BNF for Children 2011-2012

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242 BNFC 2011–20125 Infections5 Infections5.1 Antibacterial drugs 2435.1.1 Penicillins 2575.1.1.1 Benzylpenicillin and phenoxymethylpenicillin2575.1.1.2 Penicillinase-resistant penicillins2595.1.1.3 Broad-spectrum penicillins 2605.1.1.4 Antipseudomonal penicillins 2645.1.1.5 Mecillinams 2655.1.2 Cephalosporins, carbapenems,and other beta-lactams 2665.1.2.1 Cephalosporins 2665.1.2.2 Carbapenems 2725.1.2.3 Other beta-lactam antibiotics 2735.1.3 Tetracyclines 2745.1.4 Aminoglycosides 2765.1.5 Macrolides 2805.1.6 Clindamycin 2835.1.7 Some other antibacterials 2845.1.8 Sulfonamides and trimethoprim 2895.1.9 Antituberculosis drugs 2905.1.10 Antileprotic drugs 2955.1.11 Metronidazole 2955.1.12 Quinolones 2975.1.13 Urinary-tract infections 2995.2 Antifungal drugs 3005.2.1 Triazole antifungals 3015.2.2 Imidazole antifungals 3055.2.3 Polyene antifungals 3055.2.4 Echinocandin antifungals 3065.2.5 Other antifungals 3085.3 Antiviral drugs 3095.3.1 HIV infection 3095.3.2 Herpesvirus infections 3215.3.2.1 Herpes simplex and varicella–zoster infection 3215.3.2.2 Cytomegalovirus infection 3245.3.3 Viral hepatitis 3255.3.4 Influenza 3265.3.5 Respiratory syncytial virus 3275.4 Antiprotozoal drugs 3295.4.1 Antimalarials 3295.4.2 Amoebicides 3395.4.3 Trichomonacides 3405.4.4 Antigiardial drugs 3405.4.5 Leishmaniacides 3405.4.6 Trypanocides 3415.4.7 Drugs for toxoplasmosis 3415.4.8 Drugs for pneumocystis pneumonia3425.5 Anthelmintics 3445.5.1 Drugs for threadworms 3445.5.2 Ascaricides 3455.5.3 Drugs for tapeworm infections 3455.5.4 Drugs for hookworms 3465.5.5 Schistosomicides 3465.5.6 Filaricides 3465.5.7 Drugs for cutaneous larvamigrans 3465.5.8 Drugs for strongyloidiasis 347This chapter includes advice on the drug managementof the following:anthrax, p. 297bacterial infections: table 1, summary of antibacterialtreatment, p. 244bacterial infections: table 2, summary of antibacterialprophylaxis, p. 254Lyme disease, p. 261MRSA infections, p. 259oral infections, p. 244 and p. 251
BNFC 2011–2012 5.1 Antibacterial drugs 243Notifiable diseasesDoctors must notify the Proper Officer of the localauthority (usually the consultant in communicabledisease control) when attending a patient suspectedof suffering from any of the diseases listed below; aform is available from the Proper Officer.AnthraxMumpsBotulismParatyphoid feverBrucellosisPlagueCholeraPoliomyelitis, acuteDiarrhoea (infectious bloody) RabiesDiphtheriaRubellaEncephalitis, acuteSARSFood poisoningScarlet feverHaemolytic uraemic syndrome SmallpoxHaemorrhagic fever (viral) Streptococcal diseaseHepatitis, viral(Group A, invasive)Legionnaires’ diseaseTetanusLeprosyTuberculosisMalariaTyphoid feverMeaslesTyphusMeningitisWhooping coughMeningococcal septicaemiaYellow feverNote It is good practice for doctors to also inform the consultantin communicable disease control of instances of otherinfections (e.g. psittacosis) where there could be a public healthrisk.5.1 Antibacterial drugs5.1.1 Penicillins5.1.2 Cephalosporins, carbapenems, andother beta-lactams5.1.3 Tetracyclines5.1.4 Aminoglycosides5.1.5 Macrolides5.1.6 Clindamycin5.1.7 Some other antibacterials5.1.8 Sulfonamides and trimethoprim5.1.9 Antituberculosis drugs5.1.10 Antileprotic drugs5.1.11 Metronidazole5.1.12 Quinolones5.1.13 Urinary-tract infectionsChoice of a suitable drug Before selecting an antibacterialthe clinician must first consider two factors—the child and the known or likely causative organism.Factors related to the child which must be consideredinclude history of allergy, renal and hepatic function,susceptibility to infection (i.e. whether immunocompromised),ability to tolerate drugs by mouth, severity ofillness, ethnic origin, age and, if an adolescent female,whether pregnant, breast-feeding or taking an oral contraceptive.The known or likely organism and its antibacterialsensitivity, in association with the above factors, willsuggest one or more antibacterials, the final choicedepending on the microbiological, pharmacological,and toxicological properties.The principles involved in selection of an antibacterialmust allow for a number of variables including age,changing renal and hepatic function, increasing bacterialresistance, and new information on side-effects.Duration of therapy, dosage, and route of administrationdepend on site, type and severity of infection andresponse.Antibacterial policies Local policies often limit theantibacterials that may be used to achieve reasonableeconomy consistent with adequate cover, and to reducethe development of resistant organisms. A policy mayindicate a range of drugs for general use, and permitother drugs only on the advice of the microbiologist orpaediatric infectious diseases specialist.Before starting therapy The following principlesshould be considered before starting:. Viral infections should not be treated with antibacterials.However, antibacterials may be indicated fortreatment of secondary bacterial infection (e.g. bacterialpneumonia secondary to influenza);. Samples should be taken for culture and sensitivitytesting whenever possible; ‘blind’ antibacterial