Melaena (Black Tarry Stools)

80 mg by intravenous bolus infusion over 30 minutes, then 8 mg per hour by continuous infusion. Where a pump is not available the article's alternative is intermittent dosing of 40 mg two to four times daily. x 72 hours of high-dose therapy, then twice-daily oral acid suppression for 14 days, then once daily to complete ulcer treatment

The 80 mg bolus and 8 mg per hour regimen is an adult one and neither document extends it to children. The formulary's separate paediatric intravenous entry is for gastric antisecretory treatment when the oral route is not possible - 0.5 mg/kg once daily from 1 month to under 1 year, 10 mg once daily from 1 to 17 years under 55 kg, 20 mg at 55 kg and over, each infused over 10 to 30 minutes for up to 10 days. Melaena in a child is an emergency paediatric referral.

Egyptian National Drug Formulary - GIT 2024 (esomeprazole monograph, p73), which for prevention of rebleeding after therapeutic endoscopy for acute bleeding gastric or duodenal ulcer gives an 80 mg intravenous bolus infusion over 30 minutes followed by a continuous infusion of 8 mg per hour over 3 days, then oral acid suppression. The same two figures appear in the card's own upper gastrointestinal bleeding article, which puts them before endoscopy as well.

The article states that patients with significant bleeding should have an 80 mg proton pump inhibitor bolus followed by 8 mg per hour, or intermittent 40 mg two to four times daily, and reports that giving a high-dose inhibitor before endoscopy reduced high-risk ulcer features and the need for endoscopic therapy in a randomised trial. It names the class rather than a drug; esomeprazole is the drug the Egyptian formulary carries at exactly these figures, and seven intravenous products are marketed here.

Black tarry stools signal bleeding from the upper digestive tract, a medical emergency; a GP recognises it, may start empiric acid suppression, and arranges urgent hospital transfer rather than managing it alone. - Refer, with advice

The drug rows above are instilled, not dosed by weight. The referral threshold and the safety-netting are the same at any age.

No dose - referral pathway, no medicine given in primary care

Black tarry stools signal bleeding from the upper digestive tract, a medical emergency; a GP recognises it, may start empiric acid suppression, and arranges urgent hospital transfer rather than managing it alone.

1 g intravenously every 24 hours x 2 to 5 days, stopping once the bleeding is controlled and no infection is evident

The article's prophylaxis figure is adult. Ceftriaxone is contraindicated in the neonate receiving calcium-containing intravenous fluids.

WATCH group - carries resistance cost. Egyptian EML 2025.

Upper Gastrointestinal Bleeding - StatPearls - NCBI Bookshelf - disease-level clinical article (melaena-full.txt), which states that antibiotic prophylaxis for 2 to 5 days is advised in patients with cirrhosis presenting with acute gastrointestinal bleeding and that ceftriaxone 1 g intravenously per 24 hours is commonly used.

In a patient with cirrhosis the article puts bacterial translocation, aspiration pneumonia and spontaneous bacterial peritonitis alongside the bleed itself, and gives prophylaxis its own recommendation with a stated dose. That matters in Egypt, where post-hepatitis and schistosomal cirrhosis put variceal bleeding high in the differential for melaena.