Download Pediatric Decontamination/ Prophylaxis

Pediatric Decontamination and
Prophylaxis
Purpose: These recommendations are intended to assist planning for the needs of
all children requiring decontamination that present to the hospital during a disaster or
terrorist attack. Children require special considerations that may not be addressed in
the general Hospital Decontamination Plan. These guidelines will assist hospitals to
properly decontaminate infants and children in a timely manner.
Pediatric and Obstetrical Emergency Preparedness Tool Kit
General Guidelines:
Infants and children have unique needs that require special considerations
during the process of hospital-based decontamination.
•
Separation of families during decontamination should be avoided, especially
under conditions of large number of patients in a chaotic situation but medical issues
take priority.
•
Older children may resist or be difficult to handle out of fear, peer pressure,
and modesty issues, even in front of their parents or caregivers.
•
If the water temperature is below 98º F, the risk of inducing hypothermia
increases proportionately with the smaller, younger child.
•
Attention to airway management is a priority throughout decontamination
showers.
•
It cannot be assumed that the parents or caregivers will be able to
decontaminate both themselves and their children at the same time. “Hot zone”
personnel should recognize the need to assist them.
•
Large volume, low pressure water delivery system (e.g. handheld hose
sprayers) that are “child friendly” should be incorporated into the hospital
decontamination showers.
•
Regarding considerations such as hypothermia, airway management,
separation of families and the ability to effectively decontaminate a child, the smaller
the child, the bigger the problem.
Decontamination Recommendations Based on Age of Child:
•
Children are divided into three groups by age – Less than 2 years old (infants
and toddlers), ages 2to 8yearsold (preschool/young children), and ages
8to18yearsold (school age).
•
The recommendations are based on the child’s estimated age, since asking
children’s ages may be impractical due to the limitations of the PPE worn by
decontamination team members or to a large influx of patients.
•
The recommendations are meant as general guidelines.
Children Less than 2 Years of Age (Infants and Toddlers):
Infants and toddlers represent the most challenging group to safely
decontaminate due to their developmental stage, their dependent nature and
their physical characteristics.
These special needs and considerations are the most important:
•
All infants and toddlers should be placed on a stretcher and disrobed by
either the child’s caregiver or “hot zone” personnel. Use trauma sheers, if necessary
to speed the disrobing process.
•
A hand should be kept on the infant or toddler at all times, even when
bedrails are raised. (Small children can fall through.) Some have found plastic
laundry baskets to be useful in moving infants through the decontamination area.
•
It is not recommended that the child be carried due to the possibility of
injury resulting from a fall, or from dropping a slippery and squirming child.
•
All clothes and items that cannot be decontaminated should be placed in
appropriate containers or bags as provided by the hospital and labeled.
•
Ensure the temperature of the shower does not present a danger to the
infant/toddler.
•
Each infant and toddler should then be accompanied through the
decontamination shower by either their caregiver or “hot zone” personnel to ensure
the entire patient is properly decontaminated.
•
Special attention must be given to the child’s airway while in the shower.
•
Children and their families (parents or caregivers) should not be separated
unless critical medical issues take priority.
•
Once through the shower, the infant’s or toddler’s caregiver or “cold zone”
personnel escort should be given a towel and sheets to dry off the child, and a
hospital gown to dress the child. Immediately, the child should be given a unique
identification number on a wristband and then triaged to an appropriate area for
medical evaluation.
•
Remember that temperature regulation is a major issue for infants and
toddlers. If necessary, cover the child with a blanket.
Children 2 to 8 Years of Age (Preschool/Young Children):
From ages two to eight, children should be able to walk and speak, yet will still look
like a child with considerable variations in physiology and anatomy.
•
Ambulatory children should be assisted in disrobing by either the child’s
caregiver or “hot zone” personnel.
•
All clothes and items that cannot be decontaminated should be placed in
appropriate containers or bags as provided by the hospital and labeled.