prescribingfor unexplained pyrexia usually leads tofurther difficulty in establishing the diagnosis;. Knowledge of prevalent organisms and their currentsensitivity is of great help in choosing anantibacterial before bacteriological confirmation isavailable. Generally, narrow-spectrum antibacterialsare preferred to broad-spectrum antibacterialsunless there is a clear clinical indication(e.g. life-threatening sepsis);. The dose of an antibacterial varies according to anumber of factors including age, weight, hepaticfunction, renal function, and severity of infection.The prescribing of the so-called ‘standard’ dose inserious infections may result in failure of treatmentor even death of the patient; therefore it is importantto prescribe a dose appropriate to the condition.An inadequate dose may also increase thelikelihood of antibacterial resistance. On the otherhand, for an antibacterial with a narrow marginbetween the toxic and therapeutic dose (e.g. anaminoglycoside) it is also important to avoid anexcessive dose and the concentration of the drugin the plasma may need to be monitored;. The route of administration of an antibacterial oftendepends on the severity of the infection. Life-threateninginfections often require intravenous therapy.Antibacterials that are well absorbed may be givenby mouth even for some serious infections. Par-5 Infections
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Medicines information servicesInfor
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Published byBMJ GroupTavistock Squa
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iv BNFC 2011-2012PrefaceBNF for Chi
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vi BNFC 2011-2012BNF StaffDigital D
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viii BNFC 2011-2012Nurse Prescriber
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x BNFC 2011-2012. incorporating the
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xii BNFC 2011-2012prescribing notes
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Branded oral liquid preparations th
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xvi BNFC 2011-2012Finding significa
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xviii BNFC 2011-2012Epilim Chronosp
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xx BNFC 2011-2012Tears Naturale c S
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2 General guidance BNFC 2011-2012Ge
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4 Prescription writing BNFC 2011-20
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6 Supply of medicines BNFC 2011-201
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8 Emergency supply of medicines BNF
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10 Prescribing Controlled Drugs BNF
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Adverse reactions to drugs12 Advers
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Prescribing in hepatic impairment14
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Prescribing in pregnancy16 Prescrib
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18 Prescribing in palliative care B
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20 Prescribing in palliative care B
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22 Prescribing in dental practice B
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Emergency treatment of poisoning24
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26 Emergency treatment of poisoning
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36 1.1.1 Antacids and simeticone BN
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38 1.1.2 Compound alginate preparat
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40 1.2 Antispasmodics and other dru
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42 1.3 Antisecretory drugs and muco
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44 1.3.3 Chelates and complexes BNF
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46 1.4 Acute diarrhoea BNFC 2011-20
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48 1.5 Chronic bowel disorders BNFC
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50 1.5.1 Aminosalicylates BNFC 2011
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52 1.5.1 Aminosalicylates BNFC 2011
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54 1.5.3 Drugs affecting the immune
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56 1.5.4 Food allergy BNFC 2011-201
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58 1.6.1 Bulk-forming laxatives BNF
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60 1.6.2 Stimulant laxatives BNFC 2
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62 1.6.4 Osmotic laxatives BNFC 201
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64 1.6.5 Bowel cleansing preparatio
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66 1.7 Local preparations for anal
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68 1.8 Stoma and enteral feeding tu
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70 1.9.2 Bile acid sequestrants BNF
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72 1.9.4 Pancreatin BNFC 2011-20121
