BNF for Children 2011-2012

BNFC 2011–2012 3.7 Mucolytics 165HOOF and further instructions are available atwww.bprs.co.uk/oxygen.html.Eastern EnglandBOC Medicalto order:Tel: 0800 136 603Fax: 0800 169 9989North EastSouth WestSouth LondonSouth East CoastSouth CentralNorth WestYorkshire and HumbersideEast MidlandsWest MidlandsNorth LondonWalesAir Liquideto order:Tel: 0808 202 2229Fax: 0191 497 4340Air Liquideto order:Tel: 0500 823 773Fax: 0800 781 4610Air Productsto order:Tel: 0800 373 580Fax: 0800 214 709In Scotland, refer the child for assessment by a paediatricrespiratory consultant. If the need for a concentratoris confirmed the consultant will arrange for theprovision of a concentrator through the Common ServicesAgency. In Northern Ireland oxygen concentratorsand cylinders should be prescribed on form HS21;oxygen concentrators are supplied by a local contractor.In Scotland and Northern Ireland, prescriptions foroxygen cylinders and accessories can be dispensed bypharmacies contracted to provide domiciliary oxygenservices.3.7 MucolyticsMucolytics, such as carbocisteine and mecysteine, areused to facilitate mucociliary clearance and expectorationby reducing sputum viscosity but evidence ofefficacy is limited.Dornase alfa is a genetically engineered version of anaturally occurring human enzyme which cleaves extracellulardeoxyribonucleic acid (DNA); it is used toreduce sputum viscosity in children with cystic fibrosis.Dornase alfa is administered by inhalation using a jetnebuliser (section 3.1.5), usually once daily at least 1hour before physiotherapy; however, alternate-day therapymay be as effective as daily treatment. Not allchildren benefit from treatment with dornase alfa;improvement occurs within 2 weeks, but in moreseverely affected children a trial of 6–12 weeks maybe required.Nebulised hypertonic sodium chloride solution mayimprove mucociliary clearance in children with cysticfibrosis.Mesna (Mistabron c , available from ‘special-order’manufacturers or specialist importing companies, seep. 809) is used in some children with cystic fibrosiswhen other mucolytics have failed to reduce sputumviscosity; 3–6 mL of a 20% solution is nebulised twicedaily.Acetylcysteine has been used to treat meconium ileusin neonates and distal intestinal obstruction syndromein children with cystic fibrosis, but evidence of efficacyis lacking. Gastrografin c (section 1.6.5), or a bowelcleansing preparation containing macrogols (section1.6.5), is usually more effective. Acetylcysteine may beused as a mucolytic to prevent further obstruction.ACETYLCYSTEINECautions history of peptic ulceration; asthmaSide-effects hypersensitivity-like reactions includingrashes and anaphylaxisLicensed use not licensed for use in meconium ileusor for distal intestinal obstructive syndrome inchildren with cystic fibrosisIndication and doseMeconium ileus (but see notes above). By mouthNeonate 200–400 mg up to 3 times daily ifnecessaryTreatment of distal intestinal obstructivesyndrome (but see notes above). By mouthChild 1 month–2 years 0.4–3 g as a single doseChild 2–7 years 2–3 g as a single doseChild 7–18 years 4–6 g as a single dosePrevention of distal intestinal obstructionsyndrome. By mouthChild 1 month–2 years 100–200 mg 3 times dailyChild 2–12 years 200 mg 3 times dailyChild 12–18 years 200–400 mg 3 times dailyAdministration For oral administration, use oralgranules, or dilute injection solution (200 mg/mL) to aconcentration of 50 mg/mL; orange or blackcurrantjuice or cola drink may be used as a diluent to maskthe bitter tasteAcetylcysteine (Non-proprietary) AOral granules, acetylcysteine 100 mg/sachet;200 mg/sachet. Label: 13Available from ‘special-order’ manufacturers or specialistimporting companies, see p. 809InjectionSee Emergency treatment of poisoning, p. 28CARBOCISTEINECautions history of peptic ulcerationContra-indications active peptic ulcerationPregnancy manufacturer advises avoid in first trimesterBreast-feeding no information availableSide-effects rarely gastro-intestinal bleeding; hypersensitivityreactions (including rash and anaphylaxis)also reportedIndication and doseReduction of sputum viscosity. By mouthChild 2–5 years 62.5–125 mg 4 times dailyChild 5–12 years 250 mg 3 times daily3 Respiratory system