Basic and Advanced

Clinical Outpatient Management

for Polillo RHU

Michael S. Caampued, MD,MPM(HSD)

February 8, 2013
January 22, 2014
Infectious Diseases
1. URI 14. Malaria
2. LRTI/CAP 15. Varicella
3. Bronchitis 16. Furuncle/Skin
4. Otitis Media infection/infected wound
5. Sinusitis 17. Mumps
6. Conjunctivitis 18. Scabies
7. AGE 19. Tinea
8. PTB 20. Amoebiasis
9. ATP 21. Intestinal Parasitism
10. STI 22. Filariasis
11. Hepatitis
12. Dengue
13. Measles
Others
Pulmonology/Immunology Gastro-intestinal Others
1. Bronchial Asthma 1. GERD/ Peptic Ulcer 1. Diabetes Mellitus
2. Allergic rhinitis 2. Malnutrition 2. Insomnia
3. Eczema 3. Migraine
4. Allergic Reaction Musculo-skeletal 4. Seizures
5. COPD 1. Muscle 5. BPH
Diseases/Costochondritis 6. Burn
Hematology and 2. Osteoarthritis 7. AGN
Cardiovascular 3. Gout/ Acout Gouty
1. CHD attacks

2. CHF 4. Constipation

3. Angina Pectoris/Ischemic 5. Rheumatoid arthritis

Heart disease
4. Hypertension
5. Anemia
Basic Pharmacologic Dosaging
 Desired dose - the doctor’s ordered
amount needed per kg (patient’s weight)
 Concentration (per volume on
hand) – the label of mg/mL of the
medication
 Administration – the mode of
administration divided into the desired
frequency per day and the duration of
administration (mL __x/day for ___ days)
Basic Pharmacologic Dosaging
 Desired Dosages:
◦ mg/kg/day
◦ mg/kg/dose

 Concentration:
◦ mg/mL
◦ mg/tab
◦ mg/cap
 Basic Pharmacologic Dosaging
 Formula:
◦ First get the patient weight
◦ Then identify the desired dose
Volume on hand (mL)
Patient weight (kg) x Desired dose x _________________

Concentration(mg)

=
Volume to administer (mL)
__________________________________

Frequency of administration
(times/day)
URTI/URI
 Nonspecific URIs
◦ Acute, mild, lasts about 1 week
◦ Symptoms of rhinorrhea, nasal congestion,
sore throat, cough, hoarseness, body malaise,
sneezing, fever
◦ Antibiotics generally not indicated, only
symptom-based approach
URTI/URI
 Sinusitis
◦ Usually maxillary sinus
◦ Acute sinusitis: if <4 weeks
◦ S/Sx: nasal drainage, congestion, facial pain on
pressure, headache, thick purulent nasal
discharge, tooth pain, pain when supine or
leaning forward
◦ Usually if <7 days = viral
URTI/URI
 Sinusitis
◦ Tx:
1. decongestants: phenylephrine, phenylpropanolamine
containing medicines
2. Initial therapy:
1. Adult: Amoxicillin 500 mg PO TID or TMP-SMX PO BID
x 7 days
2. Pedia: Amoxicillin 50 mg/kg/day in 3 divided doses for 7
days
3. If showing resistance:
1. Adult: Coamoxiclav 500mg/125mg tab 3 times/day for 7
days
2. Pedia: Coamoxiclav 50mg/kg/day in three divided doses
for 7 days
URTI/URI
 Acute Tosillopharyngitis
◦ Clinical suspicion of Streptococcal pharyngitis
(common cause of Rheumatic Heart Disease) –
fever, tinsillar swelling, exudates, enlarged/tender
anterior cervical lymph nodes, absence of cough
◦ Tx:
1. Initial therapy:
1. Adult: Amoxicillin 500 mg PO BID or TMP-SMX PO BID
x 7 days or Erythromycin 250 mg PO qID x 7 days
2. Pedia: Amoxicillin 50 mg/kg/day in 3 divided doses for 7
days
2. Nonpharma: Oral rinse, oral fluid intake, avoidance
of citrus irritants and sweets,
3. If with severe dysphagia: adult: single dose of 20 mg
Prednisone
URTI/URI
 Otitis Media
◦ Acute onset of middle ear inflammation/loss of cone of light,
fever, otalgia, decreased hearing, tinnitus, erythematous tympanic
membrane

