Hospital Bautista –Tips for visiting doctors
Written August 8, 2006 by Jessica Tan, MD
Medical practice in Honduras is different from the States due to the limited resources and the difficulty of patients complying with our treatment advice. Keep medical regimens simple. Try to dose medication once or twice a day. Give medicine for the least number of days you think will likely be effective.
Appetite complaints along with dizziness, pallor and fatigue – these symptoms usually mean that patient specifically want vitamins.
A complain of “allergy” means a rash.
Order lab test that will definitely change the way you will treat a patient.
Check pharmacy daily for medication availability.
Consult our local doctors: Daniel Lagos, Denis Estrada, and Francisco Osorio.
The following treatments are recommended and used by the doctors at Hospital Bautista.
| Disease | Clinical presentation | Treatment (adults) | Treatment (children) |
| GASTROINTESTINAL | |||
| Ascariasis | Abdominal pain without diarrhea.
Often asymptomatic. Treat children under age 6 at least every six months. Treat any adult with GI symptoms or anemia |
Albendazole 400mg PO QD x 1 or
mebendazole 100 mg BID x 3 days (consider repeating dose of albendazole in 15 days if abdominal pain has been persistent for >1 week) |
Albendazole
>6 yrs: 400 mg PO QD x 1 (tablet) 2-6 yrs: 2 tsp PO x 1 (liquid 200 mg/5 cc) or mebendazole 100 mg BID x 3 days for children>2 yrs or Piperazine (500 mg/5 cc), for children <2 yrs and patients with visible worms 75 mg/kg/day divided into two doses x 5 days (consider repeating dose of albendazole in 15 days if abdominal pain has been persistent for >1 week) |
| Amebiasis | Abdominal pain with diarrhea.
Nausea, cramping, bloating, intermittent watery diarrhea, chronic lower abdominal pain, decreased appetite Caused by Entamoeba histolytica and related protozoa. |
metronidazole 500 mg PO TID x 7
days
or tinidazole 500 mg 2 tablets PO BID x 2 days |
Metronidazole 50 mg/kg/day in
three divided doses x 7 days
(125 mg/5cc) =12 yrs: 500 mg PO TID x 7 days >6 yrs: 2 tsp TID x 7 days 2-6 yrs: 1 tsp TID x 7 days <2 yrs: 50 mg/kg/day divided into three doses x 7 days |
| Giardiasis | Periumbilical abdo pain with intermittent explosive diarrhea, bloating, cramping, rotten egg burps | Metronidazole 500 mg TID x 7
days.
Also treat for worms with albendazole 400 mg PO x 1 |
Metronidazole 25 mg/kg/day divided into three doses x 5-7 days |
| Bacterial gastroenteritis | Abdominal pain with diarrhea.
Fever, nausea, vomiting, cramps |
Ciprofloxacin 500 mg PO BID x
5-7 days
or TMP/SMX 80/400 mg 2 tabs PO BID x 5-7 days |
TMP/SMX (40 mg trimethoprim/5 cc)
<1 yr: 4 mg/kg BID x 5-7 days 1-5 yrs: 5 cc BID x 5-7 days 6-11 yrs: 10 cc BID x 5-7 days |
| Viral gastroenteritis | Nausea, vomiting, abdo pain nonbloody diarrhea, no fever | Fluids, anti-emetics | |
| GERD/Gastritis | Heartburn, awaken with pain at night, worse with
food
(very common, due to the frequent excessive consumption of strong coffee) |
Antacid one tablet before each
meal or
Cimetidine 800 mg PO BID or Prevacid 30 mg PO QHS or other available PPI (pharmacy supply limits treatment duration) |
|
| PARASITIC FEVERS | |||
| Dengue fever | Fever, chills, headache, retro-orbital pain,
backache, myalgia.
