{ "schema_version": 1, "kind": "condition", "id": "henoch-schonlein-purpura", "name": "IgA vasculitis (Henoch-Schonlein purpura)", "category": "acute", "sources": "IgA Vasculitis (Henoch-Schönlein Purpura) - StatPearls (NCBI Bookshelf NBK537252) - https://www.ncbi.nlm.nih.gov/books/NBK537252/ · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-full.txt) · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-clinical.txt) · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170) · MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg. · Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170) - oral, usual initial doses 5 to 60 mg per day given as a single daily dose or in 2 to 4 divided doses, with a worked tapered regimen; general paediatric anti-inflammatory or immunosuppressive dosing, oral, initial 0.1 to 2 mg/kg/day in divided doses 1 to 4 times daily.", "review_status": "reviewed", "verified_against": "IgA Vasculitis (Henoch-Schönlein Purpura) - StatPearls (NCBI Bookshelf NBK537252) - https://www.ncbi.nlm.nih.gov/books/NBK537252/ · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-full.txt) · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-clinical.txt) · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170) · MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg. · Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170) - oral, usual initial doses 5 to 60 mg per day given as a single daily dose or in 2 to 4 divided doses, with a worked tapered regimen; general paediatric anti-inflammatory or immunosuppressive dosing, oral, initial 0.1 to 2 mg/kg/day in divided doses 1 to 4 times daily.", "verified_date": "2026-08", "treatments": [ { "id": 917, "generic": "Prednisolone", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "Oral, usual initial dose 5 to 60 mg per day, as a single morning dose or in 2 to 4 divided doses, then tapered rather than stopped", "adult_duration": "A short course over the painful phase, tapered - the formulary prints a worked 6-day taper from 30 mg down to 5 mg", "dose_source": "Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170) - oral, usual initial doses 5 to 60 mg per day given as a single daily dose or in 2 to 4 divided doses, with a worked tapered regimen; general paediatric anti-inflammatory or immunosuppressive dosing, oral, initial 0.1 to 2 mg/kg/day in divided doses 1 to 4 times daily.", "rationale": "The article says severe abdominal pain should prompt consideration of prednisone or prednisolone with a taper, and reports randomised trials in which prednisone shortened the duration and severity of abdominal pain over the first two weeks. It also states plainly that steroid does not prevent renal disease, though it reduces the risk of persistent renal complications in children. The article names the drug without an amount, so the band above is the formulary's general anti-inflammatory band, which is the right band because this is an inflammatory indication.", "cautions": [ "For severe abdominal pain, not for the rash and not for the joints. Most IgA vasculitis settles on supportive care alone, and the article is explicit that steroid does not prevent the nephritis.", "Exclude intussusception before treating severe abdominal pain with a steroid - the article puts ultrasonography and, where needed, air-contrast enema or surgery in this position.", "Taper, never stop abruptly. The formulary asks for gradual reduction and prints a 6-day taper as its worked example.", "Contraindicated in systemic infection and in hypersensitivity to prednisolone.", "Renal involvement changes who prescribes. The article's algorithm runs oral prednisolone for low-level vasculitic nephritis, oral or pulsed corticosteroid for moderate disease, and pulsed corticosteroid with intravenous cyclophosphamide for severe forms - decisions for a nephrologist, on a card whose purpose is the referral.", "The formulary's own equivalence table puts 5 mg of prednisolone alongside 5 mg of prednisone, which is why the article's mention of either drug maps onto the same figures." ], "peds_mgkg_low": 0.1, "peds_mgkg_high": 2.0, "peds_max_mg": null, "peds_basis": "day", "peds_unit": "mg", "peds_note": "The formulary's general anti-inflammatory or immunosuppressive band for infants, children and adolescents: oral, initial 0.1 to 2 mg/kg/day, in divided doses 1 to 4 times daily. No ceiling appears above because the formulary states none for this band; it asks instead for the lowest dose that controls the condition and for gradual reduction. As a cross-check on a big child it also offers fractions of the adult dose - about 75% at 12 years, 50% at 7 years, 25% at 1 year.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 1, "high_mg": 20, "capped": false }, { "weight_kg": 20, "low_mg": 2, "high_mg": 40, "capped": false }, { "weight_kg": 30, "low_mg": 3, "high_mg": 60, "capped": false }, { "weight_kg": 40, "low_mg": 4, "high_mg": 80, "capped": false } ], "brands": [ { "trade_name": "HOSTACORTIN H 5MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 12.0, "pack_count": 30, "unit_price": 0.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNISOLONE 5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDILONE 5MG 10 TAB. (25 STRIPS PACK)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 250.0, "pack_count": 10, "unit_price": 25.0, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 69.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 79.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 84.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI WINTHROP > SANOFI", "price_egp": 84.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ACETASEE 1% EYE DROPS (SUSP.) 5 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "PREDNIS 5MG/5ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 9.