◦ Tx:
1. Initial therapy:
1. Adult: Amoxicillin 80 mg/kg/day in two to three divided doses
or Cefuroxime 30 mg/kg/day BID or Erythromycin 500 mg PO TID x 7 days
1. Pedia: Amoxicillin 60 mg/kg/day in 3 divided doses for 7 days or
Erythromycin 30 mg/kg/day in 3 divided doses x 7 days
2. If showing resistance:
1. Adult: Coamoxiclav 500mg/125mg tab 3 times/day for 7 days or Ceftriaxone
50 gm/kg/day IM in 2 divided doses for 3 days ( )ANST
2. Pedia: Coamoxiclav 50mg/kg/day in three divided doses for 7 days
3. Non-Pharma: increased fluid intake, cough etiquette
URTI/URI
 Otitis Externa
◦ Swimmer’s ear
◦ Furunculosis on the outer third of ear canal,
severe otalgia especially on ear manipulation,
fever, white clumpy discharge --- specially if
swimmer, ear pruritus

◦ Therapy:
1. Adult/Pedia: Polymyxin B + Neomycin + hydrocortisone
or Ofloxacin otic drops (3%) otic solution 2-3 drops 3
x/day for 7-10 days
2. Avoid ear manipulation
3. Avoid swimming
LRTI
 Bronchitis
 Community Acquired Pneumonia
 Pulmonary Tuberculosis – for special
session
Bronchitis
 Fever, chills, sweats, cough, (either
nonproductive or productive of mucoid,
purulent, or blood tinged sputum), pleuritic
chest pain, dyspnea

 Other sx (especially if pedia): nausea,

vomiting, diarrhea, fatigue, headache, myalgia,
arthralgias

 PE: tachypnea, harsh bronchial breath sounds,

occasional wheezing
Community Acquired Pneumonia
 Fever, chills, sweats, cough, (either
nonproductive or productive of mucoid,
purulent, or blood tinged sputum), pleuritic
chest pain, dyspnea

 Other sx (especially if pedia): nausea,

vomiting, diarrhea, fatigue, headache, myalgia,
arthralgias

 PE: tachypnea, crackles, bronchial breath

sounds, occasional wheezing
Community Acquired Pneumonia
Adult:
 If previously healthy and no antibiotics in the
past 3 months:
◦ Cefalexin 500 mg/cap PO q6-q8
◦ Erythromycin 500 mg/tab PO TID x 7-10 days or
Doxycycline 100 mg PO BID for 7 days
 If with co-morbidities or antibiotics in the
past 3 months:
◦ Ciprofloxacin 500 mg/tab or Ofloxacin 400
mg/tab PO BID x 7 days
◦ Co-amoxiclav 500/125 PO TID for 7 days
◦ Cefuroxime 500 mg/tab PO BID
Community Acquired Pneumonia
Pedia:
 For Mild and Moderate:
 Amoxicillin 50 mg/kg/day PO TID for 7 days
 Cefalexin 30 mg/kg/day PO BID for 7 days
 Cotrimoxazole 30 mg/kg/day in BID for 7 days
 Erythromycin 30 mg/kg/day given TID x 7-10 days
• For severe or unresolving
 Co-amoxiclav 50mg/kg/day PO in 2 divided doses
for 7 days
 Check if PTB
CAP/ Bronchitis
 Symptomatic treatment:
◦ If in acute exacerbation: Nebulize immediately:
 adult – 2 nebules (5mL),
 5-15 years old: 1 nebule(2.5mL);
 0-5 years old, 1-1.5 mL
◦ If with wheezing or tight air entry:
 Adult: Salbutamol 4 mg/tab PO q6-q8
 Pedia: Salbutamol
 5-15 years old: 2 mg/tab PO q6-q8
 0-5 years old: 2mg/5mL -2.5-5mL PO q6-q8
 Non-pharma advice:
◦ Bed rest, inc. OFI, cough etiquette
INFECTIOUS SKIN
DISEASE
Bacterial Skin Diseases
 Staphylococcal Infection
◦ Furunculosis/ Folliculitis
◦ Carbuncle
◦ Impetigo Contagiosa
◦ Cellulitis
◦ Abscess
Staphylococcal infection
 S aureus,
 Cloxacillin or a cephalosporin is the first choice
 Kapag nagiging resistant na maaari nang magsimula ng:
clindamycin, trimethoprim-sulfamethoxazole, doxycycline
 Ito ay kadalasang dahilan sa pagharang sa hair follicle ng dumi
na magiging lugar na dadami ang Staphylococcus aureus.