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74 2.1.1 Cardiac glycosides BNFC 20
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76 2.2 Diuretics BNFC 2011-20122 Ca
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78 2.2.2 Loop diuretics BNFC 2011-2
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BNFC 2011-2012 2.2.4 Potassium-spar
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BNFC 2011-2012 2.3.2 Drugs for arrh
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BNFC 2011-2012 2.3.2 Drugs for arrh
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BNFC 2011-2012 2.4 Beta-adrenocepto
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BNFC 2011-2012 2.5.1 Vasodilator an
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BNFC 2011-2012 2.5.4 Alpha-adrenoce
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BNFC 2011-2012 2.5.5 Drugs affectin
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BNFC 2011-2012 2.5.5 Drugs affectin
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BNFC 2011-2012 2.6.2 Calcium-channe
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BNFC 2011-2012 2.7.1 Inotropic symp
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BNFC 2011-2012 2.7.2 Vasoconstricto
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BNFC 2011-2012 2.8.1 Parenteral ant
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BNFC 2011-2012 2.8.1 Parenteral ant
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BNFC 2011-2012 2.8.2 Oral anticoagu
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BNFC 2011-2012 2.10 Myocardial infa
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BNFC 2011-2012 2.11 Antifibrinolyti
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BNFC 2011-2012 2.12 Lipid-regulatin
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BNFC 2011-2012 2.14 Drugs affecting
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BNFC 2011-2012 1333 Respiratory sys
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BNFC 2011-2012 3.1 Bronchodilators
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BNFC 2011-2012 3.1.1 Adrenoceptor a
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BNFC 2011-2012 3.1.1 Adrenoceptor a
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BNFC 2011-2012 3.1.2 Antimuscarinic
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BNFC 2011-2012 3.1.3 Theophylline 1
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BNFC 2011-2012 3.1.5 Peak flow mete
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BNFC 2011-2012 3.2 Corticosteroids
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BNFC 2011-2012 3.3 Cromoglicate and
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BNFC 2011-2012 3.4 Antihistamines,
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BNFC 2011-2012 3.4.1 Antihistamines
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BNFC 2011-2012 3.4.2 Allergen immun
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BNFC 2011-2012 3.4.3 Allergic emerg
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BNFC 2011-2012 3.4.3 Allergic emerg
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BNFC 2011-2012 3.6 Oxygen 163ment
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BNFC 2011-2012 3.7 Mucolytics 165HO
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BNFC 2011-2012 3.9 Cough preparatio
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BNFC 2011-2012 1694 Central nervous
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BNFC 2011-2012 4.1.2 Anxiolytics 17
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BNFC 2011-2012 4.2.1 Antipsychotic
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BNFC 2011-2012 4.3 Antidepressant d
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BNFC 2011-2012 4.3.1 Tricyclic anti
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BNFC 2011-2012 4.3.3 Selective sero
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BNFC 2011-2012 4.4 CNS stimulants a
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BNFC 2011-2012 5.1.9 Antituberculos
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BNFC 2011-2012 5.1.11 Metronidazole
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BNFC 2011-2012 5.1.12 Quinolones 29
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BNFC 2011-2012 5.1.13 Urinary-tract
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BNFC 2011-2012 5.2.1 Triazole antif
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BNFC 2011-2012 5.2.1 Triazole antif
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BNFC 2011-2012 5.2.2 Imidazole anti
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BNFC 2011-2012 5.2.4 Echinocandin a
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BNFC 2011-2012 5.3 Antiviral drugs
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BNFC 2011-2012 5.3.1 HIV infection
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BNFC 2011-2012 5.3.2 Herpesvirus in
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BNFC 2011-2012 5.3.3 Viral hepatiti
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BNFC 2011-2012 5.3.5 Respiratory sy
