Im an intern, im posted in rhtc ,so tell mi common condition which can be expected in a rural areas and give me simple symptomatic treatment to each of those conditions according to age
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RHTC rural health training centre common conditions India intern treatment protocol
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common diseases rural India RHTC PHC symptomatic treatment age-wise diarrhea fever ARI scabies worms hypertension diabetes
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Common Conditions at RHTC and Their Symptomatic Treatment (Age-Wise)
As a rural intern, the bulk of your OPD will be these conditions. They are grouped by system and each has age-stratified treatment.
1. ACUTE DIARRHEA / GASTROENTERITIS
The #1 cause of morbidity in rural India, especially in children under 5.
Cornerstone: ORS + Zinc
| Age | ORS (each loose stool) | Zinc |
|---|---|---|
| < 6 months | 50-100 mL | 10 mg/day x 14 days |
| 6 months - 2 years | 100-200 mL | 20 mg/day x 14 days |
| 2-10 years | 100-200 mL | 20 mg/day x 14 days |
| > 10 years / Adults | As much as tolerated (200-400 mL) | Not routinely needed |
- ORS recipe if packets unavailable: 1 litre boiled water + 6 tsp sugar + 1/2 tsp salt
- Antibiotics: Only for cholera-suspect (tetracycline 250 mg QID x 3 days in adults; in children use cotrimoxazole) or bloody diarrhea/dysentery (ciprofloxacin 500 mg BD x 3 days in adults; nalidixic acid in children)
- Metronidazole 400 mg TDS x 5-7 days if amoebiasis/giardiasis suspected (loose, foul-smelling, frothy stools)
- DO NOT give anti-motility agents (loperamide) in children
2. ACUTE RESPIRATORY INFECTIONS (ARI / URTI)
Includes common cold, pharyngitis, tonsillitis, sinusitis - very common year-round.
Symptomatic Treatment
| Age | Paracetamol (fever/pain) | Antihistamine + Decongestant | Notes |
|---|---|---|---|
| < 2 years | 10-15 mg/kg/dose every 4-6h | Avoid OTC cold syrups | Saline nasal drops, breastfeed |
| 2-12 years | 10-15 mg/kg/dose Q6H | Chlorpheniramine 0.1 mg/kg/dose BD | Steam inhalation |
| Adults | 500 mg - 1 g Q6H | Cetrizine 10 mg OD OR CPM 4 mg TDS | Warm saline gargles |
- Antibiotics only if bacterial infection suspected: fever >3 days, purulent exudate, severe throat pain, ear pain (otitis media) - use Amoxicillin 250 mg TDS (children: 25-40 mg/kg/day in 3 divided doses) x 5-7 days
- Pneumonia (tachypnea + fever): refer or start Amoxicillin 40 mg/kg/day; in adults - Amoxicillin 500 mg TDS x 5-7 days; refer if severe (chest indrawing, cyanosis, SpO2 < 94%)
3. MALARIA
Most common presenting complaint in rural endemic areas: fever with chills/rigors.
P. vivax Treatment (per National Programme / Park's Textbook)
| Age | Chloroquine (150 mg base tablet) Day 1 | Day 2 | Day 3 | Primaquine (2.5 mg tab) Days 1-14 |
|---|---|---|---|---|
| < 1 year | 1/2 tab | 1/2 tab | 1/4 tab | Contraindicated |
| 1-4 years | 1 tab | 1 tab | 1/2 tab | 1 tab/day |
| 5-8 years | 2 tabs | 2 tabs | 1 tab | 2 tabs/day |
| 9-14 years | 3 tabs | 3 tabs | 1.5 tabs | 4 tabs/day |
| ≥15 years/Adults | 4 tabs | 4 tabs | 2 tabs | 6 tabs/day |
| Pregnancy | 4 tabs | 4 tabs | 2 tabs | Primaquine contraindicated |
P. falciparum Treatment (ACT-SP regimen, non-NE India)
- Artesunate 4 mg/kg/day x 3 days + Sulfadoxine-Pyrimethamine single dose on Day 1
- Primaquine 0.75 mg/kg single dose on Day 2 (not in infants, pregnancy, G6PD deficiency)
- Severe malaria: IV Artesunate - refer urgently
Always confirm with RDT or peripheral smear before treating.
