Page 167 - PJ MED OPS Handbook 8th Ed

Metronidazole (Flagyl )
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Aviation personnel are grounded for the initial 24 hours of antibiotic therapy and until the
medical condition no longer interferes with safely performing aviation duties and the patient is free
of side-effects.
• Description: Nitroimidazole antibiotic
• Indications: gastroenteritis presumed due to Giardia
• Adult Dose:
○ Amebic Dysentery – 750mg PO tid × 5–10 days
○ Trichomoniasis – 2g PO × 1 dose; OR 250mg PO tid × 7 days
○ Giardia – 250mg PO tid × 5–7 days
○ Severe anaerobic infections – 1g IV, the 500mg IV q6hr
• Pediatric Dose:
○ Safety and efficacy have not been established, except for amebiasis. 35-50mg/kg tid for 10
days. Newborns exhibit a reduced capacity to eliminate the drug.
Contraindications: hypersensivity to any component of product, or other nitroimidazole de-
rivatives, pregnancy (first trimester in patients with Trichomoniasis), administer with caution
to patients with CNS diseases, use with caution in patients with history of blood dyscrasias
• Side-effects: disulfiram-like reaction including flushing, palpitations, tachycardia, nausea,
vomiting may occur with concomitant ethanol ingestion. Refrain from ethanol during therapy
and ≥1 to 3 days afterward.
• Adverse Reactions: seizures, peripheral neuropathy (numbness or paresthesia of extremity),
patients with undiagnosed candidiasis may present more prominent symptoms during ther-
apy; treat with candicidal agent

®
Midazolam (Versed )
GROUNDING medication for personnel on flight status
• Class: benzodiazepine
• Indications: sedation for medical procedures, active seizures, sedation for agitation, psychi-
atric symptoms, battlefield anxiety, anxiety induced by exfil platform/method, severe muscle
spasms, sedation for TBI with combative behavior
• Dose:
○ Adult:
n Sedation and anxiety: 2mg IV/IO, 5mg IM/IN used in increments up to 10mg
n Seizures: 5mg IV/IO/IM
○ Pediatric:
n IV: 0.1mg/kg, may titrate to effect
n IM: 0.2mg/kg
n Intranasal: 0.3mg/kg
n PO: 0.5mg/kg
• Side-effects: laryngospasm, bronchospasm, wheezing, shallow respirations
Contraindications: known sensitivity to midazolam or other benzodiazepine, injectable mid-
azolam should not be administered to adult or pediatric patients in shock or coma, or in acute
alcohol intoxication with depression of vital signs, pregnancy

Chapter 9. Pararescue Drug Formulary n 165