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BNFC 2011-2012 5.4 Antiprotozoal dr
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BNFC 2011-2012 5.4.1 Antimalarials
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BNFC 2011-2012 5.4.6 Trypanocides 3
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BNFC 2011-2012 5.4.8 Drugs for pneu
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BNFC 2011-2012 5.5.2 Ascaricides 34
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BNFC 2011-2012 5.5.8 Drugs for stro
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BNFC 2011-2012 6.1.1 Insulins 349Tr
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BNFC 2011-2012 6.1.1 Insulins 351So
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BNFC 2011-2012 6.1.1 Insulins 353IN
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BNFC 2011-2012 6.1.1 Insulins 355Hi
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BNFC 2011-2012 6.1.2 Antidiabetic d
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BNFC 2011-2012 6.1.4 Treatment of h
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BNFC 2011-2012 6.1.6 Diagnostic and
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BNFC 2011-2012 6.2 Thyroid and anti
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BNFC 2011-2012 6.2.2 Antithyroid dr
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BNFC 2011-2012 6.3.2 Glucocorticoid
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BNFC 2011-2012 6.4 Sex hormones 377
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BNFC 2011-2012 6.4.2 Male sex hormo
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BNFC 2011-2012 6.4.3 Anabolic stero
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BNFC 2011-2012 6.5.1 Hypothalamic a
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BNFC 2011-2012 6.5.2 Posterior pitu
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BNFC 2011-2012 6.5.2 Posterior pitu
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BNFC 2011-2012 6.6.2 Bisphosphonate
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BNFC 2011-2012 6.7.3 Metyrapone 391
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BNFC 2011-2012 7.2.2 Vaginal and vu
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BNFC 2011-2012 7.3.1 Combined hormo
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BNFC 2011-2012 7.3.2 Progestogen-on
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BNFC 2011-2012 7.3.2 Progestogen-on
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BNFC 2011-2012 7.3.4 Contraceptive
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BNFC 2011-2012 7.4 Drugs for genito
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BNFC 2011-2012 7.4.5 Drugs for erec
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BNFC 2011-2012 8.1 Cytotoxic drugs
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BNFC 2011-2012 8.1 Cytotoxic drugs
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BNFC 2011-2012 8.1.1 Alkylating dru
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BNFC 2011-2012 8.1.2 Cytotoxic anti
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BNFC 2011-2012 8.1.3 Antimetabolite
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BNFC 2011-2012 8.1.3 Antimetabolite
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BNFC 2011-2012 8.1.5 Other antineop
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BNFC 2011-2012 8.2 Drugs affecting
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BNFC 2011-2012 9.2.1 Oral preparati
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BNFC 2011-2012 9.3 Intravenous nutr
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BNFC 2011-2012 9.4.2 Enteral nutrit
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BNFC 2011-2012 9.5 Minerals 471dren
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BNFC 2011-2012 9.5.2 Phosphorus 475
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BNFC 2011-2012 9.5.3 Fluoride 477Ch
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BNFC 2011-2012 9.6.2 Vitamin B grou
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BNFC 2011-2012 9.6.3 Vitamin C 481I
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BNFC 2011-2012 9.6.4 Vitamin D 483N
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BNFC 2011-2012 9.8.2 Acute porphyri
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BNFC 2011-2012 49910 Musculoskeleta
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BNFC 2011-2012 10.1.1 Non-steroidal
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BNFC 2011-2012 11.3.1 Antibacterial
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BNFC 2011-2012 11.6 Treatment of gl
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BNFC 2011-2012 11.6 Treatment of gl
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BNFC 2011-2012 11.7 Local anaesthet
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BNFC 2011-2012 11.8.1 Tear deficien
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BNFC 2011-2012 11.9 Contact lenses
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BNFC 2011-2012 12.1.1 Otitis extern
