Peripheral neuropathy medical therapy: Difference between revisions

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Revision as of 15:20, 5 September 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Disease Name

1 Stage 1 - Name of stage
- 1.1 Specific Organ system involved 1
  - 1.1.1 Adult
    - Preferred regimen (1): drug name 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
    - Preferred regimen (2): drug name 500 mg PO q8h for 14-21 days
    - Preferred regimen (3): drug name 500 mg q12h for 14-21 days
    - Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
    - Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
    - Alternative regimen (3): drug name 500 mg PO q6h for 14–21 days
  - 1.1.2 Pediatric
    - 1.1.2.1 (Specific population e.g. children < 8 years of age)
      - Preferred regimen (1): drug name 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
      - Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
      - Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
    - 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
      - Preferred regimen (1): drug name 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
      - Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
- 1.2 Specific Organ system involved 2
  - 1.2.1 Adult
    - Preferred regimen (1): drug name 500 mg PO q8h
  - 1.2.2 Pediatric
    - Preferred regimen (1): drug name 50 mg/kg/day PO q8h (maximum, 500 mg per dose)

2 Stage 2 - Name of stage
- 2.1 Specific Organ system involved 1
  Note (1):
  
  Note (2):
  
  Note (3):
  - 2.1.1 Adult
    - Parenteral regimen
      - Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
      - Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
      - Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
    - Oral regimen
      - Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
      - Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
      - Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
      - Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
      - Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
      - Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
  - 2.1.2 Pediatric
    - Parenteral regimen
      - Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
      - Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
      - Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
    - Oral regimen
      - Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
      - Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
      - Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
      - Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
- 2.2 'Other Organ system involved 2'
  Note (1):
  
  Note (2):
  
  Note (3):
  - 2.2.1 Adult
    - Parenteral regimen
      - Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
      - Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
      - Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
    - Oral regimen
      - Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
      - Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
      - Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
      - Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
      - Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
      - Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
  - 2.2.2 Pediatric
    - Parenteral regimen
      - Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
      - Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
      - Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
    - Oral regimen
      - Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
      - Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
      - Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
      - Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
      - Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
      - Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)