 Treatment:
 Warm compresses ay makakatulong sa pagpapahinog ng pigsa
 Ang Drainage o pagpiga ng pigsa ay dapat gawin at epektibo
lalo na sa malalaking pigsa
 Antibiotic ointment sa mga kalat at basang sugat na infected,
at oral antibiotic din lalo na sa marami, malalaki at paulit-ulit
na pigsa
Furuncle/ Boil
Folliculitis
Impetigo Contagiosa
Mga Dapat Malaman sa Impetigo
 Direct contact o nasal carrier,
 mukhang natuyong pulot (honey colored crust)
 palaginang paliligo at pagsasabon at pag-iingat sa mga
sugat, kamot at gasgas sa balat na hindi mahawahan
 pagpapanatili na maiksi ang kuko at paghuhugas ng
kamay
 pagiwas sa mga mayroon nitong sakit
 ginagamot ng mupirocin ointment o kung malala
naman ay mag erythromycin ointment na
 pagpapainom ng cloxacillin o cefalexin
 hugas paminsan ng agua oxinada/hydrogen peroxide
Cellulitis
Mga Dapat Malaman sa Cellulitis
 infection sa ilalim ng balat na kumakalat sa
may taba
 kadalasang mula sa sugat, paso, crack sa
balat, o mga nagdaan sa injection na hindi
malinis ang gawa
 maaaring madalas sa mga diabetiko
 binibigyan ng cloxacillin o co-amoxiclav sa
malalang kalagayan at
paracetamol/mefenamic kung masakit
Cradlecap Impetigo
Pagsusuri
 Cradlecap vs impetigo
 Cradle cap’, is caused by overactive oil
glands, and usually disappears by the first
year of age.
 Treatment is by applying mineral oil or
baby oil after shampooing, and rubbing
the scales off with a soft brush. Cradle
cap is harmless and non-contagious, but
may itch.
Abscess
Viral Skin Diseases
 Varicella
 Measles
 Herpes Zoster
Varicella
Mga Dapat Malaman sa Varicella
 hawa mula sa ubo ng mayroong bulutong
 mukhang patak ng tubig sa petal ng rosas
 pinakanakakahawa 1-5 days bago lumitaw ang
rashes at nagpapatuloy hanggang limang araw
pagtapos matuyo ng lahat ng butlig
 iiwasang mainfect ng bacteria at putukin ang mga
butlig, ibaba ang temperature
 ang pawis at init ay mas nakakakati ng butlig,
pwedeng haplasan ng yelo para guminhawa
 magbigay ng paracetamol sa lagnat, at
diphenhydramine sa kati, at antibiotic kung may
nadagdag na skin infection
Herpes zoster
Mga Dapat Malaman sa Herpes zoster
 isang uri ng bulutong kadalasan sa matanda.
 ito ay labis na masakit, mapula, at
pulu=pulutong sa isang hilera ng balat
 ginagamot lamang ang sintomas na pananakit
at paglalagnat, maaari ding hangarin ang
pagpapaigsi ng duration ng sakit gamit ang
antiviral gaya ng acyclovir
 pag-iwas na makahawa ng bulutong ay
mahalaga
 huwag putukin dahilan ito ay maaaring
mainfect
Fungal Skin Diseases
 Tinea (capitis, corporis, pedia, ungium,
versicolor)
 Malassezia furfur (Tinea versicolor)
 Jock’s Itch (tinea cruris)
 Athlete’s Foot (tine pedis)
 Ringworm (tinea corporis)
 Treatment of choice of tinea unguium is
probably oral terbinafine daily for four
months.
 Itraconazole and griseofulvin are also
effective but treatment times are longer, and
in the case of the much cheaper griseofulvin,
treatment failure is very common.
 Scopulariopsis treatment may well require
avulsion of the nail followed by topical
and/or systemic azoles until a normal nail
grows.
 Tinea capitis is fungal infection of the scalp mostly
seen in pre-school children (3-7 years of age), but can
also occur in adults. It is caused by group of fungi that
normally live on the skin (dermatophytes) but may
overgrow in certain circumstances. Tinea capitis may
present as itchy, scaling area of hair loss, black
dots (parts of broken hair in the scalp skin), yellow
crusts (favus) or rough, thickened inflamed area
(kerion). Lymph nodes on the sides of the back of the
neck may be enlarged.
 Tinea capitis is contagious, so other family members
should be examined in suspected cases.
 Therapy is by prescribed anti-fungals by mouth such
as griseofulvin or terbinafine for 4-6 weeks
Tinea Capitis Tinea capitis

Tinea
Mga Dapat Malaman sa Tinea Capitis
 fungal infection sa ulo
 bilog na paglalagas ng buhok, pangangati, at
black dot sa anit, at dandruff
 ginagamot ng oral antifungal gaya ng
itraconazole at fluclonazole
 maaring galing sa barbero na hindi
nagaalcohol ng gamit at ginupitan
Tinea corporis Tinea versicolor