•
Each child should be directly accompanied through the shower by either the
child’s caregiver or “hot zone” personnel to ensure the entire patient is properly
decontaminated.
•
It is recommended that the child not be separated from family member(s) or
the adult caregiver unless serious medical conditions dictate otherwise.
•
In the case of children with special health care needs or injured children who
are non-ambulatory:
•
• Non-ambulatory children should be placed on a stretcher by “hot zone”
personnel and disrobed (using trauma shears if necessary). Again, all clothes and
items that cannot be decontaminated should be placed in appropriate containers or
bags as provided by the hospital and labeled.
• Each non-ambulatory child on a stretcher is escorted through the
decontamination shower and assisted with decontamination to ensure the entire
patient is properly decontaminated.
• Children of this age may find the showering of their face to be aversive. Care
should be taken to keep their airway open during the showering procedure.
•
Once through the shower, each child should be given a towel and sheets to
dry, and a hospital gown. Immediately, the child should be given a unique
identification number on a wristband and then triaged to an appropriate area for
medical evaluation. Ask if they would like a blanket.
Children 8 to 18 Years of Age (School-Age Children):
At the age of 8 years and upward, the airway anatomy approximates that of an adult.
Although it is tempting to regard this age group as “small adults,” there are special
needs unique to this age group.
First, privacy is likely to be a bigger issue with this age group than with younger
children, so steps should be taken to protect modesty of the patient and limit the
number of people to which the child appears to be exposed.
Second, this group will be more likely to want explanations about procedures. The
child is likely to be more cooperative if age-appropriate explanations are given.
•
Ambulatory children should be instructed to disrobe by “hot zone” personnel.
•
All clothes and items that cannot be decontaminated should be placed in
appropriate containers or bags as provided by the hospital and labeled. Children this
age should able to accomplish this themselves.
•
Each ambulatory child should then walk through the decontamination shower,
preferably in succession with their parent or caregiver, and essentially
decontaminate him/herself.
•
Non-ambulatory children should be placed on a stretcher by “hot zone”
personnel and disrobed (using trauma shears, if necessary). This may include
children with mobility impairments, children with special health care needs or injured
children. Clothing should be placed in appropriate containers or bags provided and
labeled. Then, each non-ambulatory child is escorted through the decontamination
shower and assisted with decontamination to ensure the entire patient is properly
decontaminated.
•
Once through the shower, each child will be given a towel and sheets to dry,
and a hospital gown. Immediately, the child should be given a unique identification
number on a wristband and then triaged to an appropriate area for medical
evaluation.
•
Children and their families (parents or caregivers) should not be separated
unless critical medical issues take priority.
Home Preparation for Emergency Doses of
Doxycycline for Infants and Children Exposed to
Anthrax
Once you have been notified by your federal, state, or local authorities that you have been
exposed to anthrax, you may need to prepare emergency doses of doxycycline for infants and
children using doxycycline tablets.
You will need:
• One 100 milligram (mg.) doxycycline tablet
• Metal teaspoon
• 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.)
measuring spoons [NOTE: Measuring
spoons are preferred, however if they are
not available, use the metal spoon to grind,
measure and give the medicine.]
• 1 small bowl
• One of these foods:
– chocolate syrup
– maple syrup
– caramel syrup
– applesauce
– unsweetened
– applesauce
– jarred pureed baby
– fruit
Directions:
1.
Put one (1) 100mg doxycycline tablet into a small bowl. Crush the tablet with
the back of the metal spoon until no large pieces are seen.
2.
Add four (4) level teaspoons (tsp) of a food to the crushed doxycycline. Stir
them together until the drug looks evenly mixed with the food.
3.
Use the chart on the following page to find out how much of the mixture to
give the child.
How Much of the Doxycycline Mixture to Give a Child:
•
The number of teaspoons of the doxycycline mixture to give a child depends
on the child’s weight.
•
If child’s weight is unknown, weigh child before giving the first dose.
•
The chart below tells you how much to give a child for one dose.