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "henoch-schonlein-purpura" }, { "id": 918, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Diagnose on palpable purpura over the buttocks and legs with a normal platelet count, plus at least one of abdominal pain, joint pain or arthritis, or the kidney involved. Dipstick the urine with microscopy at every visit and keep doing it for six months - renal involvement arrives one to three months after the rash, in 20 to 55 percent of children, and is the commonest cause of serious illness here. Same-day surgical assessment for severe abdominal pain, bloody stool or a palpable mass: intussusception occurs in 3 to 4 percent. Refer a child with persistent proteinuria to a nephrologist.", "adult_duration": null, "dose_source": "IgA Vasculitis (Henoch-Schönlein Purpura) - StatPearls (NCBI Bookshelf NBK537252) - https://www.ncbi.nlm.nih.gov/books/NBK537252/", "rationale": "IgA vasculitis usually settles on its own, and the two things that make it dangerous are an abdomen that turns surgical and a kidney that declares itself weeks later. Both are follow-up problems, which is why the urine matters more than any prescription. The article names paracetamol and prednisolone without stating an amount for a child; the amounts printed above come from the product labels, and the steroid stays a specialist decision.", "cautions": [ "WHAT MAKES THE DIAGNOSIS - IgA vasculitis is diagnosed on petechiae with a normal platelet count, or on palpable purpura falling mainly over the legs, together with at least 1 of 4 further features: pain in the abdomen; joint pain or frank arthritis; the kidney involved, shown by protein in the urine, red cell casts or blood; or, on histology, a proliferative glomerulonephritis or a leukocytoclastic vasculitis in which IgA is the dominant deposit.", "WHERE THE RASH SITS - it turns into purpura you can feel and into petechiae, sitting most often over the buttocks and the legs, and on the extensor surfaces above all. Every patient with IgAV has skin involvement, and it is usually what shows first.", "TEST THE URINE, AND KEEP TESTING IT - order a urinalysis with microscopy, looking for blood, protein, or red cell casts. Where the dipstick shows protein, follow it with a 24-hour collection to measure how much is being lost. What matters over the long run, in the article's own summing up, is following the child properly and testing the urine often, so that the kidney is caught if it becomes involved.", "THE KIDNEY DECLARES ITSELF AFTER THE RASH HAS GONE - renal symptoms tend to arrive 1 to 3 months after the rash appears, and they do so in 20% to 55% of affected children. Where proteinuria persists, the risk of a progressive glomerulonephritis is high. A child discharged the week the rash fades has been discharged too early.", "AND THE KIDNEY IS WHAT KILLS - dying of IgA vasculitis is rare, but of everything that makes these patients ill or kills them, kidney disease is the commonest.", "RED FLAG - THE ABDOMEN. The complications that can end a life are intussusception, a perforated bowel, gangrenous bowel, and torrential bleeding. Of those, intussusception is the one seen most, in 3% to 4% of children with IgAV. Severe abdominal pain in a child with purpura is a same-day surgical assessment.", "THE ABDOMEN CAN COME FIRST AND FOOL EVERYONE - in 10% to 40% of patients, the gut trouble shows up ahead of the rash.", "PREFER PARACETAMOL OVER AN NSAID WHEN THE GUT OR KIDNEY IS INVOLVED - where the bowel or the kidney is involved, paracetamol, or an opioid, is generally chosen for pain ahead of a non-steroidal anti-inflammatory. The article states no strength, frequency or maximum for a child, so no amount is printed here.", "STEROIDS ARE A SPECIALIST DECISION, NOT A FIRST PRESCRIPTION - where the abdominal pain is severe, prednisone or prednisolone with a tapering course is worth considering. It will not stop renal disease from happening, but it does lower the chance that renal complications persist in a child. No paediatric dose appears in the article.", "MOST OF IT IS SUPPORTIVE - where the kidney is not involved, treating the symptoms and supporting the child is what the management rests on.", "WHAT TO TELL THE PARENTS - teach them that the symptoms will probably clear inside a few weeks, though they may come back. Full recovery takes 4 weeks in most children. About one in three has a recurrence, 4 to 6 months after it first began.", "JOINTS ACHE BUT DO NOT SCAR - 75% of these children get joint pain or arthritis, and it passes without destroying the joint.", "THE SMALL MINORITY THAT ENDS BADLY - roughly 1% of patients with IgA vasculitis go on to end-stage renal failure and need a transplant. A child with proteinuria belongs to a nephrologist: where the renal involvement is severe, treatment must be aggressive and the care must be a nephrologist's." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "henoch-schonlein-purpura" }, { "id": 916, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g three or four times daily, maximum 4 g in 24 hours", "adult_duration": "While the joint and abdominal pain lasts - most of it settles within weeks", "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg.", "rationale": "The article makes symptomatic and supportive care the foundation of treatment where the kidneys are not involved, and states that acetaminophen or opioids are often preferred over non-steroidal anti-inflammatory drugs for pain control where the gut or the kidney is affected. The distinction matters because the joint pain invites an NSAID, and an NSAID is the wrong drug in a vasculitis that is already bleeding into the bowel wall and inflaming the glomerulus.", "cautions": [ "PREFER THIS TO AN NSAID where there is abdominal or renal involvement - that is the article's own instruction, and ibuprofen is the reflex it exists to interrupt.", "Severe or colicky abdominal pain in this illness is not simply pain to treat. The article puts intussusception next to it, confirmed on ultrasonography and then reduced by air-contrast enema or dealt with surgically, so worsening abdominal pain means imaging, not a bigger analgesic dose.", "Urinalysis has to be repeated over months after the rash has gone. The article makes frequent urinalysis to screen for renal involvement an essential part of follow-up, because the nephritis can appear late.", "Check every other product for paracetamol, and reduce the maximum in liver disease." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "15 mg/kg per dose three or four times daily from 1 month of age, maximum 60 mg/kg per day. Under 1 month, 10 mg/kg per dose three or four times daily, maximum 40 mg/kg per day. This is mainly a disease of children, so the weight table is the column that will be used.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "henoch-schonlein-purpura" } ] }