Tinea
Mga Dapat Malaman sa Tinea
Versicolor
 matatagpuang sakit sa balat kadalasan sa mga naninirahan sa
lugar a may mainit at maalinsangang panahon
 makakatulong ang topical antifungal creams gaya ng nizoral
ointment o di kaya ang pagpapaligo ng shampoo na may
selenium sulfide (head and shhoulderS).
 pwede ring painumin ng clotrimazole o ketoconazole at ang
pagpapahid ng agua oxinada ay maaaring makatulong
 Hindi ito nakakahawa
Tinea corporis
 Ito ay nakakahawa
 Ang paggamot ay pareho sa versicolor
 Tinatawag ding ringworm
Tinea unguium Tinea Unguium

Tinea
Mga Dapat Malaman sa Tinea Unguium
 Pagkapal, pagputi, at paninilaw ng kuko
 Kadalasan matatagpuan sa mga naglalaba o
sa mga laging babad sa tubig ang mga kuko
 maaaring manggaling sa mainit, kulob, at
basang sapatos
 gingamot sa kombinasyon ng oral
antifungal at topical antifungal
Tinea cruris Tinea Pedis

Tinea
Skin Infestations
 Pediculosis
 Scabies
Pediculosis capitis Pediculosis

Pediculosis
Scabies adult Scabies baby

Scabies
Scabies
Scabies at Pediculosis
 Ang lisa ay nagdudulot ng labis na pangangati at
allergic reaction ng balat dahil sa laway na inilalabas ng
lisa.
 Ito ay nakakahawa sa direktang contact
 Ang gamot ay paggamit ng Scabicide soap gaya ng Dr.
Wong, o di kaya ng Permethrin soap, shampoo at
lotion
 Mariing ipinararating sa mga pamilya na kung ang ka-
pamilya ay mayroon, dapat lahat na sila ay maggamot.
 Hugasan at ibilad ng maigi ang mga unan aty kumot na
ginagamit, at huwag makisalo sa damit o headphones
ng mayroon nito para di na makahawa.
GUIDELINES ON THE
TREATMENT OF URINARY
TRACT INFECTIONS
Categories
 Acute Uncomplicated Cystitis in Women
 Acute Uncomplicated Pyelonephritis
 Asymptomatic bacteriuria
 UTI in Pregnancy
 Recurrent UTI
 Complicated UTI
 UTI in Men
Acute Uncomplicated Cystitis in
Women
 Sa hindi buntis pagitan ng 18-64 years old
 Sintomas ng
◦ masakit o mahapding pag-ihi
◦ Madalas na pag-ihi
◦ Dugo sa ihi
◦ +/- pananakit ng likod o balakang
◦ +/- abnormal na discharge sa ari
Acute Uncomplicated Cystitis in
Women
 Mga rekomendasyon:
◦ Hindi required magpa-urinalysis liban na lang kung
mayroon discharge o vaginal irritation
◦ Gamutan: Kahit alin sa mga sumusunod:
 Cotrimoxazole 800/160 2x/day x 3 days
 Ciprofloxacin 250 mg 2x/day x 3 days
 Ofloxacin 200 mg 2x/day x 3 days
 Cefuroxime 250 mg 2x/day x 3 days
 Co-amoxiclav 625 mg 2x/day x 7 days
◦ Kung 65 years old o higit pa at wala namang ibang
sakit, maaari ding gamitin ang parehong gamutan
Acute Uncomplicated Cystitis in
Women
 Mga rekomendasyon:
◦ Kung hindi gumaling sa 3 day therapy
 Magpa-urinalysis
 Kung sa labis nang 7 days na therapy ay hindi
gumagaling, ituring na COMPLICATED UTI
◦ Kung gumaling na, huwag nang ipa-urinalysis
Acute Uncomplicated
Pyelonephritis in Women
 Sintomas ng
◦ Paglalagnat T>38C at/o pangangatog
◦ pananakit ng likod o balakang
◦ Pagkaliyo at pagsusuka
◦ URINALYSIS: >/= 5 wbc/hpf
◦ +/- masakit o mahapding pag-ihi
