeutic doses produces dissociative effects; this is a known adolescent abuse pattern in Indonesia (from OTC products). Short-term use only (max 7 days). Available: 7.5 mg/5ml, 15 mg/5ml syrup; 15 mg, 30 mg tablet; widely present in combination products (with antihistamines, decongestants). Woods Antitussive and Bisolvon Dry are most recognised in Indonesia.

Highly beta-2 selective with a longer duration (about 8–12 hours) than salbutamol, which is why it is dosed twice daily; syrup dose = 0.25 ml/kg (5 mcg/ml). For acute attacks use salbutamol — procaterol does not replace a rescue inhaler or inhaled corticosteroid controller therapy. Reassess if symptoms persist or night-time use rises. Available: 5 mcg/ml syrup, 25 mcg tablet (Meptin Mini), 50 mcg tablet (Meptin), and a dry-powder inhaler (Meptin Swinghaler — follow product label for dosing). Warn parents about tremor and restlessness; check potassium if combined with steroids or aminophylline.

⚠ NOT a substitute for ORS (oral rehydration therapy) — ORS is primary treatment! Loperamide only adjunctive. NEVER use in invasive/febrile diarrhea. Opioid receptor agonist — does not cross BBB at therapeutic doses. Max treatment duration: 2 days acute diarrhea.

Acts as a physical adsorbent. ORS remains primary treatment. Limit to 2 days. Available as 300 mg chewable tablet, 600 mg tablet. Not absorbed systemically. Separate from other drugs.

Part of WHO diarrhea treatment (ORS + Zinc). Reduces diarrhea duration by ~25% and severity by ~30%. Give with food to ↓nausea. 10 mg elemental Zn = 44.5 mg zinc sulfate = 27.4 mg zinc acetate. Continue for 10–14 days even after diarrhea resolves.

⚠ EMA 2014: restrict to short-term (max 1 week). Risk of QT prolongation — avoid in patients with cardiac disease. Neonates: risk of neurological side effects; use with extreme caution. Available: 1 mg/ml suspension, 10 mg tablet.

Preferred over metoclopramide in children (no EPS risk). ODT (orally disintegrating tablet) very useful in vomiting children — dissolves on tongue. Available: 4 mg/5ml syrup, 4 mg & 8 mg tablets/ODT, 2 mg/ml injection. Onset: 30 min (oral), 15 min (IV).

⚠ EPS CAUTION: Children are at significantly higher risk of acute dystonic reactions than adults — use lowest effective dose, shortest duration. If acute dystonia occurs: treat with IV/IM diphenhydramine 1 mg/kg or benztropine. Preferred agent is ondansetron in children. Max 5 days. Available: 5 mg/5ml syrup, 10 mg tablet, 5 mg/ml injection.

Onset 24–48 hours — counsel parents not to expect immediate effect. Available as 3.35 g/5ml (667 mg/ml) solution. Can be mixed with juice/water to improve palatability. For constipation, titrate dose to achieve 1–2 soft stools per day. Avoid in galactosaemia.

Works best in acidic environment — give 1 hour BEFORE meals and at bedtime. Avoid antacids within 30 min of sucralfate. Available: 500 mg/5ml suspension, 500 mg & 1 g tablets. Not systemically absorbed — safe. Widely used in Indonesia for gastritis and peptic ulcer adjunct therapy.

Give 30–60 min before meals for maximum efficacy. Capsules can be opened and mixed with water/applesauce for small children — do NOT crush enteric-coated pellets. Available: 10 mg, 20 mg capsules; 20 mg, 40 mg injection; 10 mg/5ml suspension. Onset: ~1 hour; maximum effect after 4 days of continuous use.

Give 30 minutes before meals (breakfast preferred) for optimal efficacy — acid pump activation required. Capsules can be opened and granules sprinkled on soft food (applesauce, yogurt) or dispersed in water — do NOT crush granules. May have slightly less CYP2C19 interaction than omeprazole (relevant for clopidogrel co-therapy). Available: capsule 15 mg, 30 mg; dispersible tablet (MUPS) 15 mg, 30 mg. MUPS tablets can be dissolved in water for children — very useful. Onset: 1–3 hours; maximum suppression after 2–4 days of daily use.