•
You should give the child two doses each day for 10 days. (One dose is
given in the morning and one dose is given in the evening.)
If the child
weighs:
4 – 11 pounds
(lbs.)
12 – 22 pounds
(lbs.)
23 – 33 pounds
(lbs.)
34 45 pounds
(lbs.)
46 55 pounds
(lbs.)
56 65 pounds
(lbs.)
66 77 pounds
(lbs.)
78 88 pounds
(lbs.)
Over 88 pounds
(lbs.)
Give the child:
One half (1⁄2) teaspoon (tsp) (2.5mL) of the doxycycline mixture
One (1) teaspoon (5mL) of the doxycycline mixture
One and one half (1 1⁄2) teaspoons (7.5mL) of the doxycycline mixture
Two (2) teaspoons (10mL) of the doxycycline mixture
Two and one half (2 1⁄2) teaspoons (12.5mL) of the doxycycline mixture
Three (3) teaspoons (15mL) of the doxycycline mixture
Three and one half (3 1⁄2) teaspoons (17.5mL) of the doxycycline mixture
Four (4) teaspoons (20mL) of the doxycycline mixture (or 1 tablet)
Children heavier than 88 pounds who are exposed to anthrax should take one (1) 100mg
tablet of doxycycline two times a day (at the same time each day if possible) for 10 days.
If the child cannot swallow tablets, use the directions for preparing a mixture and give 4
teaspoons twice a day.
How already prepared Doxycycline mixture should be stored:
•
Doxycycline mixed with any of the recommended foods will keep for at least
24 hours.
•
Store the mixture in a covered container and refrigerate.
•
Prepare the doxycycline mixture daily; unused portions should be thrown
away.
Note: Children receiving doxycycline for brucellosis prophylaxis should also receive rifampin. See additional sheets for
instructions and dosing.
How To Prepare Emergency Dosages Of
Rifampin For Children and Adults Exposed To
Brucellosis
Once you have been notified by your federal, state, or local authorities that you have been
exposed to brucellosis, it may be necessary to prepare emergency doses of rifampin for
infants and children using rifampin capsules.
You will need:
• Two (2) 300 milligram (mg.) rifampin
capsules
• Metal teaspoon
• 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.)
measuring spoons [NOTE: Measuring spoons
are preferred, however if they are not
available, use the metal spoon to grind,
measure and give the medicine.]
• 1 small bowl
• One of these foods:
– chocolate syrup
– unsweetened applesauce
– maple syrup
– jarred pureed baby fruit
– caramel syrup
– ketchup
Directions:
1. Open two (2) 300mg rifampin capsules into a small bowl. Put the contents of
the capsules into a small bowl and discard the empty capsule. Crush the
contents with the back of the metal spoon until no large pieces are seen
2. Add six (6) level teaspoons (tsp) of a food to the crushed rifampin. Stir them
together until the drug looks evenly mixed with the food.
1. Use the chart on the following page to find out how much of the mixture to give
the child.
How Much of the Rifampin Mixture to Give a
Child:
•
The number of teaspoons of the rifampin mixture to give a child depends on
the child’s weight.
•
If child’s weight is unknown, weigh child before giving the first dose.
•
The chart tells you how much to give the child for one dose.
•
You should give the child one dose each day for 3 to 6 weeks.
If the child weighs:
Less than 10 pounds
(lbs.)
10 – 17 pounds (lbs.)
18 – 30 pounds (lbs.)
31 – 44 pounds (lbs.)
45 – 55 pounds (lbs.)
56 – 70 pounds (lbs.)
71 88 pounds (lbs.)
Over 88 pounds (lbs.)