◦ +/ - Madalas na pag-ihi
◦ +/ - Dugo sa ihi
◦ +/- abnormal na discharge sa ari
Acute Uncomplicated
Pyelonephritis in Women
 Dapat bang mag-admit? Hindi kailangan
kung:
◦ hindi buntis
◦ masunurin naman sa gamutan at marunong
magfollow up
◦ walang ibang kumplikasyon
◦ hindi labis na masakit ang balakang
◦ At labis na mataas ang lagnat
Acute Uncomplicated
Pyelonephritis in Women
 Rekomendadong gamutan:
 Ciprofloxacin 500 mg 2x/day x 7days
 Ofloxacin 400 mg 2x/day x 14 days
 Cefuroxime 500 mg 2x/day x 14 days
 Co-amoxiclav 625 mg 3x/day x 14 days
◦ Hindi kaya ng Amoxicillin o Cefalexin
◦ Sinusubukan nang iiwas sa Cotrimoxazole
dahil sa mataas na resistance dito
Acute Uncomplicated
Pyelonephritis in Women
 Rekomendadong gamutan:
◦ Kung sa pagitan ng 72 hours o 3 araw ay hindi
nawawala ang paglalagnat o umuulit o lumalala
ang sintomas, isipin ang posibilidad ng
 Bato sa Bato (Kidneys)
 Baradong Urinary tract
 Abscess sa Bato
◦ Kung hindi pa rin gumaling, ipa-Culture na ang
Ihi para itama ang gamutan ayon sa mikrobyo
Asymptomatic Bacteriuria
 UTI na walang sintomas liban na lamang sa
pagkakaroon ng moderate to many na
BACTERIA o >10 wbc/hpf SA (2)
Urinalysis
 Mga nag-uurinalysis ng walang sintomasng
UTI ay ang mga:
◦ Ooperahan
◦ Renal transplant
◦ Diabetiko
Asymptomatic Bacteriuria
 Mga rekomendasyon:
◦ Gamutan: Kahit alin sa mga sumusunod:
 Cotrimoxazole 800/160 2x/day x 7 days
 Ciprofloxacin 250 mg 2x/day x 7 days
 Ofloxacin 200 mg 2x/day x 7 days
 Cefuroxime 250 mg 2x/day x 7 days
 Co-amoxiclav 625 mg 2x/day x 7 days
◦ Kung 65 years old o higit pa at wala namang
ibang sakit, maaari ding gamitin ang parehong
gamutan
Asymptomatic Bacteriuria in
Pregnancy
 UTI na walang sintomas liban na lamang sa
pagkakaroon ng moderate to many na
BACTERIA o >5 wbc/hpf SA (2)
Urinalysis ng BUNTIS
 Mga rekomendasyon:
◦ Routine urinalysis sa buntis 9-17th weeks AOG
Asymptomatic Bacteriuria
 Rekomendadong gamutan:
◦ Nitrofurantoin (liban kung 3rd trimester)
◦ Coamoxiclav 625 mg 2x/day x 7 days
◦ Cefalexin 500 mg/cap 3x/day x 7 days
◦ Cotrimoxazole 800/160 2x/day x 7 days (liban
kung 1st and 3rd trimester)
 Dapat na may follow up na urinalysis
Acute Cystitis in Pregnancy
 Sintomas ng:
◦ Madalas na pag-ihi
◦ Di mapigilang pag-ihi
◦ Masakit o mahapding pag-ihi
◦ > 5 WBC o Bacteria sa urinalysis (+/- fever)
◦ CVA tenderness o pananakit ng balakang
◦ +/- Dugo sa ihi
Acute Cystitis in Pregnancy
◦ Gamutan: Kahit alin sa mga sumusunod:
 Cotrimoxazole 800/160 2x/day x 7 days
 Cefuroxime 250 mg 2x/day x 7 days
 Co-amoxiclav 625 mg 2x/day x 7 days
◦ Mag follow up urinalysis
Acute Uncomplicated
Pyelonephritis in Pregnancy
 Sintomas ng:
◦ Paglalagnat T>38C at/o pangangatog
◦ pananakit ng likod o balakang
◦ Pagkaliyo at pagsusuka
◦ URINALYSIS: >/= 5 wbc/hpf
◦ +/- masakit o mahapding pag-ihi
◦ +/ - Madalas na pag-ihi
◦ +/ - Dugo sa ihi
◦ +/- abnormal na discharge sa ari
Acute Uncomplicated
Pyelonephritis in Pregnancy

