BNF for Children 2011-2012

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