H₂ antagonist — blocks histamine-stimulated acid secretion. Less potent than PPIs but onset faster (within 1–2h). Can be used when PPI not available or in combination for refractory GERD. NDMA recall (FDA April 2020): carcinogen found in brand and generic ranitidine — FDA requested global withdrawal. Famotidine is the preferred H₂ blocker alternative (no NDMA). Available in Indonesia: 150 mg, 300 mg tablets; 25 mg/ml injection (50 mg/2ml ampoule). Reduce dose by 50% in severe renal impairment.

Preferred H₂ blocker over ranitidine (no NDMA contamination risk). 20–50× more potent than cimetidine on molar basis. Longer duration of action than ranitidine (10–12h vs 8h). Suitable for twice-daily dosing — good compliance. IV: dilute in NS, infuse over 15–30 min — avoid rapid IV (QT risk). Onset: 1h oral, faster IV. Duration: 10–12h. No antiandrogenic effects (unlike cimetidine). Available in Indonesia: 20 mg, 40 mg tablets; 10 mg/ml IV injection (20 mg/2ml). Gaster brand widely used in Indonesian hospitals.

Mechanism: replaces hydrophobic (toxic) bile acids with hydrophilic UDCA → ↓hepatocyte injury, ↑bile flow. Give with food/feeds for best absorption. For neonatal cholestasis: start early, monitor GGT, bilirubin, LFTs monthly. Response may take 4–8 weeks — do not stop prematurely. For biliary atresia: UDCA is adjunct to Kasai surgery, not a substitute. Monitor fat-soluble vitamin levels (A, D, E, K) in all cholestatic patients — supplement accordingly. Available: 150 mg, 250 mg, 300 mg tablets/capsules; 50 mg/5ml, 250 mg/5ml suspension (compounded or imported). Widely used in Indonesian NICUs and paediatric hepatology. Urdafalk and Hepalin most commonly seen in Indonesian hospitals.

First-line for many pediatric infections. Available: 125 mg/5ml, 250 mg/5ml suspension; 250 mg, 500 mg capsules. Can be taken with/without food. High-dose regimen targets resistant S. pneumoniae.

Dose is based on amoxicillin component. Available: 200/28.5 mg/5ml, 400/57 mg/5ml (high-dose suspension), 250/125 mg, 500/125 mg tablets. Take with food to ↓GI side effects. Different ratio suspensions available.

Long half-life (68 hours) allows once-daily dosing and short courses. Excellent intracellular penetration. Available: 200 mg/5ml suspension, 250/500 mg tablets. Take on empty stomach for ↑absorption. Good for atypical pneumonia.

TMP:SMX ratio 1:5 (every 80 mg TMP = 400 mg SMX = 1 tablet). Available: 40/200 mg/5ml suspension, 80/400 mg (single strength), 160/800 mg (double strength) tablets. High rates of resistance in many areas — check local sensitivity.

Oral 3rd-generation cephalosporin. Excellent gram-negative coverage. Available: 100 mg/5ml suspension, 100 mg & 200 mg tablets. Useful when amoxicillin resistance suspected. Not active vs MRSA or Enterococcus.

Older macrolide — largely replaced by azithromycin (better tolerability). Still preferred for pertussis in neonates. Available: 125 mg/5ml, 250 mg/5ml suspension; 250 mg, 500 mg tablets. Give with food to ↓GI effects.

Long half-life (6–9 hours) allows once-daily dosing — great compliance. IM route feasible for outpatient single-dose therapy (AOM, gonorrhea). Dilute with lidocaine 1% for IM to reduce pain. Available: 250 mg, 500 mg, 1 g, 2 g IV/IM vials. Do NOT mix with calcium-containing IV fluids.

Widely used oral cephalosporin in Indonesia — excellent tolerability and compliance with twice-daily dosing. Available: 125 mg/5ml, 250 mg/5ml suspension; 250 mg & 500 mg capsules. Can be taken with food. Good bioavailability (~90%). Not active against MRSA.

⚠ Warn parents: STOP and seek review immediately if child develops severe diarrhea — risk of pseudomembranous colitis. Excellent bone/joint penetration — first-line for osteomyelitis step-down. Good anaerobic coverage. Available: 75 mg/5ml suspension, 150 mg & 300 mg capsules, 150 mg/ml injection. Swallow capsules with full glass of water to avoid esophageal irritation.