 Rekomendadong dapat i-ospital ang

gamutan at i-refer sa Doktor
Recurrent UTI
 UTI ng hindi buntis at walang abnormal na
urinary tract na na-diagnose ng UTI
>/=2x/year
 Sa mga taong ito dapat mabigyan ng
prophylaxis o paunang lunas
 Ang prophylaxis ay ibibigay na
◦ Maintenance ng low dose na gamot sa loob ng
6-12 months
◦ Pag-inom ng gamot pagtapos magtalik
Recurrent UTI
 Sistema ng gamutan:
◦ Low dose prophylaxis:
 Cotrimoxazole 200/40 per tab 1 tab at bedtime
 Ciprofloxacin 125 mg/tab 1 tab at bedtime
 Cefalexin 125 mg/cap 1 cap at bedtime
◦ Post coital o pagtapos magtalik
 Cotrimoxazole 200/40 per tab 1 tab
 Ciprofloxacin 125 mg/tab 1 tab
COMPLICATED UTI
 UTI sa naka-catheter
 Kapag may nalamang obstruction
 Kapag may sakit sa bato
 Renal transplant
 Diabetiko
 May HIV/AIDS
 UTI na may resistant bacteria
 UTI sa mga lalaki liban sa mga batang lalaki
COMPLICATED UTI
 Sistema ng gamutan:
◦ Kapag may mababang paglalagnat kasama ang
sintomas ng UTI: Cipro 500mg 2x/day x 14
days o Ofloxacin 400 mg 2x/day x 14 days
◦ Kapag mataas ang paglalagnat: ipa-ospital
Urinary Candidiasis
 Kung sa urinalysis ay mayroon Candida o
mayroong matinding pangangati ng ari at
maputing parang kesong discharge
 Gamutan
 Fluconazole 400 mg loading dose at
200mgday 7-14 days
UTI in Men
 Ito ay tinuturing na complicated liban kung
sa pagitan ng 15-40 years old at masigla at
walang ebidensya ng obstruction.
 Sintomas ng
◦ masakit o mahapding pag-ihi
◦ Madalas na pag-ihi
◦ Dugo sa ihi
◦ Urinalysis na >10 wbc kung biglang salo or
>/=5 wbc kung midstream urine
◦ +/- pananakit ng likod o balakang
◦ +/- abnormal na discharge sa ari
UTI in Men
◦ Gamutan: Kahit alin sa mga sumusunod:
 Cotrimoxazole 800/160 2x/day x 7 days
 Ciprofloxacin 250 mg 2x/day x 7 days
 Ofloxacin 200 mg 2x/day x 7 days
ALGORITHM
ALGORITHM
ALGORITHM
TIPS
SPECIAL INFECTIOUS
NOTIFIABLE CASES
1. Measles
2. Filariasis
3. Malaria
MEASLES/ RUBELLA
Measles
Measles
Mga Dapat Malaman sa Measles
 Tinatawag ding Rubeola
 mapupulang maliliit na butlig, kasabay ng
pagsisipon, paglalagnat, panghihina, at minsa'y
pamumula ng mata
 maaaring makatagpo ng koplik's spots (maaaring
mawala agad)
 magbigay ng paracetamol, at vitamin c para
umiwas sa paglala ng ubo. kung magka-pneumonia,
bigyan ng antibiotic
 iwasan ang aspirin o aspilet dahil posibilidad sa
baby ng Reye's syndrome
 maaaring makatulong ang Vitamin A sa edad 2
pataas
Standard Measles-Rubella Case Definition

Suspected Case
Any individual, regardless of age, with the following signs
and symptoms:
• fever (38°C of more, or hot to touch); and
• Maculo-papular rash (non-vesicular)
• at least one of the following:
cough, coryza (runny nose) or
conjunctivitis (red eyes).
What are the Differential Diagnosis used to
Detect Cases?

 Febrile exanthems (fever and rash)

 Rubella
 Roseola infantum (exanthema subitum)
 Dengue
 Scarlet
fever
 Mononucleosis
 Meningococcemia
 Other viral exanthems
MEASLES-RUBELLA LAB
CONFIRMATION
 Laboratory confirmation is very important
in measles elimination since clinical
diagnosis is not sufficient to confirm
measles infection

Serum sample collection remains the

GOLD STANDARD for confirming
suspect cases under surveillance.
ALLERGIC SKIN
DISEASES
Allergic Skin Disease
 Hives
 Eczema/ Skin Atopy
 Dishydrotic Eczema
 Lichen Simplex Chronicus
 Miliaria Rubra (Heat Rash)
Eczema face Eczema hand

Eczema
Mga Dapat Malaman sa Eczema
 pamumula, pagkapal, pangangati ng balat
dahilan sa pagiging sensitibo o allergic
 maaring mamaga o magbalat, at magluha
 ito ay iniiwasang kamutin at magsugat para di
mainfect, panatilihin ang moisture ng balat
gamit ang lotion, at umiwas sa mga nakaka-
allergy
 ipagtanong mabuti sa tuwing kailan
nagkakaroon
 ang paggamot at topicallow dose steroid
cream gaya ng hyrocortisone cream o
clobetasol ointment
Lichen Simplex chronicus (late) Lichen Simplex chronicus (early)