Give the child:
One half (1/2) teaspoon (tsp) (2.5mL) of the rifampin mixture
One (1) teaspoon (5mL) of the rifampin mixture
Two (2) teaspoons (10mL) of the rifampin mixture
Three (3) teaspoons (15mL) of the rifampin mixture
Four (4) teaspoons (20mL) of the rifampin mixture
Five (5) teaspoons (25mL) of the rifampin mixture
Six (6) teaspoons (30mL) of the rifampin mixture
Children heavier than 88 pounds who are exposed to brucellosis should take two (2)
300mg capsules of rifampin once a day (at the same time each day if possible) for 3 to
6 weeks. If the child cannot swallow capsules, use the directions for preparing a
mixture and give 6 teaspoons once a day.
How already prepared Rifampin mixture should be stored:
•
Prepare the rifampin mixture daily and throw away any unused portions.
•
Rifampin mixed with any of the recommended foods will keep for at least 24
hours in the refrigerator.
Note: Children 8 years or older should also receive Doxycycline. Children less than 8 years should also receive
Cotrimoxazole. Please see additional sheets for directions and dosing of those drugs.
How To Prepare Emergency Dosages of
Tamiflu For Infants and Children Exposed
to Influenza
Once you have been notified by your federal, state, or local authorities that you
have been exposed to influenza, it may be necessary to prepare emergency
doses of Tamiflu (oseltamivir) for infants and children using Tamiflu capsules
. You will need:
• One (1) 75 milligram (mg.) tamiflu
(oseltamivir) capsule
• Metal teaspoon
• 1 teaspoon (tsp.) measuring spoon [NOTE:
Measuring spoons are preferred, however if
they are not available, use the metal spoon to
grind, measure and give the medicine.]
• 1 small bowl
• One of these foods:
– chocolate syrup
– maple syrup
– caramel syrup
– applesauce
– unsweetened applesauce
– jarred pureed baby fruit
– apple juice
– strawberry jam
Directions:
1.
Put one (1) 75mg Tamiflu capsule contents into a small bowl, discarding empty
capsule. Add two (2) level teaspoons (tsp) of water. Stir the water and capsule
contents for 1 minute
2.
Add three (3) level teaspoons (tsp) of a food or drink to the Tamiflu and water
mixture. Stir them together until the drug looks evenly mixed with the food or drink.
The final concentration is 3 mg/ml (2 tsp = 30 mg).
3.
Use the chart on the following page to find out how much of the mixture to
give the child.
How Much of the Tamiflu Mixture to Give a
Child:
•
The number of teaspoons of the Tamiflu mixture to give a child depends on
the child’s weight.
•
If child’s weight is unknown, weigh child before giving the first dose.
•
The chart tells you how much to give a child for one dose.
•
You should give child one dose each day (once in the morning).
If the child weighs:
Less than 33 pounds
(lbs.)
33 – 51 pounds (lbs.)
51 – 88 pounds (lbs.)
Over 88 pounds (lbs.)
Adults and
adolescents 13 years
and older
Give the child:
Two (2) teaspoons (tsp) or 30 mg of the Tamiflu solution
Three (3) teaspoons (tsp) or45 mg of the Tamiflu solution
Four (4) teaspoons (tsp) or 60 mg of the Tamiflu solution
Five (5) teaspoons (tsp) or 75 mg of the Tamiflu solution
The recommended oral dose of Tamiflu prophylaxis of influenza in adults and
adolescents 13 years and older is 75 mg once daily for 10 days. Treatment should
begin within 2 days of exposure.
How already prepared Tamiflu solution should be stored:
•
Tamiflu mixed with any of the recommended foods and drinks will keep for at
least 24 hours.
•
If mixed with food, store the mixture in a covered container and refrigerate.
•
Mixtures made with juice can be stored at room temperature.
How To Prepare Emergency Dosages of
Doxycycline For Infants and Children
Exposed to Plague
Once you have been notified by your federal, state, or local authorities that you have been
exposed to plague, it may be necessary to prepare emergency doses of doxycycline for
infants and children using doxycycline tablets
. You will need:
• One 100 milligram (mg.) doxycycline tablet
• Metal teaspoon
• 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.)
measuring spoons [NOTE: Measuring spoons
are preferred, however if they are not
available, use the metal spoon to grind,
measure and give the medicine.]