References

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Peripheral neuropathy}}
+{{CMG}}; {{AE}}{{MMJ}}
-{{CMG}} {{AE}} {{SME}}
+==Overview==
-==Medical Therapy==
+There is no treatment for [disease name]; the mainstay of therapy is supportive care.
+OR
+Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
+OR
-No medical treatments now exist that can cure inherited peripheral neuropathy. However, there are therapies for many other forms. Any underlying condition is treated first, followed by symptomatic treatment. Peripheral nerves have the ability to regenerate, as long as the nerve cell itself has not been killed. Symptoms often can be controlled, and eliminating the causes of specific forms of neuropathy often can prevent new damage.
+The majority of cases of [disease name] are self-limited and require only supportive care.
-In general, adopting healthy habits-such as maintaining optimal weight, avoiding exposure to toxins, following a physician-supervised exercise program, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption-can reduce the physical and emotional effects of peripheral neuropathy. Active and passive forms of exercise can reduce cramps, improve muscle strength, and prevent muscle wasting in paralyzed limbs. Various dietary strategies can improve gastrointestinal symptoms. Timely treatment of injury can help prevent permanent damage. Quitting smoking is particularly important because smoking constricts the blood vessels that supply nutrients to the peripheral nerves and can worsen neuropathic symptoms. Self-care skills such as meticulous foot care and careful wound treatment in people with diabetes and others who have an impaired ability to feel pain can alleviate symptoms and improve quality of life. Such changes often create conditions that encourage nerve regeneration.
+OR
-Systemic diseases frequently require more complex treatments. Strict control of blood glucose levels has been shown to reduce neuropathic symptoms and help people with diabetic neuropathy avoid further nerve damage. Inflammatory and autoimmune conditions leading to neuropathy can be controlled in several ways. Immunosuppressive drugs such as prednisone, cyclosporine, or azathioprine may be beneficial. Plasmapheresis-a procedure in which blood is removed, cleansed of immune system cells and antibodies, and then returned to the body-can limit inflammation or suppress immune system activity. High doses of immunoglobulins, proteins that function as antibodies, also can suppress abnormal immune system activity.
+[Disease name] is a medical emergency and requires prompt treatment.
-Neuropathic pain is often difficult to control. Mild pain may sometimes be alleviated by analgesics sold over the counter. Several classes of drugs have recently proved helpful to many patients suffering from more severe forms of chronic neuropathic pain. These include mexiletine, a drug developed to correct irregular heart rhythms (sometimes associated with severe side effects); several antiepileptic drugs, including gabapentin, phenytoin, and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline. Injections of local anesthetics such as lidocaine or topical patches containing lidocaine may relieve more intractable pain. In the most severe cases, doctors can surgically destroy nerves; however, the results are often temporary and the procedure can lead to complications.
+OR
-Mechanical aids can help reduce pain and lessen the impact of physical disability. Hand or foot braces can compensate for muscle weakness or alleviate nerve compression. Orthopedic shoes can improve gait disturbances and help prevent foot injuries in people with a loss of pain sensation. If breathing becomes severely impaired, mechanical ventilation can provide essential life support.
+The mainstay of treatment for [disease name] is [therapy].
-===Treatment of Neuropathic Pain===
+OR
-Neuropathic pain can be very difficult to treat. Sometimes strong [[opioid]] analgesics  may provide only partial relief. Opioid analgesics are to be considered only as a tertiary treatment.  Several classes of medications not normally thought of as analgesics are often effective, alone or in combination with opioids and other treatments. These include [[tricyclic antidepressant]]s such as [[amitriptyline]] (Elavil®), [[anticonvulsant]]s such as [[gabapentin]] (Neurontin®) and [[pregabalin]] (Lyrica®).
+The optimal therapy for [malignancy name] depends on the stage at diagnosis.
-In animal models of neuropathic pain it has been found that compounds which only block serotonin reuptake do not improve neuropathic pain.<!--
+OR
-  --><ref>{{cite journal |author=Bennett G, Xie Y |title=A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man |journal=Pain|volume=33 |issue=1 |pages=87-107 |year=1988 |pmid=2837713}}</ref><!--
-  --><ref>{{cite journal |author=Seltzer Z, Dubner R, Shir Y |title=A novel behavioral model of neuropathic pain disorders produced in rats by partial sciatic nerve injury|journal=Pain |volume=43 |issue=2 |pages=205-18 |year=1990 |pmid=1982347}}</ref><!--
-  --><ref>{{cite journal |author=Kim S, Chung J |title=An experimental model for peripheral neuropathy produced by segmental spinal nerve ligation in the rat |journal=Pain|volume=50 |issue=3 |pages=355-63 |year=1992 |pmid=1333581}}</ref><!--
-  --><ref>{{cite journal |author=Malmberg A, Basbaum A |title=Partial sciatic nerve injury in the mouse as a model of neuropathic pain: behavioral and neuroanatomical correlates |journal=Pain |volume=76 |issue=1-2 |pages=215-22 |year=1998 |pmid=9696476}}</ref><!--