Lichen Simplex Chronicus

Mga Dapat Malaman sa LSC
 ito ay pangangapal ng balat at labis na
pagbabalat dahilan sa labis na pangangati
 ito ay kadalsang matatagpuan sa paa, at
kadalsang paulit-ulit at lumilitaw sa labis na
stress
 ito ay ginagamot gamit ang Salicylic acid at
steroid cream at lotion. Ang dulot nito ay
para panipisin ang balat
Miliaria profunda Miliaria rubra

Miliaria rubra (Heat rash)

Mga Dapat Malaman sa Heat Rash
 prickly heat o bungang araw
 madalas lumitaw pag mainit at maalinsangan
 ang "milia" ay nangangahulugan ng "beads"
 umiwas sa labis na pagpapawis at palagiang
maduming balat dahil sa di paliligo
 maligo sa malamig na tubig
 calamine menthol lotion, o camphor, at
paggamit ng Prickly heat powder gaya ng
Fissan o Triclosan.
 Magsuot ng malamig na damit
Hives
Bronchial Asthma
 S/Sx:
◦ Chronic airway hyperresponsiveness, increased sputum
production
◦ Usually in atopic combination of allergic rhinitis and eczema,
especially if onset is in childhood
◦ Triad of wheezing, dyspnea and cough
◦ May worsen at nigh and a common cause of insomnia for infants
and children, and even in adults
◦ PE: respiratory distress, tachypnea, use of accessory muscles, and
cyanosis, wheezing and rhonchi throguhout the chest; evidence
of allergic nasal, sinus, or skin disease

 Treatment:
◦ Bronchodilators: Salbutamol given every 4-8 hours, depending on
severity
◦ Inhaled corticosteroids: Fluticasone, budesonide
 Bronchial Asthma

Mild Mild Moderate Severe Very Severe

intermittent Persistent Persistent Persistent Persistent
Short acting b2 agonist: Salbutamol
+ Low dose inhaled
Corticosteroid/ Inhalers
High dose steroid inhalers

If Salbutamol is always used: poorly

controlled
Must begin using inhalers with
Corticosteroids
Conjunctivitis
 Tearing, foreign body sensation, eye
redness, suffusion, pruritus, matting of
lashes (if Bacterial), bloody tears
 Tx:
◦ Chloramphenicol eye drops 2 gtts q1 for 2-3
days
◦ Non-pharma: strict handwashing
Measles
S/Sx:
 Supposedly wala na tayo nito
 Highly contagious, rash of 10-14 days of duration
 Prodrome for 2-4 days of malaise, cough, coryza,
conjunctivitis, nasal discharge and fever. Fever resolves 4-5
days after rash.
 Koplik’s spots: blue white spots ona bright red background,
typically alongside second molars, 1-2 dyas before the rash

Treatment:
1. Supportive – antibiotics for bacterial superinfections
2. Vit A expecially for young children
3. MMR vaccine should have been given, 12-15 months, and at
school age children 4-12 years.
Diabetes Mellitus
 Pathogenic hyperglycemia
 S/Sx:
◦ FBS: >= 7.0 mmol/L or 126 mg/dL or RBS of
>=11.1 mmol/L or 200 mg/dL
◦ Polyuria, polydipsia, weight loss, fatigue,
weakness, blurred vision, frequent superficial
infecitons, poor wound healing
◦ History of overweight, poor exercise, smiking,
alcohol intake, family history of DM and Heart
disease
Diabetes Mellitus
 Tx:
◦ Small frequent feedings, weight loss
◦ Pharma:
1. Metformin 500 mg-2500 mg 1-3x/day (avoid in
kidney and liver disease patients) – improves
lipid profile, weight loss, lowersi nsulin level,
does not cause fast hypoglycemia
2. Sulfonylureas: Glibenclamide/Gliclazide
3. Simvastatin 20 mg/tab OD at night if beyond
forty and specially if obese
4. Insulin
SPECIAL CLINICAL
CONSIDERATIONS
ADVERSE EVENTS FOLLOWING IMMUNIZATION

 Medical incident that happens after

immunization and causes concern.
 Although vaccines are EXTREMELY safe
and effective, events can still occur
following vaccination
ADVERSE EVENTS FOLLOWING IMMUNIZATION