• 1 small bowl
• One of these foods:
– chocolate syrup
– maple syrup
– caramel syrup
– applesauce
– unsweetened applesauce
– jarred pureed baby fruit
Directions:
1.
Put one (1) 100mg doxycycline tablet into a small bowl. Crush the tablet with
the back of the metal spoon until no large pieces are seen.
2.
Add four (4) level teaspoons (tsp) of a food to the crushed doxycycline. Stir
them together until the drug looks evenly mixed with the food.
3.
Use the chart on the following page to find out how much of the mixture to
give the child.
How Much of the Doxycycline Mixture to Give a Child:
•
The number of teaspoons of the doxycycline mixture to give a child depends
on the child’s weight.
•
If child’s weight is unknown, weigh child before giving the first dose.
•
The chart tells you how much to give the child for one dose.
•
You should give the child two doses each day (one in the morning and one in
the afternoon) for 7 days.
If the child weighs:
Give the child:
4 – 11 pounds
(lbs.)
12 – 22 pounds
(lbs.)
23 – 33 pounds
(lbs.)
34 45 pounds (lbs.)
46 55 pounds (lbs.)
56 65 pounds (lbs.)
66 77 pounds (lbs.)
78 88 pounds (lbs.)
Over 88 pounds
(lbs.)
One half (1/2) teaspoon (tsp) (2.5mL) of the doxycycline mixture
One (1) teaspoon (5mL) of the doxycycline mixture
One and one half (1 1⁄2) teaspoons (7.5mL) of the doxycycline mixture
Two (2) teaspoons (10mL) of the doxycycline mixture
Two and one half (2 1⁄2) teaspoons (12.5mL) of the doxycycline mixture
Three (3) teaspoons (15mL) of the doxycycline mixture
Three and one half (3 1⁄2) teaspoons (17.5mL) of the doxycycline mixture
Four (4) teaspoons (20mL) of the doxycycline mixture (or 1 tablet)
Children heavier than 88 pounds who are exposed to plague should take
one (1) 100mg tablet of doxycycline two times a day (at the same time
each day if possible) for 7 days. If the child cannot swallow tablets, use
the directions for preparing a mixture and give 4 teaspoons twice a day.
How already prepared Doxycycline mixture should be stored:
•
Prepare the doxycycline mixture daily and store it in a covered container,
refrigerated.
•
Doxcycline mixed with any of the recommended foods will keep for at least 24
hours.
•
Throw away any unused portions.
How To Prepare Emergency Dosages of
Ciprofloxacin For Infants and Children Exposed to
Plague
Once you have been notified by your federal, state, or local authorities that you have been
exposed to plague, it may be necessary to prepare emergency doses of ciprofloxacin
for infants and children using ciprofloxacin tablets.
You will need:
• One (1) 500 milligram (mg.) ciprofloxacin
tablet
• Metal teaspoon
• 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.)
measuring spoons [NOTE: Measuring spoons
are preferred, however if they are not
available, use the metal spoon to grind,
measure and give the medicine.]
• 1 small bowl
• One of these foods:
– chocolate syrup
– maple syrup
– caramel syrup
– unsweetened applesauce
– jarred pureed baby fruit
– ketchup
Directions:
1.
Put one (1) 500mg ciprofloxacin tablet into a small bowl. Crush the tablet with
the back of the metal spoon until no large pieces are seen
2.
Add six (6) level teaspoons (tsp) of a food to the crushed ciprofloxacin. Stir
them together until the drug looks evenly mixed with the food.
3.
Use the chart on the following page to find out how much of the mixture to
give the child.
How Much of the Ciprofloxacin Mixture to Give a
Child:
•
The number of teaspoons of the ciprofloxacin mixture to give a child depends
on the child’s weight.
•
If child’s weight is unknown, weigh child before giving the first dose.
