Antibacterial Combination

Drug

Dosage

Remarks

Co-trimoxazole
(Sulfamethoxazole [SMZ] and
Trimethoprim [TM])

800 mg SMZ and 160 mg TM PO 12 hourly x 14 days

Adverse Reactions

GI effects (nausea/vomiting, anorexia, diarrhea, rarely antibiotic-associated diarrhea/colitis, glossitis); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (eg rash, Stevens-Johnson syndrome); GU effect (crystallization in the urine); Other effects (aseptic meningitis, hepatotoxicity, hematologic effects)

Special Instructions

Maintain adequate fluid intake
Contraindicated in patients allergic to sulfonamides
Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to folic acid deficiency
Use with caution in patients with renal impairment or severe hepatic dysfunction and with folate deficiency (may consider administration of folinic acid)

Cough & Cold Preparations

Drug	Dosage	Remarks
Acetylcysteine (N-acetylcysteine)	200 mg PO 8-12 hourly 300 mg PO 12 hourly or 400 mg PO 8-12 hourly or 600 mg PO 24 hourly preferably at night	Adverse Reactions GI effects (nausea/vomiting); Hypersensitivity effects (bronchospasm, rashes); Other effect (hypotension) Special Instructions Use with caution in patients with gastric or duodenal ulcer, bronchial asthma Acetylcysteine effervescent tab/granules for oral solution: Avoid in patients with phenylketonuria
Ambroxol	30 mg PO 8 hourly Extended-release: 75 mg PO 24 hourly
Bromhexine¹	8-16 mg PO 8 hourly
Carbocisteine¹ (Carbocysteine)	500 mg PO 8 hourly or 750 mg PO 8-12 hourly
Erdosteine	300 mg PO 8-12 hourly	Adverse Reactions GI effects (GI discomfort, rarely taste alterations); Other effects (rarely, headache, dyspnea, urticaria, erythema, dermatitis) Special Instructions Contraindicated in patients with hepatic cirrhosis, hepatic impairment, cystathionine-synthetase enzyme deficiency and severe renal failure
Guaifenesin¹	100-200 mg PO 6-12 hourly or 200-400 mg PO 4 hourly Max dose: 2,400 mg/day	Adverse Reactions GI effects (GI discomfort, nausea/vomiting) Special Instructions Use with caution in patients with persistent or chronic cough, asthma, chronic bronchitis or emphysema Discontinue use if cough persists for >7 days with fever, rash or persistent headache
Lagundi leaves (Vitex negundo L)	300-600 mg PO 6-8 hourly	Adverse Reactions GI effects (nausea/vomiting, diarrhea); Other effect (itchiness) Special Instructions May be taken with or without food
Levodropropizine	60 mg PO 8 hourly	Adverse Reactions CNS effects (somnolence, faintness, clouding of consciousness, dizziness, headache); Other effects (palpitation, GI disturbance) Special Instructions Use with caution in patients with excessive mucus discharge, limited mucociliary function, hepatic dysfunction, renal insufficiency and diabetes

¹Combination preparation is available. Please see latest MIMS for specific formulations and prescribing information.

Macrolides

Drug	Dosage¹	Remarks
Erythromycin	Children: 30-50 mg/kg/day PO divided 6 hourly Adults: 250 mg PO 6 hourly or 500 mg PO 12 hourly	Adverse Reactions GI effects (nausea/vomiting, abdominal discomfort, diarrhea and other GI disturbances, antibiotic-associated diarrhea/colitis); Other effect (candidal infections) Azithromycin and Clarithromycin tend to cause less GI disturbances than Erythromycin Special Instructions May take with food to decrease gastric distress Use with caution in patients with hepatic dysfunction
Roxithromycin	Children 6-40 kg: 5-8 mg/kg/day PO divided 12 hourly x 5-10 days Children ≥40 kg: 150 mg PO 12 hourly x 5-10 days Adults: 150 mg PO 12 hourly x 5-10 days or 300 mg PO 24 hourly x 5-10 days
Advanced Macrolides
Azithromycin	Children: 10 mg/kg PO 24 hourly x 3 days or 10 mg/kg PO 24 hourly x 1 day followed by 5 mg/kg PO x 4 days Adults: 500 mg PO 24 hourly x 3 days or 500 mg PO 24 hourly x 1day followed by 250 mg PO 24 hourly x 4 days
Clarithromycin	Children: 7.5 mg/kg PO 12 hourly x 7 days Adults: 250-500 mg PO 12 hourly x 7 days