⚠ MONITOR FBC regularly during treatment. Do NOT use for trivial infections or prophylaxis. Grey Baby Syndrome: neonatal toxicity from immature hepatic glucuronidation — dose must be strictly limited and serum levels monitored. Available: 125 mg/5ml suspension, 250 mg capsules, 1 g IV vial. Excellent CNS penetration. Use only when no safer alternative exists.

Classical first-line for neonatal sepsis combined with gentamicin (synergistic, broad coverage including Group B Strep and Listeria). Oral absorption poor and erratic — IV/IM preferred for serious infections. Give oral on empty stomach (food ↓absorption ~50%). Reconstituted IV solution stable only 1 hour at room temperature — prepare fresh. Available: 125 mg/5ml, 250 mg/5ml suspension; 250 mg, 500 mg capsules; 250 mg, 500 mg, 1 g, 2 g injection vials.

⚠ THERAPEUTIC DRUG MONITORING (TDM) mandatory for courses >48h: Once-daily dosing — pre-dose (trough) target <1 mg/L; peak (1h post-dose) 5–12 mg/L. Traditional dosing — trough <2 mg/L, peak 5–10 mg/L. Monitor renal function and hearing with prolonged use. Infuse IV over 30 min (never rapid bolus — neuromuscular blockade risk). Neonatal dosing based on gestational age and postnatal age — always use neonatal-specific protocol. Available: 10 mg/ml, 40 mg/ml injection. Widely used in Indonesian NICUs and paediatric wards.

⚠ MUST avoid alcohol during treatment and 48h after. Available: 200 mg/5ml suspension, 200 mg/400 mg/500 mg tablets, 5 mg/ml IV. Good CNS and GI penetration. Can turn urine dark brown — reassure patients/parents. Take with food to ↓GI effects.

⚠ Requires gastric acid for absorption — give with food/acidic drink; avoid antacids/PPIs within 2 hours. Monitor LFTs before and during prolonged therapy (>2 weeks). FDA has restricted systemic ketoconazole use due to hepatotoxicity — use only when no alternatives available. Available: 200 mg tablet, 100 mg/5ml suspension.

Not absorbed from GI tract — acts locally only. For oral thrush: apply with dropper to each side of mouth, on tongue and mucosa — instruct to swish and hold before swallowing. Treat simultaneously with mother's nipples (nystatin cream) to prevent ping-pong reinfection in breastfeeding pairs. Available: 100,000 units/ml suspension. Continue for 48h after symptoms clear.

Treat all household members simultaneously for enterobiasis (prevent reinfection). Repeat dose in 2 weeks for pinworm. Chewable tablet — can crush and mix with food. For ascariasis, dead worms passed in stool for days after — reassure parents. Available: 100 mg chewable tablet, 100 mg/5ml suspension. Wash hands, cut fingernails — hygiene education essential.

Acts as depolarising neuromuscular blocker — paralyses worms. Poorly absorbed — acts locally in GI tract. Available as 125 mg/5ml suspension (as pamoate). Note: 250 mg pyrantel pamoate = 144 mg pyrantel base — dose based on BASE. Treat whole family simultaneously for pinworm. Can be taken with or without food, any time of day.

WHO's preferred agent for school-age deworming programs (POPM). Take with fatty meal to ↑systemic absorption (important for cysticercosis/systemic infections — not necessary for intestinal). No fasting required. Chewable tab 200 mg / 400 mg, syrup 200 mg/5ml. Tab 400 mg can be crushed for compounding. For pinworm: treat all household members simultaneously; repeat dose after 2 weeks.

Drug of choice for filariasis in Indonesia. Mazzotti reactions peak 3–12h post-dose — treat symptomatically (antihistamines, paracetamol, steroids if severe). Available as tab 100 mg. Start at low dose and escalate over 3 days for treatment course to minimize Mazzotti. For MDA: single dose 6 mg/kg + albendazole 400 mg annually. Tab 100 mg can be halved for dose adjustment.

Take on empty stomach with water. Available as tab 3 mg (Mectizan), 6 mg, 12 mg. Dosing chart by weight: 15–24 kg = 3 mg; 25–35 kg = 6 mg; 36–50 kg = 9 mg; 51–65 kg = 12 mg; 66–79 kg = 15 mg; ≥80 kg = 0.2 mg/kg. For scabies: combine with topical permethrin for better outcomes in crusted scabies.