4. ENTERIC FEVER (TYPHOID)
Gradual-onset fever, step-ladder pattern, relative bradycardia, coated tongue.
| Age | First-line Treatment |
|---|---|
| Adults | Ciprofloxacin 500 mg BD x 14 days OR Azithromycin 1 g on Day 1 then 500 mg OD x 6 days |
| Children | Azithromycin 20 mg/kg/day OD x 7 days OR Cefixime 20 mg/kg/day BD x 14 days |
| Pregnancy | Ceftriaxone 2 g IV OD x 14 days (refer) |
- Symptomatic: Paracetamol for fever, adequate oral hydration, soft diet
- Avoid NSAIDs (risk of GI bleed/perforation)
5. ANEMIA (Iron Deficiency - most common in rural India)
Especially prevalent in: children 6 months-5 years, adolescent girls, pregnant women.
| Age Group | Treatment |
|---|---|
| Children 6m-5 yrs | Ferrous sulfate 3 mg/kg/day elemental iron in 2 divided doses |
| 5-12 years | 60 mg elemental iron + 0.5 mg folic acid OD |
| Adolescent girls | 100 mg elemental iron + 0.5 mg folic acid OD x 16 weeks (WIFS scheme) |
| Pregnant women | 100 mg elemental iron + 0.5 mg folic acid BD during pregnancy + 3 months postpartum |
| Adults (general) | 100-200 mg elemental iron daily in 2-3 divided doses |
- Give iron between meals for better absorption; with Vitamin C (lemon water) helps
- Treat underlying cause (worms - give Albendazole 400 mg single dose in children > 2 yrs and adults)
6. INTESTINAL WORM INFESTATIONS
Very common in children - ascariasis, hookworm, whipworm.
| Age | Drug | Dose |
|---|---|---|
| 1-2 years | Albendazole | 200 mg single dose |
| > 2 years & Adults | Albendazole | 400 mg single dose |
| Alternative | Mebendazole | 500 mg single dose or 100 mg BD x 3 days |
- Repeat every 6 months (National Deworming Day protocol)
- Always combine with iron supplementation if anemia present
7. SKIN CONDITIONS
7a. Scabies (very common - affects whole families)
| Age | Treatment |
|---|---|
| < 2 months | 5-10% Sulfur ointment applied all over body (below neck) x 3 consecutive nights |
| 2 months - 2 years | 5% Permethrin cream - apply neck down, wash off after 8-12 hours; repeat in 1 week |
| > 2 years & Adults | 5% Permethrin OR Benzyl Benzoate 25% (dilute to 12.5% for children); Ivermectin 200 mcg/kg single dose (adults, not in pregnancy) |
- Treat ALL family members simultaneously
- Wash and hot-press all clothing and bedding
- Antihistamine (CPM) for itch; secondary infection - Amoxicillin/Cloxacillin
7b. Fungal Infections (Tinea)
- Adults & Children: Clotrimazole 1% cream BD x 2-4 weeks (topical)
- Extensive/nail: Fluconazole 150 mg weekly x 4 weeks OR Griseofulvin 10-20 mg/kg/day (children)
8. HYPERTENSION (increasing in rural areas)
| Age | First-line Drug |
|---|---|
| Adults < 60 yrs | Amlodipine 2.5-5 mg OD; if not controlled add Enalapril 5-10 mg BD |
| > 60 yrs / Elderly | Amlodipine 2.5 mg OD (start low); avoid ACEI if dry cough |
| With diabetes | ACEI (Enalapril 5-10 mg BD) or ARB preferred |
| Pregnancy | Methyldopa 250 mg BD-TDS (safest); Labetalol if available |
- Lifestyle: salt restriction (<5 g/day), reduce alcohol, weight loss, regular walking
- BP > 180/110 or symptoms (headache, visual changes): start treatment same day, monitor closely
9. DIABETES MELLITUS TYPE 2
| Age | First-line |
|---|---|
| Adults (newly diagnosed, non-obese) | Metformin 500 mg OD with meals, titrate to 500 mg TDS over weeks |
| Adults (obese) | Metformin 500 mg-1g BD (start low to avoid GI upset) |
| Elderly | Metformin with caution (hold if eGFR < 30); Glipizide 5 mg OD as alternative |
| Children (rare, Type 1 more common) | Refer; requires insulin |
- Dietary counseling: avoid white rice in excess, sugary drinks, processed foods
- Screen for complications: eyes, feet, urine protein, BP at each visit
- FBS target < 126 mg/dL; HbA1c < 7% ideally
10. MALNUTRITION (especially children under 5)
| Grade | Action |
|---|---|
| Mild-Moderate (MAM) | High-energy nutritious diet counseling; therapeutic feeding; micronutrient supplementation; deworming |
| Severe Acute Malnutrition (SAM) | Refer to NRC (Nutrition Rehabilitation Centre); F75 then F100 feeds; treat infection |
- Vitamin A supplementation: 1,00,000 IU for 6-11 months; 2,00,000 IU for 1-5 years (biannual)
- Zinc 20 mg/day x 14 days when diarrhea present
11. EYE CONDITIONS
Acute Conjunctivitis ("Madras Eye")
| All ages | Ciprofloxacin 0.3% eye drops 1-2 drops Q2-4H x 7 days |
|---|---|
| Allergic | Sodium cromoglycate drops + Antihistamine orally |
| Neonatal conjunctivitis | Immediate referral; erythromycin/tetracycline ointment |
12. URINARY TRACT INFECTION (UTI)
Very common in women and elderly men in rural areas.
