BNF for Children 2011-2012

264 5.1.1 Penicillins BNFC 2011–20125 InfectionsOral suspension, co-amoxiclav 250/62 (amoxicillin250 mg as trihydrate, clavulanic acid 62.5 mg aspotassium salt)/5 mL when reconstituted with water,net price 100 mL = £6.29. Label: 9Note Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionDental prescribing on NHS Co-amoxiclav 250/62 Suspensionmay be prescribedInjection 500/100, powder for reconstitution, coamoxiclav500/100 (amoxicillin 500 mg as sodiumsalt, clavulanic acid 100 mg as potassium salt), netprice per vial = £1.21Injection 1000/200, powder for reconstitution, coamoxiclav1000/200 (amoxicillin 1 g as sodium salt,clavulanic acid 200 mg as potassium salt), net priceper vial = £2.63Augmentin c (GSK) ATablets 375 mg, f/c, co-amoxiclav 250/125 (amoxicillin250 mg as trihydrate, clavulanic acid 125 mg aspotassium salt), net price 21-tab pack = £4.19. Label: 9Tablets 625 mg, f/c, co-amoxiclav 500/125 (amoxicillin500 mg as trihydrate, clavulanic acid 125 mg aspotassium salt). Net price 21-tab pack = £8.00.Label: 9Suspension ‘125/31 SF’, sugar-free, co-amoxiclav125/31 (amoxicillin 125 mg as trihydrate, clavulanicacid 31.25 mg as potassium salt)/5 mL when reconstitutedwith water. Net price 100 mL (raspberry- andorange-flavoured) = £4.08. Label: 9Excipients include aspartame 12.5 mg/5 mL (section 9.4.1)Suspension ‘250/62 SF’, sugar-free, co-amoxiclav250/62 (amoxicillin 250 mg as trihydrate, clavulanicacid 62.5 mg as potassium salt)/5 mL when reconstitutedwith water. Net price 100 mL (raspberry- andorange-flavoured) = £5.74. Label: 9Excipients include aspartame 12.5 mg/5 mL (section 9.4.1)Injection 600 mg, powder for reconstitution, coamoxiclav500/100 (amoxicillin 500 mg as sodiumsalt, clavulanic acid 100 mg as potassium salt). Netprice per vial = £1.31Electrolytes Na + 1.35 mmol, K + 0.5 mmol/600-mg vialInjection 1.2 g, powder for reconstitution, co-amoxiclav1000/200 (amoxicillin 1 g as sodium salt, clavulanicacid 200 mg as potassium salt). Net price per vial= £2.61Electrolytes Na + 2.7 mmol, K + 1 mmol/1.2-g vialTwice daily oral preparationsCo-amoxiclav (Non-proprietary) ASuspension ‘400/57’, co-amoxiclav 400/57 (amoxicillin400 mg as trihydrate, clavulanic acid 57 mg aspotassium salt)/5 mL when reconstituted with water.Net price 35 mL = £4.13, 70 mL = £5.79. Label: 9Excipients may include aspartame (section 9.4.1)Note Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionBrands include Augmentin-Duo cDoseChild 2 months–2 years 0.15 mL/kg twice daily,doubled in severe infectionChild 2–6 years (13–21 kg) 2.5 mL twice daily, doubledin severe infectionChild 7–12 years (22–40 kg) 5 mL twice daily, doubledin severe infections5.1.1.4 Antipseudomonal penicillinsPiperacillin, a ureidopenicillin, is only available in combinationwith the beta-lactamase inhibitor tazobactam.Ticarcillin, a carboxypenicillin, is only available incombination with the beta-lactamase inhibitor clavulanicacid (section 5.1.1.3). Both preparations have abroad spectrum of activity against a range of Grampositiveand Gram-negative bacteria, and anaerobes.Piperacillin with tazobactam has activity against awider range of Gram-negative organisms than ticarcillinwith clavulanic acid and it is more active againstPseudomonas aeruginosa. These antibacterials arenot active against MRSA.These antipseudomonal penicillins are used in the treatmentof septicaemia, peritonitis, hospital-acquiredpneumonia, complicated urinary-tract infections, andskin and soft-tissue infections. They may be used forthe empirical treatment of septicaemia in immunocompromisedchildren but otherwise should generally bereserved for serious infections resistant to other antibacterials.For severe pseudomonas infections (especiallyin neutropenia or endocarditis) these antipseudomonalpenicillins can be given with an aminoglycoside(e.g. gentamicin, section 5.1.4) since they have a synergisticeffect.Piperacillin with tazobactam is used in cystic fibrosis forthe treatment of Ps. aeruginosa colonisation whenciprofloxacin and nebulised colistimethate sodiumhave been ineffective; it can also be used in infectiveexacerbations, when it is combined with an aminoglycoside.Owing to the sodium content of many of these antibiotics,high doses may lead to hypernatraemia.PIPERACILLIN WITH TAZOBACTAMCautions see under Benzylpenicillin (section 5.1.1.1);interactions: Appendix 1 (penicillins)Contra-indications see under Benzylpenicillin (section5.1.1.1)Renal impairment dose expressed as a combinationof piperacillin and tazobactam (both as sodium salts).Child under 12 years 90 mg/kg (max. 4.5 g) every 8hours if estimated glomerular filtration rate 20–40 mL/minute/1.73 m 2 ; 90 mg/kg (max. 4.5 g) every12 hours if estimated glomerular filtration rate lessthan 20 mL/minute/1.73 m 2 . Child 12–18 years max.4.5 g every 8 hours if estimated glomerular filtrationrate 20–80 mL/minute/1.73 m 2 ; max. 4.5 g every 12hours if estimated glomerular filtration rate less than20 mL/minute/1.73 m 2Pregnancy manufacturer advises use only if potentialbenefit outweighs riskBreast-feeding present in milk—manufactureradvises use only if potential benefit outweighs riskSide-effects see under Benzylpenicillin (section5.1.1.1); also nausea, vomiting, diarrhoea; less commonlystomatitis, dyspepsia, constipation, jaundice,hypotension, headache, insomnia, and injection-sitereactions; rarely abdominal pain, hepatitis, oedema,fatigue and eosinophilia; very rarely hypoglycaemia,hypokalaemia, pancytopenia, Stevens-Johnsonsyndrome, and toxic epidermal necrolysisLicensed use not licensed for use in children under12 years (except for children with neutropenia andcomplicated appendicitis)