{ "schema_version": 1, "kind": "condition", "id": "melaena", "name": "Melaena (Black Tarry Stools)", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS15 - condition scope only, no dose · Upper Gastrointestinal Bleeding - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470300/ · Egyptian National Drug Formulary - GIT 2024 (esomeprazole monograph, p73) · 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. · 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.", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - GIT 2024 (esomeprazole monograph, p73) · 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. · 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.", "verified_date": "2026-08", "treatments": [ { "id": 1174, "generic": "Esomeprazole", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 40.0, "adult_dose": "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.", "adult_duration": "72 hours of high-dose therapy, then twice-daily oral acid suppression for 14 days, then once daily to complete ulcer treatment", "dose_source": "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.", "rationale": "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.", "cautions": [ "The transfer comes first. Acid suppression is started while the ambulance is arranged, never instead of it - black tarry stool means upper gastrointestinal bleeding until proven otherwise.", "Two documents place the same regimen at different moments and both are recorded: the formulary gives 80 mg then 8 mg per hour for preventing rebleeding after therapeutic endoscopy, while the article gives the identical figures before endoscopy. The evidence the article cites for the pre-endoscopy use showed fewer high-risk ulcer features and less endoscopic therapy, with no difference in transfusion, rebleeding or 30-day mortality.", "Ask about anticoagulants before anything else. The article's threshold for holding the drug and giving a reversal agent is a life-threatening bleed - shock, severe hypotension needing vasopressors, a haemoglobin fall of more than 5 g/dL, or 5 or more units transfused - and it prefers prothrombin complex concentrate to fresh frozen plasma on a vitamin K antagonist.", "Iron and bismuth blacken the stool without any bleeding. Confirm with a rectal examination rather than a history alone.", "Contraindicated in hypersensitivity to any substituted benzimidazole proton pump inhibitor." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "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": [ { "trade_name": "MERAZODEL 40 MG POWDER FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 31.2, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ESOMEPEX 40 MG POWDER FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG AGENCY (IDI) > NOVELL PHARMA", "price_egp": 41.5, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOMEGIPRAL 40MG POWDER FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEGAPRAZOLE 40 MG POWDER FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 53.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ESMORAP 40 MG POWDER FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE. > AUG PHARMA", "price_egp": 86.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NEXIUM 40 MG POWDER FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTRA ZENECA", "price_egp": 100.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ESOMEPRAZOLE-EVA 40MG 3 POWDER FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 204.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "melaena" }, { "id": 1176, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "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.", "cautions": [ "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.", "RED FLAG - Hemodynamic instability (low blood pressure, fast pulse), ongoing or large-volume bleeding, or known liver disease or varices with the risk of a variceal bleed requires emergency hospital referral." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The drug rows above are instilled, not dosed by weight. The referral threshold and the safety-netting are the same at any age.", "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": "melaena" }, { "id": 1175, "generic": "Ceftriaxone", "line": 1, "is_adjunct": true, "form": "injection", "strength_mg": 1000.0, "adult_dose": "1 g intravenously every 24 hours", "adult_duration": "2 to 5 days, stopping once the bleeding is controlled and no infection is evident", "dose_source": "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.", "rationale": "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.", "cautions": [ "Only for the patient with known or suspected cirrhosis. It is not given for every melaena.", "The article's vasoactive drugs for suspected variceal bleeding - octreotide, somatostatin or terlipressin, run for 2 to 5 days - and its prokinetic erythromycin 250 mg intravenously 20 to 90 minutes before endoscopy are hospital treatments started by the receiving team, not in a clinic.", "Avoid in penicillin or cephalosporin hypersensitivity.", "Where renal and hepatic impairment coexist, the Egyptian formulary caps ceftriaxone at 2 g daily." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The article's prophylaxis figure is adult. Ceftriaxone is contraindicated in the neonate receiving calcium-containing intravenous fluids.", "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": [ { "trade_name": "ZOXIDEL 1 GM PD. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 22.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOXIDEL 1 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINTRIAXONE 1 GM PD. FOR I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOTRIAXONE 1 GM I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OFRAMAX 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > SUN PHARMA EGYPT LIMITED", "price_egp": 71.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "melaena" } ] }