•
The chart tells you how much to give a child for one dose.
•
You should give child two doses each day (one in the morning and one in the
evening) for 7 days.
If the child
weighs:
4 – 5 pounds
(lbs.)
5.5 10 pounds
(lbs.)
11 – 15 pounds
(lbs.)
16 20 pounds
(lbs.)
21 – 25 pounds
(lbs.)
26 30 pounds
(lbs.)
31 – 35 pounds
(lbs.)
36 – 40 pounds
(lbs.)
41 – 45 pounds
(lbs.)
46 – 50 pounds
(lbs.)
51 – 55 pounds
(lbs.)
56 60 pounds
(lbs.)
Over 60 pounds
(lbs.)
Give the child:
One half (1⁄2) teaspoon (tsp) (2.5mL) of the ciprofloxacin mixture
One (1) teaspoon (5mL) of the ciprofloxacin mixture
One and one half (1 1⁄2) teaspoons (7.5mL) of the ciprofloxacin mixture
Two (2) teaspoons (10mL) of the ciprofloxacin mixture
Two and one half (2 1⁄2) teaspoons (12.5mL) of the ciprofloxacin mixture
Three (3) teaspoons (15mL) of the ciprofloxacin mixture
Three and one half (3 1⁄2) teaspoons (17.5mL) of the ciprofloxacin mixture
Four (4) teaspoons (20mL) of the ciprofloxacin mixture
Four and one half (4 1⁄2) teaspoons (22.5mL) of the ciprofloxacin mixture
Five (5) teaspoons (25mL) of the ciprofloxacin mixture
Five and one half (5 1⁄2) teaspoons (27.5mL) of the ciprofloxacin mixture
Six (6) teaspoons (30mL) of the ciprofloxacin mixture (or 1 tablet)
Children heavier than 60 pounds who are exposed to plague should take one (1) 500mg
tablet of ciprofloxacin two times a day (at the same time each day if possible) for 7 days. If
the child cannot swallow tablets, use the directions for preparing a mixture and give 6
teaspoons twice a day
How already prepared Ciprofloxacin mixture should be stored:
•
•
•
•
Prepare the Ciprofloxacin mixture daily.
Store the mixture in a covered container and refrigerate.
Mixture will keep for at least 24 hours refrigerated.
Throw away any unused portions.
Home Preparation for Emergency Doses of
Doxycycline for Infants and Children Exposed to
Tularemia
Once you have been notified by your federal, state, or local authorities that you have been
exposed to tularemia, it may be necessary to prepare emergency doses of doxycycline for
infants and children using doxycycline tablets.
You will need:
• One 100 milligram (mg.) doxycycline tablet
• Metal teaspoon
• 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.)
measuring spoons [NOTE: Measuring spoons
are preferred, however if they are not
available, use the metal spoon to grind,
measure and give the medicine.]
• 1 small bowl
• One of these foods: –
chocolate syrup – maple
syrup – caramel syrup –
applesauce –
unsweetened applesauce
– jarred pureed baby fruit
Directions:
1. Put one (1) 100mg doxycycline tablet into a small bowl. Crush the tablet with the
back of the metal spoon until no large pieces are seen.
1. Add four (4) level teaspoons (tsp) of a food to the crushed doxycycline. Stir them
together until the drug looks evenly mixed with the food.
1. Use the chart on the following page to find out how much of the mixture to give
the child.
How Much of the Doxycycline Mixture to Give a Child:
•
The number of teaspoons of the doxycycline mixture to give a child depends
on the child’s weight.
•
If child’s weight is unknown, weigh child before giving the first dose.
•
The chart tells you how much to give the child for one dose.
•
You should give the child two doses each day (one in the morning and one in
the afternoon) for 14 days.
If the child weighs:
Give the child:
4 – 11 pounds
(lbs.)
12 – 22 pounds
(lbs.)
23 – 33 pounds
(lbs.)
34 45 pounds (lbs.)
46 55 pounds (lbs.)