Give in morning (mimics cortisol) to ↓HPA suppression. If >2 weeks, taper dose — do not stop abruptly (adrenal insufficiency). 5 mg prednisolone = 4 mg methylprednisolone = 0.75 mg dexamethasone. Available: 5 mg/5ml syrup, 5 mg & 25 mg tablets.

⚡ Potency: 1 mg dexamethasone ≈ 6.7 mg prednisolone. No mineralocorticoid activity (unlike prednisolone). Preferred for croup (single oral dose 0.15–0.6 mg/kg as effective as nebulized budesonide). Available: 0.5 mg/5ml elixir, 0.5/4 mg tablets, 4 mg/ml injection.

Low systemic bioavailability (first-pass metabolism). Rinse mouth & gargle after inhalation to prevent oral candidiasis. Use with spacer in children. Available: 100, 200 µg/dose Turbuhaler; 0.25 mg/ml, 0.5 mg/ml, 1 mg/ml nebulizing suspension.

Give in morning to mimic cortisol rhythm and ↓HPA suppression. If >2 weeks: TAPER — do NOT stop abruptly (adrenal insufficiency). Equivalency: 5 mg prednisone = 5 mg prednisolone = 4 mg methylprednisolone = 0.75 mg dexamethasone. Available: tab 5 mg, 10 mg. Tab 5 mg commonly used in compounding for children.

Equivalency: 4 mg methylprednisolone = 5 mg prednisolone = 5 mg prednisone = 0.75 mg dexamethasone. NO mineralocorticoid activity — no Na retention. Pulse therapy: MUST infuse slowly over 30–60 min — rapid bolus causes cardiac arrhythmia! Available: tab 4 mg, 8 mg, 16 mg (Medrol); injection 125 mg, 500 mg, 1 g. Tab 4 mg used in compounding. Taper if >2 weeks.

⚡ SICK-DAY RULES — every child on chronic steroids MUST have a sick-day plan: (1) Fever/mild illness: double or triple oral dose. (2) Vomiting/unable to take oral: IM hydrocortisone immediately then go to hospital. (3) Surgery: IV hydrocortisone perioperatively. Potency: hydrocortisone 1 = prednisolone 0.25 = dexamethasone 0.075 (has mineralocorticoid activity unlike others). For adrenal crisis: IV hydrocortisone + IV fluids (NS) + glucose (if hypoglycaemic) — do NOT delay for tests. Available: Solu-Cortef 100 mg, 250 mg IV vial; 5 mg, 10 mg, 20 mg tablets; 10 mg/ml oral suspension. Teach families of adrenal-insufficient children emergency IM injection technique.

Equivalence: triamcinolone 4 mg = prednisolone 5 mg = hydrocortisone 20 mg = dexamethasone 0.75 mg; intermediate-acting with minimal mineralocorticoid activity, so it is not suitable for adrenal replacement. Kenalog-40 is a suspension for deep gluteal IM only — shake well, never IV; Kenalog-10 is for intralesional/intra-articular use, not IM. Depot IM steroids are rarely appropriate in children — reserve for specialist-directed cases and monitor growth and BP. If given beyond 2–3 weeks, taper rather than stop abruptly. Available: 4 mg tablet (Kenacort), 10 mg/ml and 40 mg/ml injection (Kenalog), oral paste 0.1% (Kenalog in Orabase).

WHO low-osmolarity ORS: Na 75 mEq/L, K 20 mEq/L, Cl 65 mEq/L, Citrate 10 mEq/L, Glucose 75 mmol/L = 245 mOsm/L. Give small sips frequently. Continue breastfeeding. Reassess after 4h rehydration. Continue regular diet after rehydration.

Continue treatment for 3 months after Hb normalises to replenish stores. Give on empty stomach for ↑absorption (if GI-intolerable, give with food — ↓absorption by ~40% but improves compliance). Reticulocyte response expected by day 7–10; Hb rise by week 3–4. Ferrous sulfate 60 mg tab = 20 mg elemental Fe. Drops 15 mg/0.6ml elemental Fe commonly used in infants. Stools will be dark/black — inform parents. Check Hb at 4 weeks to confirm response.

Key comparison: Ferrous sulfate = cheapest, most available, highest elemental Fe%; Ferrous gluconate = gentler on GI; Ferrous fumarate = high Fe content per tab; IPC (Maltofer/Ferrum Hausmann) = best tolerated, no ionic reactivity, given with food. All dosed in elemental iron. Maltofer drops: 50 mg elemental Fe/ml — commonly used in Indonesia for infants. Duration same as sulfate: treat + 3 months to replenish stores.

