BNF for Children 2011-2012

BNFC 2011–2012 5.1.1 Penicillins 261of Staph. aureus, E. coli, and H. influenzae, as well asmany Bacteroides and Klebsiella spp. Co-amoxiclavshould be reserved for infections likely, or known, tobe caused by amoxicillin-resistant beta-lactamase-producingstrains.A combination of ampicillin with flucloxacillin (as cofluampicil)is available to treat infections involvingeither streptococci or staphylococci (e.g. cellulitis).Lyme disease Lyme disease should generally betreated by those experienced in its management. Amoxicillin[unlicensed indication], cefuroxime axetil ordoxycycline are the antibacterials of choice for earlyLyme disease or Lyme arthritis but doxycycline shouldonly be used in children over 12 years of age. If theseantibacterials are contra-indicated, a macrolide (e.g.clarithromycin) can be used for early Lyme disease.Intravenous administration of ceftriaxone, cefotaxime(section 5.1.2.1), or benzylpenicillin (p. 258) is recommendedfor Lyme disease associated with cardiac orneurological complications. The duration of treatment isusually 2–4 weeks; Lyme arthritis may require furthertreatment.Oral infections Amoxicillin or ampicillin are as effectiveas phenoxymethylpenicillin (section 5.1.1.1) butthey are better absorbed; however, they may encourageemergence of resistant organisms.Like phenoxymethylpenicillin, amoxicillin and ampicillinare ineffective against bacteria that producebeta-lactamases. Co-amoxiclav is active against betalactamase-producingbacteria that are resistant toamoxicillin. Co-amoxiclav may be used for severedental infection with spreading cellulitis or dental infectionnot responding to first-line antibacterial treatment.AMOXICILLIN(Amoxycillin)Cautions see under Ampicillin; maintain adequatehydration with high doses (particularly during parenteraltherapy); interactions: Appendix 1 (penicillins)Contra-indications see under AmpicillinRenal impairment risk of crystalluria with high doses(particularly during parenteral therapy). Reduce dosein severe impairment; rashes more commonPregnancy not known to be harmfulBreast-feeding trace amounts in milk—not known tobe harmful but be alert for hypersensitivity in infantSide-effects see under AmpicillinIndication and doseSusceptible infections including urinary-tractinfections, sinusitis, uncomplicated community-acquiredpneumonia, oral infections (Table1, section 5.1), Lyme disease (see notesabove), salmonellosis. By mouthNeonate 7–28 days 30 mg/kg (max. 62.5 mg) 3times daily; dose doubled in severe infectionChild 1 month–1 year 62.5 mg 3 times daily; dosedoubled in severe infection, community-acquiredpneumonia, salmonellosis, or Lyme diseaseChild 1–5 years 125 mg 3 times daily; dosedoubled in severe infection, community-acquiredpneumonia, salmonellosis, or Lyme diseaseChild 5–18 years 250 mg 3 times daily; dosedoubled in severe infection, community-acquiredpneumonia, salmonellosis, or Lyme disease. By intravenous injection or infusionNeonate under 7 days 30 mg/kg every 12 hours;dose doubled in severe infection, communityacquiredpneumonia, or salmonellosisNeonate 7–28 days 30 mg/kg every 8 hours;dose doubled in severe infection, communityacquiredpneumonia, or salmonellosisChild 1 month–18 years 20–30 mg/kg (max.500 mg) every 8 hours; dose doubled in severeinfection (max. 4 g daily)Otitis media (but see Table 1, section 5.1). By mouthChild 1 month–18 years 40 mg/kg daily in 3divided doses (max. 1.5 g daily in 3 divided doses)Listerial meningitis (in combination withanother antibacterial, Table 1, section 5.1),group B streptococcal infection, enterococcalendocarditis (in combination with another antibiotic). By intravenous infusionNeonate under 7 days 50 mg/kg every 12 hours;dose may be doubled in meningitisNeonate 7–28 days 50 mg/kg every 8 hours;dose may be doubled in meningitisChild 1 month–18 years 50 mg/kg every 4–6hours (max. 2 g every 4 hours)Cystic fibrosis (treatment of asymptomatic H.influenzae carriage or mild exacerbations). By mouthChild 1 month–1 year 125 mg 3 times dailyChild 1–7 years 250 mg 3 times dailyChild 7–18 years 500 mg 3 times dailyHelicobacter pylori eradication section 1.3Note Amoxicillin doses in BNFC may differ from those inproduct literatureAdministration Displacement value may be significantwhen reconstituting injection, consult localguidelines. Dilute intravenous injection to a concentrationof 50 mg/mL (100 mg/mL for neonates). Maybe further diluted with Glucose 5% or Glucose 10% orSodium chloride 0.9% or 0.45% for intravenous infusion.Give intravenous infusion over 30 minutes whenusing doses over 30 mg/kgAmoxicillin (Non-proprietary) ACapsules, amoxicillin (as trihydrate) 250 mg, net price21 = £1.07; 500 mg, 21 = £1.31. Label: 9Brands include Amix c , Amoram c , Amoxident c , Galenamox c ,Rimoxallin cDental prescribing on NHS Amoxicillin Capsules may beprescribedOral suspension, amoxicillin (as trihydrate) forreconstitution with water, 125 mg/5 mL, net price5 Infections