| Group | Treatment |
|---|---|
| Non-pregnant women (uncomplicated) | Nitrofurantoin 100 mg BD x 5 days OR Cotrimoxazole DS BD x 3 days |
| Pregnant women | Nitrofurantoin 100 mg BD x 7 days (avoid near term); Cephalexin 500 mg QID x 7 days |
| Men / complicated | Ciprofloxacin 500 mg BD x 7-14 days |
| Elderly | Ciprofloxacin 500 mg BD x 7 days; ensure hydration |
13. MUSCULOSKELETAL / JOINT PAIN (common in elderly)
| Condition | Treatment |
|---|---|
| Osteoarthritis | Paracetamol 500-1000 mg TDS (safer than NSAIDs in elderly); topical Diclofenac gel |
| Acute sprains | RICE (Rest, Ice, Compression, Elevation) + Ibuprofen 400 mg TDS x 5 days (with food) |
| Backache (mechanical) | Paracetamol + physiotherapy counseling; avoid prolonged bed rest |
QUICK REFERENCE: KEY RED FLAGS - WHEN TO REFER
| Condition | Refer if... |
|---|---|
| Diarrhea | Unable to drink, sunken eyes, not passing urine, altered sensorium |
| Fever/Malaria | Altered consciousness, convulsions, severe anemia, jaundice |
| ARI | Chest indrawing, stridor, cyanosis, SpO2 < 92% |
| Malnutrition | SAM + complications (infection, edema) |
| Hypertension | BP > 180/120 with symptoms; hypertensive emergency |
| Pregnancy | Any danger sign: heavy bleeding, eclampsia, obstructed labor |
Practical Tips for Your Posting
- Always confirm malaria with RDT before treating - do not treat empirically without testing
- ORS first in every diarrhea case - antibiotics are rarely needed
- Zinc for 14 days after every diarrheal episode in children under 5
- Deworming every 6 months - piggyback it onto every child under-5 visit
- Malnutrition screening - use MUAC tape at every under-5 visit (< 11.5 cm = SAM; 11.5-12.5 cm = MAM)
- WIFS scheme - weekly iron-folic acid for adolescent girls; always record in register
- Primaquine is contraindicated in infants, pregnancy, and G6PD deficiency
- Metformin start low and go slow (500 mg OD for 1-2 weeks first) to reduce GI side effects
- Complete family treatment for scabies - treating only the index case leads to reinfection
- Document everything in the OPD register - it is required for RHTC records and national health data
Sources: Park's Textbook of Preventive and Social Medicine (National Malaria Programme guidelines); Katzung's Basic and Clinical Pharmacology; WHO guidelines on diarrhea, ARI, and malnutrition management; National Programme guidelines (WIFS, NDD, NVBDCP).
Create a quick reference PDF with dosing tables I can keep in pocket during OPD
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Your pocket guide is ready! Here it is:
RHTC Pocket Guide
PDF Document · PDF
What's inside (6 pages, A5 size - fits in a white coat pocket):
| Section | Content |
|---|---|
| 1. Acute Diarrhea | ORS + Zinc table by age; antibiotic indications |
| 2. Fever / URTI | Paracetamol + antihistamine doses by age |
| 3. Malaria | Full P. vivax CQ+PQ table + P. falciparum ACT-SP table by age |
| 4. Enteric Fever | Ciprofloxacin/Azithromycin/Cefixime by group |
| 5. Iron Deficiency Anemia | IFA doses by group incl. WIFS scheme |
| 6. Worms | Albendazole/Mebendazole deworming doses |
| 7. Scabies | Permethrin/Sulfur/Ivermectin by age |
| 8. Fungal Skin | Clotrimazole/Griseofulvin/Fluconazole |
| 9. Hypertension | Amlodipine/Enalapril/Methyldopa by group |
| 10. Diabetes T2 | Metformin dosing + targets |
| 11. UTI | Nitrofurantoin/Ciprofloxacin by group |
| 12. Conjunctivitis | Ciprofloxacin drops + neonatal referral |
| 13. Musculoskeletal | Paracetamol/Ibuprofen/RICE |
| 14. Malnutrition | MUAC grading + action |
| Red Flags | When to refer, per condition |
| Quick Tips | 10 key intern reminders |
Printing tip: Print double-sided on A5 paper (or A4 folded in half), laminate if possible - it will last your entire internship.
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