-  --><ref>{{cite journal |author=Sung B, Na H, Kim Y, Yoon Y, Han H, Nahm S, Hong S |title=Supraspinal involvement in the production of mechanical allodynia by spinal nerve injury in rats |journal=Neurosci. Lett. |volume=246 |issue=2 |pages=117-9 |year=1998 |pmid=9627194}}</ref><!--
-  --><ref>{{cite journal |author=Lee B, Won R, Baik E, Lee S, Moon C |title=An animal model of neuropathic pain employing injury to the sciatic nerve branches|journal=Neuroreport |volume=11 |issue=4 |pages=657-61 |year=2000 |pmid=10757496}}</ref><!--
-  --><ref>{{cite journal |author=Decosterd I, Woolf C |title=Spared nerve injury: an animal model of persistent peripheral neuropathic pain |journal=Pain |volume=87 |issue=2|pages=149-58 |year=2000 |pmid=10924808}}</ref><!--
-  --><ref>{{cite journal |author=Vadakkan K, Jia Y, Zhuo M |title=A behavioral model of neuropathic pain induced by ligation of the common peroneal nerve in mice|journal=The journal of pain : official journal of the American Pain Society |volume=6 |issue=11 |pages=747-56 |year=2005 |pmid=16275599}}</ref>
-Similarly, compounds that only block [[norepinephrine]] reuptake also do not improve neuropathic pain.  Compounds such as [[duloxetine]], [[venlafaxine]], and[[milnacipran]] that block both [[serotonin]] reuptake and norepinephrine reuptake do improve neuropathic pain.
-Antidepressants usually reduce neuropathic pain more quickly and with smaller doses than they relieve depression.  Antidepressants therefore seem to work differently
-on neuropathic pain than on depression, perhaps by activating descending norepinephrinergic and serotonergic pathways in the spinal cord that block pain signals from ascending to the brain.
-Many of the pharmacologic treatments for chronic neuropathic pain decrease the sensitivity of [[nociceptive]] receptors, or desensitize [[C fibers]] such that they transmit fewer signals. The newer anticonvulsants gabapentin and pregabalin appear to work by blocking calcium channels in damaged peripheral neurons.  Tricyclic antidepressants may also work on sodium channels in peripheral nerves.  The anticonvulsants [[carbamazepine]] (Tegretol®) and [[oxcarbazepine]] (Trileptal®), especially effective
+[Therapy] is recommended among all patients who develop [disease name].
-on [[trigeminal neuralgia]], are thought to work principally on [[sodium channels]].
-In general, the antidepressants seem to be most effective on continuous burning pain, while the anticonvulsants seem to
+OR
-work best on sudden, lancinating, "shock-like" pains that appear to involve large numbers of peripheral nerves improperly firing together.
-In some forms of neuropathy, especially post-herpes neuralgia, the topical application of local anesthetics such as [[lidocaine]] can provide relief. A transdermal patch containing 5% [[lidocaine]] is available.  [[Ketamine]] in a transdermal gel is also frequently effective when the neuropathy is localized. Neurontin 100mg/g PLO gel is also effective for treating peripheral neuropathy, including [[Carpal Tunnel Syndrome]].  [[Capsaicin]] cream can be beneficial in several neurogenic pain disorders, which causes release of the pain neurotransmitter [[Substance P]], and eventually reduces the availability of Substance P.
+Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
-[[Transcutaneous electrical nerve stimulation]] (TENS) is worth a trial in chronic neurogenic pain. Some pain management specialists will try acupuncture, with variable results. TENS, with certain electrical waveforms, appears to have an acupuncture-like function.
+OR
-In some neuropathic pain syndromes, "crosstalk" occurs between descending sympathetic nerves and ascending sensory nerves. Increases in sympathetic nervous system activity result in an increase of pain; this is known as sympathetically-mediated pain. Reducing the sympathetic nerve activity in the painful region with local nerve blocks or systemic medications such as the [[alpha-blocker]] [[clonidine]] may provide relief. Other drugs, known for their ability to desensitize cardiac tissue, include[[beta-blockers]] such as [[propanolol]] and [[calcium channel blockers]] such as [[verapamil]].
+Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
-The [[NMDA receptor]] seems to play a major role in neuropathic pain and in the development of opioid tolerance, and many experiments in both animals and humans have established that NMDA [[Receptor antagonist|antagonists]] such as [[ketamine]] and [[dextromethorphan]] can alleviate neuropathic pain and reverse opioid tolerance. Unfortunately, only a few NMDA antagonists are clinically available and their use is usually associated with unacceptable side effects.
+OR
-Several opioids, particularly [[methadone]], have NMDA antagonist activity in addition to their μ-opioid agonist properties that seems to make them effective against neuropathic pain, although this is still the subject of intensive research and clinical study. Methadone has this property because it is a [[racemic]] mixture; one stereo-isomer is a μ-opioid agonist; the other is a NMDA antagonist.
+Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
-A recent study showed smoking [[marijuana]] is beneficial in treating HIV-associated periphial <!--sp?
+OR
-  -->neuropathy.<ref>{{cite journal |author=Abrams D, Jay C, Shade S, Vizoso H, Reda H, Press S, Kelly M, Rowbotham M, Petersen K |title=Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial |journal=Neurology |volume=68 |issue=7 |pages=515-21 |year=2007 |pmid=17296917}}</ref>