¹Duration of therapy is unless otherwise stated: 14 days

Other Drugs Acting on the Respiratory System

Drug

Dosage

Remarks

Pelargonium sidoides

Children 1-5 years old: 6.25 mg PO 8 hourly
Children 6-12 years old: 12.5 mg PO 8 hourly or 20 mg PO 12 hourly
Children >12 years old and Adults: 20 mg PO 8 hourly

Adverse Reactions

GI effects (nausea/vomiting, diarrhea); Hypersensitivity effects (rash, urticaria, pruritus) associated with initial dose

Special Instructions

Contraindicated in patients with severe renal and hepatic impairment
Use with caution in patients with hematologic disorders and in patients taking anticoagulants
After symptoms subsides, advise patient to continue use for additional 2 days

Vaccines

Drug	Dosage	Remarks
Vaccine, influenza, inactivated virus^1,2 (Influenza virus strains type A and B determined annually by WHO according to surveillance data) Trivalent influenza vaccine: 2 type A and 1 type B strains Quadrivalent influenza vaccine: 2 type A and 2 type B strains High-dose trivalent or quadrivalent influenza vaccine	0.5 mL IM/deep SC to be given annually Dose and route (IM or deep SC administration) will depend on formulation Please verify dosing with package information	Adverse Reactions Local effect (injection site soreness); CNS effect (headache); Other effects (GI disturbances, oculorespiratory syndrome, fever, malaise) Special Instructions High-dose influenza vaccine is indicated for use in persons ≥65 years old Contraindicated in individuals with severe allergic reaction to any component of the vaccine Use with caution in patients with moderate to severe acute illness and with history of Guillain-Barré syndrome (GBS)
Vaccine, influenza, purified antigen (Live, attenuated influenza vaccine [LAIV])¹ (Influenza virus strains type A and B determined annually by WHO according to surveillance data)	Only indicated for healthy individuals: 0.1 mL in each nostril as a single dose	Adverse Reactions Respiratory effects (runny nose, congestion, sore throat, cough); CNS effect (headache); Other effect (fever) Special Instructions Do not administer parenterally Contraindicated in individuals with severe allergic reaction to any component of the vaccine, pregnant patients, or with severe immunodeficiency Avoid use of antivirals 48 hours before and 14 days after vaccination Use with caution in patients with moderate to severe acute illness, with history of GBS, and close contact with an immunosuppressed individual
Vaccine, influenza, recombinant virus (Influenza virus strains type A and B determined annually by WHO according to surveillance data) Trivalent influenza vaccine: 2 type A and 1 type B strains Quadrivalent influenza vaccine: 2 type A and 2 type B strains	0.5 mL IM to be given annually	Adverse Reactions Local effect (injection site soreness, pain); CNS effect (headache); Other effects (myalgia, fatigue, fever) Special Instructions Contraindicated in individuals with severe allergic reaction to any component of the vaccine Postpone vaccination in patents with acute febrile illness Use with caution in patients with thrombocytopenia or bleeding disorder
Vaccine, influenza, surface antigen, inactivated, adjuvanted with MF59C.1 (Adjuvant vaccine)	Elderly ≥65 years old: 0.5 mL IM single dose into the deltoid muscle	Adverse Reactions Local injection site reactions (redness, swelling, pain, ecchymosis and induration); Other effects (fever, malaise, shivering, headache, sweating, myalgia, arthralgia) Special Instructions Not to be administered intravascularly Contraindicated in patients with allergies to aminoglycosides, formaldehyde, cetyltrimethylammonium bromide and polysorbate 80 Postpone immunization in febrile illness or acute infection
Vaccine, respiratory syncytial virus (RSV, RSV vaccine)	0.5 mL IM as a single dose	Adverse Reactions Local effects (injection site erythema, swelling, pain); CNS effect (headache); Other effects (myalgia, arthralgia, fever, chills) Special Instructions Postpone vaccination in patients with acute febrile illness Use with caution in patients with thrombocytopenia or any other coagulation disorders

¹Influenza vaccine is also available in combination with diphtheria, tetanus, pertussis, hepatitis B and/or polio vaccines. Please see the latest MIMS for specific formulations and prescribing information.
²Various preparations of inactivated influenza vaccines (eg inactivated split virion, inactivated surface antigen, whole-virion, and virosomal adjuvanted) are available.

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.
Not all products are available or approved for above use in all countries.
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.

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