RULE: Always check serum B12 before starting folic acid for megaloblastic anaemia — if B12 deficient, treat B12 first or together. In thalassaemia/sickle cell: supplement folate continuously (increased consumption from haemolysis). Give anticonvulsant patients 1–5 mg/day to counteract enzyme-induced folate depletion. Available: tab 0.4 mg (preconception dose — OTC), tab 1 mg, tab 5 mg. Very cheap and widely available in Indonesia.

Mechanism: competitively inhibits plasminogen activation → prevents fibrin clot dissolution. CRASH-2 trial: reduces mortality in trauma if given within 3 hours of injury — efficacy drops after 3h (harmful if given >3h). In dengue with bleeding: commonly used in Indonesian practice (evidence limited — supportive role). IV: dilute in NS or D5W; infuse slowly over ≥10 min to prevent hypotension. Oral highly bioavailable (~30–50%). Available: 250 mg/5 ml IV, 250 mg/5 ml syrup, 500 mg tablet. Widely available in Indonesian hospitals (Transamin brand most common).

Standard of care: ALL neonates receive 1 mg IM Vitamin K at birth to prevent VKDB — do not omit. Exclusively breastfed infants at highest risk (breast milk very low in Vitamin K vs formula). For cholestatic patients: monitor INR/PT regularly — rising INR in cholestasis may respond to Vitamin K (fat malabsorption) rather than indicating liver synthetic failure — a key clinical distinction. IV: always dilute and give over minimum 20–30 min. Have epinephrine ready. Response to IV: INR starts falling within 2–4h, full effect by 24h. Available: 2 mg/ml (Konakion MM Paediatric — mixed micellar, can give IV/IM/oral), 10 mg/ml ampoule, 10 mg tablet. Konakion MM Paediatric (2 mg/0.2ml) is the preferred neonatal formulation in Indonesia.

Most effective when started within 24h of varicella rash. In immunocompetent children, oral treatment for uncomplicated varicella is optional. Mandatory in immunocompromised, adolescents, adults, or complicated cases. IV: infuse over 1 hour — never bolus; ensure vigorous hydration to prevent crystalluria. Available: tab 200 mg, 400 mg; cream 5% topical; IV 250 mg. Tabs can be crushed for compounding.

Most effective if started within 48 hours of symptom onset. Capsule 75 mg can be opened and mixed with sweet food/liquid for small children. Prophylaxis dose: standard dose once daily × 10 days (post-exposure) or 6 weeks (outbreak). Suspension 6 mg/ml available.

Most potent diuretic available. Monitor electrolytes (K⁺, Na⁺, Mg²⁺), creatinine, fluid balance. Give K⁺ supplementation if prolonged use. IV: give slowly (max 4 mg/min) to reduce ototoxicity risk. Available: tab 40 mg, injection 10 mg/ml, syrup 10 mg/ml. Tab 40 mg can be split/crushed for compounding.

Less potent than furosemide — suitable for mild, chronic fluid overload and hypertension. Unlike furosemide: ↑calcium reabsorption (useful in hypercalciuria). Monitor electrolytes. Give morning dose to avoid nocturia. Available: tab 25 mg, tab 50 mg. Tab 25 mg commonly compounded for pediatric patients.

Potassium-sparing — often combined with loop or thiazide diuretics to prevent hypokalemia. Monitor K⁺ closely, especially with ACE inhibitors. Onset of action 2–3 days (delayed — aldosterone antagonism). Available: tab 25 mg, 100 mg. Tab 25 mg commonly crushed for pediatric compounding. Take with food to ↑absorption and ↓GI side effects.

Give on empty stomach (food ↓absorption ~30–40%). Short-acting — 3× daily dosing required (unlike enalapril). First-line for hypertension with CKD/proteinuria in children. Monitor: BP (1st dose hypotension), K⁺, creatinine (within 1–2 weeks of starting). Dry cough — switch to ARB if intolerable. Available: tab 12.5 mg, 25 mg, 50 mg. Tab 12.5 mg crushable for compounding.