Caused by flavivirus, transmitted by mosquito. |
Acetaminophen | |
| Dengue hemorrhagic fever | Dengue fever with signs of hemorrhage (petechiae, purpura, bleeding from gums or mouth, epistaxis, or GI bleeding) | Close observation for signs of shock, IVF, correction of electrolyte abnormalities | |
| Malaria | Cycles of shaking chills, high fever, profuse
sweats and marked fatigue, delirium, headache. (cycles ~ q48 hours)
Protozoal disease caused by Plasmodium malaria, P. vivax, P. ovale, and P. falciparum. (P. vivax and P. ovale are the 2 types most common to this area, sometimes co-infecting the same person. P. falciparum occurs rarely and is more serious.) . |
Primaquine 15 mg PO QD x 15 days + Chloroquine 150-mg tablets (four tablets day 1, three tablets day 2, two tablets on day 3, one tablet on day 4). | primaquine 5 mg PO QD x 15 days
+ chloroquine max 25 mg/kg total course:
10 mg/kg PO x 1 on day 1, 5 mg/kg on days 2-4 Roughly, =12 yrs: adult dose 6-12 yrs: primaquine 5 mg PO QD x 15 days + Chloroquine 150-mg tablets (2 tablets day 1, 1.5 tablets day 2, 1 tablet on day 3, 0.5 tablet on day 4) <6 yrs: primaquine 5 days mg PO QD x 15 days + chloroquine 150-mg tablets (1 tablet day 1, 1/2 tablet day 2, 1/4 tablet day 3, 1/8 tablet day 5) |
| MUSCULOSKELETAL | |||
| Musculoskeletal pain | A very common complaint due to the lives these people live, lots of carrying, lifting, pushing and pulling. | If no significant gastritis or reflux, Ibuprofen
200-400 mg PO TID with food prn or diclofenac 50 mg
PO BID-TID prn or aspirin 325 mg
PO TID with food prn or
or Indomethacin 25-50 mg PO TID prn. If gastritis or reflux, acetaminophen 325-500 mg PO TID prn |
|
| DERMATOLOGIC | |||
| Lice | Lindane or benzylbenzoate shampoo | ||
| Scabies | Pruritic papular rash with excoriations. Other family members affected | Lindane 1%, apply 60 cc
topically chin to toes for 10 hours. Repeat in 1 week.
Treat family members. |
|
| Folliculitis and other pustular wound infection | From infected mosquito, mite or insect bites | Improved hygiene,
Triple antibiotic ointment and/or Cephalexin |
|
| Miliaria (heat rash) | Fine pruritic papular vesicular lesions on a red base | Cool and dry skin, control itching, treat any superinfection | |
| Tinea capitis | Scaly circular lesion with hair loss | Ketoconazole 200 mg PO QD x 4 weeks or clotrimazole cream or terbinafine 250 mg PO QD | |
| Tinea corporis | Raised erythematous border, pruritis, interdigital white growth | Clotrimazole cream or
Lotrimin/dexamethasone |
|
| Tinea cruris and pedis | Clotrimazole cream or
Ketoconazole 200 mg QD x 4 weeks |
||
| Tinea versicolor | Hypopigmented scaly rash over back, shoulders, face | Ketoconazole 400 mg PO x 1 or
Fluconazole 400 mg PO x 1 |
|
| Stasis dermatitis ulcers | Can develop from minor trauma or insect bites, in combination with dependent edema and poor hygiene | Wash with soap and water BID. Massage/elevation, topical or PO antibiotics if necessary. | |
| Vitiligo | Hypopigmented patches.
(a very common concern) |
Reassurance
(may use 1% hydrocortisone cream) |
|
| VAGINITIS | |||
| Trichomonas | Copious, thin, foamy, green/yellow discharge with pruritus | Metronidazole cream or
sulfa cream, apply QD x 7 days or tinidazole 2 tablets PO BID. Treat patient and her sexual partner. |
|
| Candida | Thick, white, cheesy discharge with pruritus | Clotrimazole cream 100 mg QD x 7-14 days or ketoconazole 200 mg PO BID x 5 days | |
| Bacterial | Malodorous, scant discharge with fishy odor | Clindamycin cream 5 g QD x 7 days
or sulfa cream QD x 7 days |
| MISCELLANEOUS | |||
| Diabetes | Insulin is not available.
Treatment goal: FBS<150 Metformin 500, 850, 1000 mg Glipizide 5, 10 mg Glibenclamide 5 mg Avandia Actos (check pharmacy for availability) |
||
| Hypertension | Treatment goal: BP<150/90
Captopril 25 mg Lisinopril 10mg, 20mg Atenolol 50, 100 mg Valsartan/hctz Olmesartan/hctz (check pharmacy for availability) |
||
| Tuberculosis | Hemoptysis, fever, weight loss | Chest X-ray. Refer to Centro de Salud for sputum AFB and culture | |
| Hyperlipidemia | Statins, Tricor | ||
| Headache | A very common complaint.
again due to these people’s hard lives |
Tylenol prn | |
| Migraines | Imitrex, maxalt
(check pharm for availability) |
||
| Allergic rhinitis | Loratadine 10 mg PO QD and/or corticosteroid nasal sprays. | ||
| Depression | Lexapro, Zoloft, fluoxetine | ||
| Benign prostatic hypertrophy | Doxazosin, Flomax |
Available diagnostic tests:
Labs (see hospital laboratory order form)
X-ray (chest, extremities)
ultrasound
| ANTIBIOTICS | Adult doses | Children’s doses |
| Amoxicillin | 500 mg | 125 mg/5 cc, 250 mg/5 cc |
| TMP/SMX | 80/400 mg | 40 mg/5 cc |
| Cefadroxil | 500 mg | 250 mg/5 cc |
| doxycycline | 100 mg | (contraindicated for children) |
| cephalexin | 500 mg | 125 mg/5 cc, 250 mg/5 cc |