56 65 pounds (lbs.)
66 77 pounds (lbs.)
78 88 pounds (lbs.)
Over 88 pounds
(lbs.)
One half (1⁄2) teaspoon (tsp) (2.5mL) of the doxycycline mixture
One (1) teaspoon (5mL) of the doxycycline mixture
One and one half (1 1⁄2) teaspoons (7.5mL) of the doxycycline mixture
Two (2) teaspoons (10mL) of the doxycycline mixture
Two and one half (2 1⁄2) teaspoons (12.5mL) of the doxycycline mixture
Three (3) teaspoons (15mL) of the doxycycline mixture
Three and one half (3 1⁄2) teaspoons (17.5mL) of the doxycycline mixture
Four (4) teaspoons (20mL) of the doxycycline mixture (or 1 tablet)
Children heavier than 88 pounds who are exposed to tularemia should
take one (1) 100mg tablet of doxycycline two times a day (at the same
time each day if possible) for 14 days. If the child cannot swallow tablets,
use the directions for preparing a mixture and give 4 teaspoons twice a
day
How already prepared Doxycycline mixture should be stored:
•
Prepare the doxycycline mixture daily.
•
Store in a covered container and refrigerate.
•
Doxycycline mixed with any of the recommended foods will keep for at least
24 hours.
•
Throw away any unused portions.
How to Prepare Emergency Dosages of
Ciprofloxacin for Infants And Children
Exposed to Tularemia
Once you have been notified by your federal, state, or local authorities
that you have been exposed to tularemia, it may be necessary to
prepare emergency doses of ciprofloxacin for infants and children
using ciprofloxacin tablets
. You will need:
• One (1) 500 milligram (mg.) ciprofloxacin
tablet
• Metal teaspoon
• 1 teaspoon (tsp.) and 1⁄2 teaspoon (tsp.)
measuring spoons [NOTE: Measuring spoons
are preferred, however if they are not
available, use the metal spoon to grind,
measure and give the medicine.]
• 1 small bowl
• One of these foods: –
chocolate syrup – maple
syrup – caramel syrup –
unsweetened applesauce
– jarred pureed baby fruit
– ketchup
Directions:
1. Put one (1) 500mg ciprofloxacin tablet into a small bowl. Crush the tablet with the
back of the metal spoon until no large pieces are seen
1. Add six (6) level teaspoons (tsp) of a food to the crushed ciprofloxacin. Stir them
together until the drug looks evenly mixed with the food.
1. Use the chart on the following page to find out how much of the mixture to give
the child.
How much of the Ciprofloxacin Mixture to Give a Child:
•
The number of teaspoons of the ciprofloxacin mixture to give a child depends
on the child’s weight.
•
If child’s weight is unknown, weigh child before giving the first dose.
•
The chart tells you how much to give a child for one dose.
•
You should give the child two doses each day (one in the morning and one in
the evening) for 14 days.
If the child
weighs:
4 6.5 pounds
(lbs.)
7 12.5 pounds
(lbs.)
13 18 pounds
(lbs.)
19 24 pounds
(lbs.)
25 30 pounds
(lbs.)
31 37 pounds
(lbs.)
38 43 pounds
(lbs.)
44 49 pounds
(lbs.)
50 55 pounds
(lbs.)
56 61 pounds
(lbs.)
62 67 pounds
(lbs.)
68 73 pounds
(lbs.)