Prodrug → converted to active enalaprilat in liver. Longer-acting than captopril → once/twice daily dosing (better compliance). Can be taken with or without food. Monitor BP, K⁺, creatinine. If dry cough intolerable → switch to losartan/irbesartan. Available: tab 2.5 mg, 5 mg, 10 mg, 20 mg. Tab can be crushed for compounding.

Preferred ARB in pediatric guidelines. No cough — ideal substitute when ACEi cough is intolerable. Can be taken with or without food. Monitor: BP, K⁺, creatinine (same as ACEi). FDA-approved for hypertension ≥6 years. For <6 years: use captopril or enalapril. Available: tab 25 mg, 50 mg, 100 mg. Tablets can be crushed — pharmacy can prepare extemporaneous suspension 2.5 mg/ml.

Not a prodrug (active directly — unlike losartan). No cough. Once-daily dosing — good compliance. Can be taken with or without food. Particularly useful in adolescents with hypertension + CKD/proteinuria when ACEi cough is a problem. Monitor: BP, K⁺, creatinine. Available: tab 75 mg, 150 mg, 300 mg. Tab can be crushed for compounding (bitter — mix with sweet food).

10% Calcium Gluconate = 100 mg/ml solution; 1 ml contains ~9 mg elemental calcium. For hyperkalaemia: acts within 1–3 min, duration 30–60 min — give first while waiting for K⁺-lowering treatments. For hypocalcaemia tetany: give slowly IV, stop if HR <60 or ECG changes. Always use large peripheral vein or central line for IV — never small dorsal hand veins. Neonates: ceftriaxone absolutely contraindicated simultaneously (fatal calcium-ceftriaxone precipitate in lungs/kidneys). Available: 10% injection (100 mg/ml), 500 mg tablet (as carbonate — different salt, note conversion). Widely used in Indonesian NICUs and emergency settings.

PALS/IDAI 1st-line for acute seizure. IV is fastest onset (1–3 min) — give slowly. Rectal Stesolid (5 mg/2.5ml, 10 mg/2.5ml) very practical in community setting (pre-hospital). Febrile seizure maintenance: routine long-term use NOT recommended by AAP — only intermittent during febrile illness. Status epilepticus protocol: Diazepam IV → Phenytoin/Phenobarbital → Midazolam infusion. Long t½ (20–100h) + active metabolites — accumulation with repeated doses. Available: tab 2 mg, 5 mg; rectal tube 5 mg/2.5ml, 10 mg/2.5ml; injection 5 mg/ml.

⚠ Specialist-initiated. Avoid in children <2 years on polytherapy (highest hepatotoxicity risk — use monotherapy if required). Monitor: LFTs, CBC, ammonia, drug levels. TDM target: 50–100 µg/ml (trough). Give with food to ↓GI effects. Extended-release (Depakote ER, Epilim Chrono) allows once-daily dosing. Available: tab 200 mg, 500 mg; syrup 250 mg/5ml; injection 400 mg. Tabs can be crushed (immediate release only — NOT ER).

⚠ Screen HLA-B*1502 in Han Chinese and Southeast Asian patients (including Indonesian patients) before initiation — 15× higher SJS/TEN risk. Autoinduces its own metabolism over first 4 weeks (dose may need ↑ after 1 month). TDM target: 4–12 µg/ml (trough). Monitor: CBC, LFTs, sodium, serum level. Start low and titrate slowly every 2 weeks. Available: tab 200 mg; syrup 100 mg/5ml; ER tab 200 mg, 400 mg. Regular tabs can be crushed; ER tabs must NOT be crushed.

Preferred over diazepam for acute seizures when IV access unavailable — buccal midazolam equally effective as rectal diazepam (Emerg Med J evidence). Faster onset and shorter duration than diazepam (half-life 1–4h vs 20–100h). Flumazenil reversal agent (0.01 mg/kg IV, max 0.2 mg; repeat PRN) — short-acting (30–60 min) so resedation may occur. Anterograde amnesia useful for procedures. Available: 5 mg/ml IV (1 ml & 3 ml ampoules), 15 mg/3 ml. Can be given buccally using IV formulation — place between gum and cheek. Oral syrup formulation: reconstitute from IV — mix with sweet drink for palatability. Dormicum most common brand in Indonesian hospitals.