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BNFC 2011-2012 12.1.2 Otitis media
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BNFC 2011-2012 12.3 Drugs acting on
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BNFC 2011-2012 12.3.2 Oropharyngeal
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BNFC 2011-2012 12.3.5 Treatment of
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BNFC 2011-2012 13.1.1 Vehicles 551m
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BNFC 2011-2012 13.3 Topical antipru
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BNFC 2011-2012 13.6.1 Topical prepa
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BNFC 2011-2012 13.6.2 Oral preparat
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BNFC 2011-2012 13.7 Preparations fo
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BNFC 2011-2012 13.8.2 Camouflagers
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BNFC 2011-2012 13.10 Anti-infective
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BNFC 2011-2012 13.10.1 Antibacteria
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BNFC 2011-2012 13.10.2 Antifungal p
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BNFC 2011-2012 13.10.3 Antiviral pr
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BNFC 2011-2012 13.11.2 Chlorhexidin
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BNFC 2011-2012 13.12 Antiperspirant
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BNFC 2011-2012 59914 Immunological
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BNFC 2011-2012 14.1 Active immunity
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BNFC 2011-2012 14.6 International t
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BNFC 2011-2012 15.1.1 Intravenous a
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BNFC 2011-2012 15.1.1 Intravenous a
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BNFC 2011-2012 15.1.2 Inhalational
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BNFC 2011-2012 15.1.3 Antimuscarini
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BNFC 2011-2012 15.1.5 Neuromuscular
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BNFC 2011-2012 Appendix 1: Interact
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BNFC 2011-2012 743A2Borderline subs
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Nutrison c(Nutricia Clinical)Nutris
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A2.1.2 Enteral feeds (non-disease s
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Infatrini c(Nutricia Clinical)Nutri
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Frebini c EnergyDrink(Fresenius Kab
Page 779 and 780:
A2.2.1.2 Nutritional supplements: M
Page 781 and 782:
Fortisip c Range(Nutricia Clinical)
Page 783 and 784:
Forticreme cComplete(Nutricia Clini
Page 785 and 786:
A2.3 Specialised formulasA2.3.1 Spe
Page 787 and 788:
Nutramigen c Lipil 2(Mead Johnson)S
Page 789 and 790:
Specialised formulas: Infant and ch
Page 791 and 792:
KetoCal c(SHS)Standard dilution(20
Page 793 and 794:
A2.4 Feed supplementsA2.4.1 High-en
Page 795 and 796:
Medium-chainTriglyceride (MCT)Oil(S
Page 797 and 798:
Calshake c(Fresenius Kabi)Powderper
Page 799 and 800:
BNFC 2011-2012 A2.5 Feed additives
Page 801 and 802:
BNFC 2011-2012 A2.6.1 Gluten-free f
Page 803 and 804:
BNFC 2011-2012 A2.7 Nutritional sup
Page 805 and 806:
Page 807 and 808:
Page 809 and 810:
Page 811 and 812:
BNFC 2011-2012 Appendix 3: Cautiona
Page 813 and 814:
BNFC 2011-2012 791A4Intravenous inf
Page 815 and 816:
BNFC 2011-2012 Appendix 4: Intraven
Page 817 and 818:
BNFC 2011-2012 Dental Practitioners
Page 819 and 820:
BNFC 2011-2012 Nurse Prescribers’
Page 821 and 822:
BNFC 2011-2012 799Non-medical presc
Page 823 and 824:
BNFC 2011-2012 Index of manufacture
Page 825 and 826:
Page 827 and 828:
Page 829 and 830:
Page 831 and 832:
BNFC 2011-2012 809Special-orderManu
Page 833 and 834:
BNFC 2011-2012 Abacavir—Alfacalci
Page 835 and 836:
BNFC 2011-2012 Anthelios—Arthrofe
Page 837 and 838:
BNFC 2011-2012 Benzodiazepines—Bu
Page 839 and 840:
BNFC 2011-2012 Cetrimide—Cocaine
Page 841 and 842:
BNFC 2011-2012 Coumarins—Dermatop
Page 843 and 844:
BNFC 2011-2012 Disinfectants—Emer
Page 845 and 846:
BNFC 2011-2012 Eye—Formaldehyde 8
Page 847 and 848:
BNFC 2011-2012 Glycogen—Homatropi
Page 849 and 850:
BNFC 2011-2012 Ibuprofen—Iodide 8
Page 851 and 852:
BNFC 2011-2012 Laxatives—Magnesiu
Page 853 and 854:
BNFC 2011-2012 Methylenedioxymetham
Page 855 and 856:
BNFC 2011-2012 Nicardipine—Oftaqu
Page 857 and 858:
BNFC 2011-2012 Paramax—Plaquenil
Page 859 and 860:
BNFC 2011-2012 Procarbazine—Regul
Page 861 and 862:
BNFC 2011-2012 Scottish—Sodium 83
Page 863 and 864:
BNFC 2011-2012 Syringes—Tocophero
Page 865 and 866:
BNFC 2011-2012 Ursofalk—Waxsol 84
Page 869 and 870:
NEWBORN LIFE SUPPORTDry the babyRem
Page 871 and 872:
PAEDIATRIC ADVANCED LIFE SUPPORTUnr
Page 873 and 874:
BODY SURFACE AREA IN CHILDRENBody-w
Page 875 and 876:
Croup(section 3.1)Dexamethasone ora
Page 877 and 878:
Recommended wording of cautionaryan
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BNF for Children 2011-2012

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