 Minor Vaccine Reactions

◦ Local swelling (pain, swelling, redness in 10%)
◦ Fever (in 5%) – fever following Measles/MMR
immunization occur 5-12 days after.
◦ Irritability, malaise and non-specific symptoms
(up to 5%)
◦ Although fever and rash may happen in 5-15%
of Measles/MMR vaccination, only 3% are
attributable to vaccine, the rest are normal
events in childhood.
ADVERSE EVENTS FOLLOWING IMMUNIZATION

Common Minor Event Management

Pain and redness Avoid touching or hitting the swollen
area; May give Paracetamol til fever
subsides. A cold cloth applied to the
site may ease the pain
Fever Paracetamol, Inc OFI
Rash : occurs in 5-15% None
Infections (Cellulitis) Refer to Physicians for further
evaluation and management.
May give antibiotics for obvious
purulence/ abscess
ADVERSE EVENTS FOLLOWING IMMUNIZATION

RARE SERIOUS Onset Interval Rates per Million

VACCINE doses
REACTIONS
Febrile Seizures 5-12 days 333
Thrombocytopenia (low 15-35 days 33
platelets)
Anaphylaxis 0-1 hour 1-50
ADVERSE EVENTS FOLLOWING IMMUNIZATION

Reactions Onset Interval Reaction per million

doses
Local reaction at 0-2 days 10%
injection site
Fever 6-12 days 5-15%
Rash 6-12 days 5%
Febrile Seizures 6-12 days 330
Thrombocytopenia 15-35 days 30
Anaphylactoid (severe 0-2 days ~10
allergic reaction)
Anaphylaxis 0-1 hour ~1
Encephalopathy 6-12 days ~1
ADVERSE EVENTS FOLLOWING IMMUNIZATION

How health workers should respond to injection reaction?

1. To avoid the likelihood of fainting health workers would do
well to shorten waiting time, ensure comfortable room
temperatures, preparation of the vaccine out of the
recipients view, privacy during immunization procedure,
and administration of the vaccine while the recipient is
seated.
2. Provide clear and adequate explanation about the
immunization and the procedures for those who are
waiting to be immunized.
3. Deliver immunization in a calm and confident manner.
4. Ensure that children had their meals prior to
immunization.
ADVERSE EVENTS FOLLOWING IMMUNIZATION
HOW TO DETECT ANAPHYLAXIS
TIME SCALE S/SX OF SEVERITY
ANAPHYLAXIS
Early warning signs Dizziness, perineal Mild
burning, warnth, pruritus
Occurs within a few Flushing, urticaria, nasal Mild to Moderate
minutes congestion, sneezing,
lacrimation, angioedema

Hoarseness, abdominal Moderate to Severe

cramps, substernal
pressure
Late, Life threatening Laryngeal edema. Severe
symptoms Dyspnea, abdominal pain

Bronchospasm, stridor,
collapse, hypotension,
dysrhythmias
ADVERSE EVENTS FOLLOWING IMMUNIZATION
HOW to DISTINGUISH ANAPHYLAXIS FROM FAINT
ONSET FAINT ANAPHYLAXIS
Skin Usually at the time or Within the first few
soon after the injection minutes after injection
Respiratory Pale, sweaty, cold, Red, raised and itchy
clammy rash; swollen eyes, face;
generalized rash
Cardiovascular Normal to deep breaths Noisy breahting from
airway obstruction
(wheeze or stridor)
Gastrointestinal Bradycardia Tachycardia
Transient hypotension Hypotension
Neurological Transient loss of Loss of consciousness,
consciousness, good little response once in
response once in prone prone position
position
ADVERSE EVENTS FOLLOWING IMMUNIZATION

How should anaphylaxis be managed?

1. Place the patient in the recumbent position and ensure
that the airway is clear.
2. Assess breathing and pulse. If strong carotid pulse, then it’s
not anaphylaxis.
3. If appropriate, begin with CPR.
4. Give epinephrine by deep IM at the deltoid area according
to the prescribed doses.
5. If the patient is conscious after epinephrine, place the head
lower than the feet and keep the patient warm.
6. Give oxygen by facemask.
7. Transfer the patient to a nearby hospital for further
management but never leave the patient alone. Give
epinephrine every 5 minutes maximum of three doses
while there’s no improvement in the patient’s condition.
ADVERSE EVENTS FOLLOWING IMMUNIZATION

Age in years Dose of Epinephrine

Less than 1 year 0.05mL
1 year 0.1mL
2 years 0.2mL
3-4 years 0.3mL
5-8 years 0.4mL
Tetanus-prone Wounds:
Core Principles
Tetanus-prone Wounds:
Protocols
Tetanus-prone Wounds:
Protocols