-In addition to pharmacological treatment there are several other modalities that help some cases. While lacking double blind trials, these have shown to reduce pain and improve patient quality of life particularly for chronic neuropathic pain: Interferential Stimulation; [[Acupuncture]]; [[Meditation]]; [[Cognitive Therapy]]; and prescribed exercise.
+Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
-In more recent years, infrared photo therapy has been used to treat neuropathic symptoms.  Photo therapy devices emit near [[infrared light]] typically at a wavelength of 890nm. This wavelength is believed to stimulate the release of [[nitric oxide]], an [[endothelium-derived relaxing factor]] into the bloodstream, thus vasodilating the capilaries and venuoles in the microcirculatory system. This increase in circulation has been shown effective in various clinical studies, to decrease pain and improve sensation in [[diabetes|diabetic]] and non-diabetic patients. Note that the U.S. [[FDA]] has not approved any infrared photo therapy devices to treat neuropathy.<ref>http://www.healthlight.stirsite.com/page/page/2909659.htm</ref>
+==Medical Therapy==
+*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
+*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
+*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
+*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
+===Disease Name===
-===Alternative Medicine Treatments===
+* '''1 Stage 1 - Name of stage'''
+** 1.1 '''Specific Organ system involved 1'''
+*** 1.1.1 '''Adult'''
+**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
+**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
+**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
+**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
+**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
+*** 1.1.2 '''Pediatric'''
+**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
+***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
+***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
+***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
+****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
+***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
+***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
+** 1.2 '''Specific Organ system involved 2'''
+*** 1.2.1 '''Adult'''
+**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
+*** 1.2.2  '''Pediatric'''
+**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
-There are 2 dietary supplements that have clinical evidence showing them to be effective treatments of diabetic neuropathy; alpha lipoic acid and benfotiamine. In several studies using a variety of dosages and routes of administration, [[alpha lipoic acid]] was found to reduce the various symptoms of peripheral diabetic neuropathy. A recent review of the published data determined “ALA should be considered as a treatment option for patients with peripheral diabetic neuropathy.” Also a recent study using orally administered alpha lipoic acid found that 600 mg once a day caused a marked reduction in the symptoms of diabetic neuropathy including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet.
+* 2 '''Stage 2 - Name of stage'''
-[[Benfotiamine]] is a lipid soluble form of thiamine that has several placebo controlled double blind trials proving efficacy in treating neuropathy and various other diabetic comorbidities. 400 mg a day was the most commonly studied dose.
+** 2.1 '''Specific Organ system involved 1 '''
+**: '''Note (1):'''
+**: '''Note (2)''':
+**: '''Note (3):'''
+*** 2.1.1 '''Adult'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
+***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
+**** Oral regimen
+***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
+***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
+***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
+***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
+*** 2.1.2 '''Pediatric'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
+***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
+***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
+**** Oral regimen
+***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
+***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
+** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
+**: '''Note (1):'''
+**: '''Note (2)''':
+**: '''Note (3):'''
+*** 2.2.1 '''Adult'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
+***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
+**** Oral regimen
+***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
+***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
+***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
+***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
+***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
+*** 2.2.2 '''Pediatric'''
+**** Parenteral regimen
+***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
+***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
+***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
+**** Oral regimen
+***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
+***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
+***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
+***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
+***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 ==References==
 {{Reflist|2}}
-[[Category:primary care]]
-[[Category:Neurological disorders]]
+{{WH}}
-[[Category:Disease]]
+{{WS}}
-[[Category:Neurology]]
+[[Category: (name of the system)]]
-[[Category:Needs overview]]
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