Over 73 pounds
(lbs)
Give the child:
One half (1/2) teaspoon (tsp) (2.5mL) of the ciprofloxacin mixture
One (1) teaspoon (5mL) of the ciprofloxacin mixture
One and one half (1 1⁄2) teaspoons (7.5mL) of the ciprofloxacin mixture
Two (2) teaspoons (10mL) of the ciprofloxacin mixture
Two and one half (2 1⁄2) teaspoons (12.5mL) of the ciprofloxacin mixture
Three (3) teaspoons (15mL) of the ciprofloxacin mixture
Three and one half (3 1⁄2) teaspoons (17.5mL) of the ciprofloxacin mixture
Four (4) teaspoons (20mL) of the ciprofloxacin mixture
Four and one half (4 1⁄2) teaspoons (22.5mL) of the ciprofloxacin mixture
Five (5) teaspoons (25mL) of the ciprofloxacin mixture
Five and one half (5 1⁄2) teaspoons (27.5mL) of the ciprofloxacin mixture
Six (6) teaspoons (30mL) of the ciprofloxacin mixture (or 1 tablet)
Children heavier than 73 pounds who are exposed to tularemia should take one (1)
500mg tablet of ciprofloxacin two times a day (at the same time each day if possible) for
14 days. If the child cannot swallow tablets, use the directions for preparing a mixture and
give 6 teaspoons twice a day.
How already prepared Ciprofloxacin mixture should be stored:
•
•
•
•
Prepare the Ciprofloxacin mixture daily.
Store the mixture in a covered container and refrigerate.
Mixture will keep for at least 24 hours refrigerated.
Throw away any unused portions.
References:
1) Occupational Safety and Health Administration (OSHA), 29 CFR 1910.120,
Hazardous Materials Incident Response Curriculum Guidelines
(HAZWOPER), last updated Directive 11/05/2003.
http://www.oshasic.gov/pls/oshaweb/owadisp.show_document?p_table=ST
ANDARDS&P_id=9765
2) OSHA Best Practices for Hospitalbased First Receivers of Victims form
Mass Casualty incidents Involving the Release of Hazardous
Substances, December 2004.
http://www.osha.gov/dts/osta/bestpractice/firstreceivers_hospital.html
3) U.S. Department of Health and Human Service: Concept of Operations Plan
(CONOPS) for Public Health and Medical Emergencies, March 2004,
Tommy G. Thompson, Secretary Dept. HHS.
http://www.dhhs.gov/nypo/pandemicplan/hhs_conops.pdf
4) Okumura T, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K,
Tanaka K, Hinohara S. Report on 640 victims of the Tokyo subway sarin attack.
Ann Emerg Med 1996 Aug;28(2):12935
5)Macintyre AG, Christopher GW, Eitsen E, Hum R,Weir S, DeAtley C, Tonat K,
Barbera JA. Weapons of mass destruction events with contaminated casualties.
JAMA 2000; 283:242249.
6) Barbera JA, Macintyre AG. Mass Casualty Handbook: Hospital, Emergency
Preparedness and Response, First edition 2003: Jane’s Information Group, Ltd.
7) Hick JL, Hanfling D, Burnstein J, Markham A, Mclntyre G, and Barbera JA.
Protective equipment for health care facility decontamination personnel:
regulations, risks, and recommendations. Ann Emerg Med Sept 2003
Sept;42(3):370380
8) Hick JL, Penn P, Hanfling D, Lapp MA, O’Laughlin D, Bunstein JL. Establishing
and training health care facility decontamination teams. Ann Emerg Med 2003
Sept; 42(3):381390
9)Markenson D. Redlener I. Pediatric Preparedness for Disasters and Terrorism: A
National Consensus Conference. Executive Summary 2003. National Center for
Disaster Preparedness. Columbia University, Mailman School of Public Health
http://www.bt.cdc.gov/children /pdf/working/execsumm03.pdf
10) Testimony before the Senate Committee on Health, Education, Labor, and
Pensions Subcommittee on Children and Families Presented by Joseph
L.Wright, MD, MPH, FAAP on Behalf of the American Academy of Pediatrics.
Senate Committee on Health, Education, Labor, and Pensions Subcommittee on
Children and Families. Washington, DC: American Academy of Pediatrics, 2001
of the United States Senate
http://www.aap.org/terrorism/resources/academy_recources.htm.
11) Oklahoma University College of Pharmacy and Oklahoma CityCounty Public
Health Department. How to prepare medication for children.