1st-line for neonatal seizures (phenytoin 2nd-line). In status epilepticus: use after benzodiazepine failure (3rd-line after 2 benzodiazepine doses). TDM target: 15–40 µg/ml (therapeutic); toxicity >60 µg/ml. Long half-life (50–160h in children) — steady state takes 2–3 weeks. IV loading: SLOW infusion over ≥20 min (max rate 1 mg/kg/min — cardiovascular/respiratory monitoring mandatory). Major concern in paediatrics: cognitive and behavioural side effects — not 1st choice for chronic epilepsy if alternatives available. Febrile seizure prophylaxis: not routinely recommended (side effects outweigh benefit for most). Available: tab 30 mg, 100 mg; elixir 15 mg/5ml; injection 200 mg/ml. Luminal brand most common in Indonesia.

⚠ IV MUST be given slowly (max 1 mg/kg/min in children, 50 mg/min adult) — rapid infusion → fatal cardiac arrhythmia. Use NS only for IV dilution (precipitates in dextrose). TDM target: 10–20 mcg/ml total (or 1–2 mcg/ml free). Non-linear (Michaelis-Menten) pharmacokinetics — small dose increases cause disproportionate level rise. Check HLA-B*1502 in Southeast Asian/Han Chinese patients before starting (↑SJS risk). Available: 100 mg capsule, 50 mg/ml injection (250 mg/5ml). Screen for gingival hyperplasia regularly — dental hygiene essential. Specialist initiation recommended.

⚡ CRITICAL: 1:1000 = 1 mg/ml (for IM/SC/nebulized). 1:10,000 = 0.1 mg/ml (for IV/IO). NEVER give 1:1000 undiluted IV. IM route preferred over SC for anaphylaxis (faster absorption). Anterolateral thigh preferred over deltoid. Keep patient supine after injection. Monitor for biphasic reaction (4–12h).

⚡ MUST be given via central venous access — extravasation causes severe tissue necrosis. If peripheral line only: use antecubital fossa minimum, monitor closely, have phentolamine ready. Paediatric target MAP typically: neonates 45–60 mmHg, infants/children 55–65 mmHg, adolescents 65 mmHg. Titrate in small increments every 5–10 min. Prepare as standard concentration in glucose 5% or NS. Available: 1 mg/ml (4 mg/4ml, 8 mg/8ml) ampoules. ICU/PICU use only — continuous haemodynamic monitoring mandatory.

Primarily beta-1 inotrope — increases cardiac contractility and heart rate with mild beta-2 vasodilation. Does NOT reliably ↑BP — if hypotension present, combine with norepinephrine. Tachycardia is the main dose-limiting side effect (HR >10% above baseline = reduce dose). Central line preferred but can use peripheral line short-term (less caustic than norepinephrine). Monitor: HR, BP, urine output, lactate. Available: 250 mg/20 ml (12.5 mg/ml) injection. Prepare in glucose 5% or NS. ICU/PICU use — continuous monitoring mandatory.

⚡ NEONATAL CONGENITAL HYPOTHYROIDISM: start immediately — every week of delay = irreversible cognitive impairment. Doses are HIGHER per kg in infants (immature metabolism + critical brain development window). Give on EMPTY STOMACH (30–60 min before feeds/food) — absorption ↓ 40% with food. Tablets can be crushed and dissolved in small amount of water or breast milk — do NOT mix with soy formula or iron-fortified formula (↓absorption). Monitor TSH every 1–3 months in first year, then 3–6 monthly. Target TSH age-appropriate. Dose DECREASES per kg as child grows — review and adjust at every visit. Available: 25 mcg, 50 mcg, 75 mcg, 100 mcg tablets. Euthyrox and Thyrax most commonly available in Indonesia.

⚠ WHY NOT PTU IN CHILDREN: PTU carries FDA black-box risk of severe hepatotoxicity (hepatic necrosis, liver failure requiring transplant) — methimazole is the preferred antithyroid drug in paediatrics. PTU exception: 1st trimester of pregnancy only (methimazole teratogenic in 1st trimester — choanal atresia, aplasia cutis). Agranulocytosis warning: check FBC at baseline. Routine FBC monitoring does NOT reliably detect agranulocytosis (can be sudden) — clinical vigilance is more important. Euthyroid typically achieved in 4–8 weeks. Monitor TFTs every 4–6 weeks during titration, 3 monthly when stable. Block-and-replace regimen (high-dose + levothyroxine) is an alternative. Available: 5 mg, 10 mg tablets. Tyrozol and Danantizol most commonly available in Indonesia. Specialist initiation strongly recommended.