BNF for Children 2011-2012

BNFC 2011–2012 5.1.1 Penicillins 263With flucloxacillinCo-fluampicil (Non-proprietary) ACapsules, co-fluampicil 250/250 (flucloxacillin250 mg as sodium salt, ampicillin 250 mg as trihydrate),net price 28-cap pack = £14.73. Label: 9, 22Brands include Flu-Amp cSyrup, co-fluampicil 125/125 (flucloxacillin 125 mgas magnesium salt, ampicillin 125 mg as trihydrate)/5 mL when reconstituted with water, net price 100 mL= £4.99. Label: 9, 22Magnapen c (Wockhardt) AInjection 500 mg, powder for reconstitution, co-fluampicil250/250 (flucloxacillin 250 mg as sodium salt,ampicillin 250 mg as sodium salt), net price per vial =£1.33Electrolytes Na + 1.3 mmol/vialCO-AMOXICLAVA mixture of amoxicillin (as the trihydrate or as thesodium salt) and clavulanic acid (as potassium clavulanate);the proportions are expressed in the formx/y where x and y are the strengths in milligrams ofamoxicillin and clavulanic acid respectivelyCautions see under Ampicillin and notes above;maintain adequate hydration with high doses (particularlyduring parenteral therapy); interactions:Appendix 1 (penicillins)Cholestatic jaundice Cholestatic jaundice can occur eitherduring or shortly after the use of co-amoxiclav. An epidemiologicalstudy has shown that the risk of acute livertoxicity was about 6 times greater with co-amoxiclav thanwith amoxicillin; these reactions have only rarely beenreported in children. Jaundice is usually self-limiting andvery rarely fatal. The duration of treatment should beappropriate to the indication and should not usually exceed14 daysContra-indications penicillin hypersensitivity, historyof co-amoxiclav-associated or penicillin-associatedjaundice or hepatic dysfunctionHepatic impairment monitor liver function in liverdisease. See also Cholestatic Jaundice aboveRenal impairment risk of crystalluria with high doses(particularly during parenteral therapy).Co-amoxiclav 125/31 suspension, 250/62 suspension,250/125 tablets, or 500/125 tablets: use normaldose every 12 hours if estimated glomerular filtrationrate 10–30 mL/minute/1.73 m 2 . Use the normal doserecommended for mild or moderate infections every12 hours if estimated glomerular filtration rate lessthan 10 mL/minute/1.73 m 2 .Co-amoxiclav 400/57 suspension: avoid if estimatedglomerular filtration rate less than 30 mL/minute/1.73 m 2 .Co-amoxiclav injection: use normal initial dose andthen use half normal dose every 12 hours if estimatedglomerular filtration rate 10–30 mL/minute/1.73 m 2 ;use normal initial dose and then use half normal doseevery 24 hours if estimated glomerular filtration rateless than 10 mL/minute/1.73 m 2Pregnancy not known to be harmfulBreast-feeding trace amounts present in milk—notknown to be harmful but be alert for hypersensitivityin the infantSide-effects see under Ampicillin; hepatitis, cholestaticjaundice (see above); Stevens-Johnsonsyndrome, toxic epidermal necrolysis, exfoliativedermatitis, vasculitis reported; rarely prolongation ofbleeding time, dizziness, headache, convulsions (particularlywith high doses or in renal impairment);superficial staining of teeth with suspension, phlebitisat injection siteIndication and doseInfections due to beta-lactamase-producingstrains (where amoxicillin alone not appropriate)including respiratory-tract infections, boneand joint infections, genito-urinary and abdominalinfections, cellulitis, animal bites. By mouth, expressed as co-amoxiclav (see alsounder Twice Daily Oral Preparations below)Neonate 0.25 mL/kg of 125/31 suspension 3times dailyChild 1 month–1 year 0.25 mL/kg of 125/31suspension 3 times daily; dose doubled in severeinfectionChild 1–6 years 5 mL of 125/31 suspension 3times daily or 0.25 mL/kg of 125/31 suspension 3times daily; dose doubled in severe infectionChild 6–12 years 5 mL of 250/62 suspension 3times daily or 0.15 mL/kg of 250/62 suspension 3times daily; dose doubled in severe infectionChild 12–18 years one 250/125 strength tablet 3times daily; increased in severe infections to one500/125 strength tablet 3 times daily. By intravenous injection over 3–4 minutes orby intravenous infusion, expressed as coamoxiclavNeonate 30 mg/kg every 12 hoursChild 1–3 months 30 mg/kg every 12 hoursChild 3 months–18 years 30 mg/kg (max. 1.2 g)every 8 hoursSevere dental infection with spreading cellulitisor dental infection not responding to first-lineantibacterial, see notes above. By mouth, expressed as co-amoxiclavChild 12–18 years one 250/125 strength tabletevery 8 hours for 5 daysAdministration for intermittent intravenous infusiondilute reconstituted solution to a concentration of10 mg/mL with Sodium Chloride 0.9%; give over 30–40 minutesCo-amoxiclav (Non-proprietary) ATablets, co-amoxiclav 250/125 (amoxicillin 250 mgas trihydrate, clavulanic acid 125 mg as potassiumsalt), net price 21-tab pack = £2.63. Label: 9Dental prescribing on NHS Co-amoxiclav 250/125 Tabletsmay be prescribedTablets, co-amoxiclav 500/125 (amoxicillin 500 mgas trihydrate, clavulanic acid 125 mg as potassiumsalt), net price 21-tab pack = £4.38. Label: 9Oral suspension, co-amoxiclav 125/31 (amoxicillin125 mg as trihydrate, clavulanic acid 31.25 mg aspotassium salt)/5 mL when reconstituted with water,net price 100 mL = £2.49. Label: 9Note Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionDental prescribing on NHS Co-amoxiclav 125/31 Suspensionmay be prescribed5 Infections